Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 111 e : COMMUNITY DEVELOPMENT Permit #: ELR2012 -00209
T I. G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/06/2012
Parcel: 1 S 133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE
Project: Westgate Baptist Church Subdivision: HAWK'S BEARD TOWNHOMES Lot: 62
Project Description: 2nd story TI /Elevator
Contractor: ADVANCED SECURITY & FIRE Owner: WESTGATE BAPTIST CHURCH
14140 SW LINDA LANE 12930 SW SCHOLLS FERRY RD
BEAVERTON, OR 97006 TIGARD, OR 97223
PHONE: 503 - 519 -4550 PHONE: 503 - 524 -3500
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/06/2012 $75.00
12% State Surcharge - Electrical 09/06/2012 $9.00
Type of Use:
Class of Work:
Total Number of Systems:
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in ordance approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A NTION: Oregon w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 throu h OAR 952 -0 1 -009 . Y may obtain a copy of the rules or direct ::: tions to OUNC by calling 503.232.19 or 1.800.3322 2344.
•
Issued B mitt ee Signature: k'
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
•
1 1 `' g �+ of Tigard � � Received 4
eive: Permit No.: ` D. g /?—ai
Re
° 13125 S W Hall Blvd., Tigard, O
M • Plan Review
Phone: 503.718.2439 Fax: 503.598.1960
DateB Other Permit:
T I G A R D Inspection Line: 503.639.4175 S p 0 6 2012 Date Ready /By: luris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
I 1 'TIGARD
TYPE ii DIVISION PLAN REVIEW
�ICw construction El AdditiA • . - t' n replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: I Job site address: 1d?3b S(LJ 130-f-1-‘ 0,16-- 1x or residential Recreational ❑ Six or more residential units. ❑Recreational vehicle parks.
City /State /ZIP: .- z, 6 Q, E S7 Z2 'j ❑Health-care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: `ilq ❑ S ervice or feeder 600 amps or more.
l,S r�j�RS FEE SCHEDULE
Cross street/directions to job site: - c pizii (i
5 , 2 JC fs „ I ce ^ Description I Qty. I Fee. I Total I •
�L![ J New residential single - or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
• Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
c Ls - t . 12. M rtb(11 r-Ini residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
' 200 amps or less 100.70 2
f2"PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: ir. , -ferito £ ' S R S T C IKUC* 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: g � V , C'(a� (:__ cIR OC•T1.6> T-^h -CI B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Qt n � u branch circuit
C. Each add'I branch circuit 7.42 2
Address: 6ri ! n 5 S 1. Ar� t5 FdY 4.4 4- �V O Miscellaneous (service or feeder not included)
City /State /ZIP: �• Each manufactured or modular
l 1, fvttts QR K d i 7O 3. � dwelling, service and/or feeder 67.84 2
Phone: (s 3) s 7 - A9 7 Fax: : ( ) Reconnect only 67.84 2
E - mail:
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR / Signal circuit(s) or limited- energy
Business name: J d yA>7 ee-a( Se c u r i 4 V ,8 F r e panel, alteration, or extension. I Page 2 75 2
/ // Each additional inspection over allowable in any of the above
Address: ` Z 1 LJ S� k ; n d, L n Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City /State/ZIP:
c 0 ve r fo r) Q 2 4 .606 Industrial plant (1 hr min) 78.18/ hr
Phone: (S O3 `q ., y 550 F 7 ) /e /� Inspections for which no fee is 90.00 / hr
// / I f/f f ��l ! specifically listed (%: hr min)
CCB Lie.: i (fib 176 rt r 7ctrical
Lie.: C L E. ), kk ELECTRICAL PERMIT FEES
49 , i Subtotal:
• Suprv. Electrician signatu , r red: 75•
Plan review (25% of permit fee): — ..
Print name: Avj d 01 Date: Q , 6- / 0 State surcharge (12% of permit fee): 1' .0
r -� D /' 9 �'� � / TOTAL PERMIT FEE: 3 /.a7
Authorized signature: /� J T his p application expires if a permit is not obtained within 180
v ✓ 2 • days after it has been accepted as complete.
)
Print name: ,
/� Op ,9 v /- Date: C _ /.2 • Number of inspections allowed per permit.
1 :\ Buitdingwermits \ELC- PermitApp.doc 07/01/10 440-46 1 5T( 1 1/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
I - 1 Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
j2r
Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10