Permit p CITY OF TIGARD ELECTRICAL PERMIT
s .. COMMUNITY DEVELOPMENT Permit #: ELC2012 -00576
T LGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/03/2012
Parcel: 2S 111 AA00401
Jurisdiction: Tigard
Site address: 14145 SW HALL BLVD
Project: Hall Baptist Church Subdivision: SUMMERFIELD BROOKSIDE CONDO Lot: 63
Project Description: (10) branch circuits for replacing light fixtures throughout the church
Contractor: COHO ELECTRIC INC Owner: HALL BOULEVARD BAPTIST
PO BOX 40 CHURCH
WILSONVILLE, OR 97070 PO BOX 230130
TIGARD, OR 97223
PHONE: 503 - 582 -9774 PHONE: 503 - 684 -0804
FAX: 503 - 582 -9840
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 10/03/2012 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/03/2012 $14.76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137.72
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 accordance with 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OA 9 2 -001- 90. You may obtain a copy of the rules or direct questions to OUNC by calling 50 003 3.232.1987 or 1.800.332.2344.
Issued By: 0//L.L Permittee Signature: Q APA./G.4 (c 0 " A , _
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.
Oct 0312 08:11a Coho Electric Inc 503 - 582 -9840 p.1
Electrical Permit Applic `n n R FOR. OFFICE, USE ONLY
- •"
City of Tigard r , 1 rr �-- _LL An Zew" r /a- Sr' Fetntil OEL' 304- O(r
a 13123 S W Hall Blvd, Tigard, OR 28 L a 2 U 2
Phone: 503.639.4171 Fax: 503.598.1960 may. OtherPennit:
T I G A R D Inspection Line: 503.639.4175 C , -,. i r • • , Date Ready/By: r I 0 See Page 2 for
Internet: www.tigard- or.gov ' f . 1 Notified Method: iD Cv I Supplemental information
' ,: - TYPE OY" 1:1-- ... ._ j .; • - PLAN REVIEW . - . . •
Please check all that apply (submit + sets of plans wlitems checked below):
❑ New construction ,mil Addition /alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑ Marinas and boatyards.
C. OIT CONSTR IQN , ; exceeds 10,000 amps at 150 volts or ❑ Floating build
1- 2-family dwelling less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
❑ y g Ej Commercial /industrial El A ccessory buildin amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: i ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB '
OB $t):'E INFORMA'QON •• AND" "IAG : ❑ Addition of new motor load of ❑ "A " "E ", "l -T", ° 1 -3 ",
Job no.: 'r,l,, ?S.. Job site address: ‘1/4.4.t....‘ 5 ,F 3 0 cal 1 RA J 100HP or more. occupancy.
❑ Six or more residential units, ❑ Recreational vehicle parr.
City /State/ZIP: -- 1 4 G � R q� a I ❑ Health - care facilities. ❑ Supply voltage for more than
■ ❑ Hazardous locations. 6C0 volts nominal.
1 Suite/bldg./apt. no.: Project name: 4 Gh .>` -.-ah 0 Service or Feeder 600 amps or more.
I Cross street/directions to job site: p Description MU $CHI D . I
J P I Qty Fee I_ Tool I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fl. or less j 168.54 4
- Ea. add'l 500 sq. ft. or portion j 33.92 1
Tax map /parcel no.:
Limited energy, residential 67.64 2
- - • . DESCRIPTION .-OF WORK . • ' • "" (wilb above sq. ft.) ,
1 Limited energy, multi-family 67.64 2
- e 1 r o, r C , r residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 1 100.70 2 1
0 PROPERTY OWNER; ;. ❑ '. TE\A1:"f. • amps sto400 • amps 133.56 2
Name: e. " ' „"�` r 4 C t l 401 amps to 600 amps I 200.34 i 2
Address: \L4 1'4 t) ` � l 601 amps to 1,000 amps 301. ` 2
\1 Over 1,000 amps or volts I 552.26 26 2
Ci / State/ZIP: a Temporary services or feeders installation, alteration, and/or
���� C1. O ��aa relocation
Phone: ( i,,, - , :scz., 4,9 Fax: ( ) 200 amps or less 59.36 j 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 sitatL re: Date:
A. Fee for branch circuits w ith
.0 APPLICANT: ; ..._ E' CONTACT ' _ above service or feeder fe e, 7.4 2 i 2
. .. . - .
Business name: each branch circuit 1
B. Fee for branch circuits •
Contact name: without service or feeder fee, 1
56.18 ' s,
"
first branch circuit xo I
Address: Each add'l branch circuit 9 7.42 1 'e .-/ 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular '
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.24 2 i
E -mail: Pump or irrigation circle 67.84 2 '
CONTRACTOR ... ° ' Sign or outline lighting 67.84 2 '
•
Business name + 1 Signal circuit(s) or limited-
C: Ci t -1e-. -,:,% (. ' energy panel, alteration, or
Address: -. ., - , 1 , extension. Describe: Pace 2 2
City / State/ZIP: i, 1; c7 -`, T f �' L (Q, s c6 Each additional inspection over allowable in an • of the above
Per inspection 66.25
Phone: (y ,7 5E 7-:: "1/4- '''' - 1 Li Fax: ( ) S v _ `1 L` V Investigation per hour (l hr min) 66.25
CCB Lic.: " , i c 1 Electrical Lic - : "? 5 c Su rv. Lic.: Industrial plant per hour 75.18
Electrician si acute, required: / / / ELECTRICAL PERMIT TEES
. �
Suprv. 'Y dam,.' �C -•� ' Subtotal: `la _cth
Plan review (25% of permit fee): '
Print name: h ` Date. 1'�t � 1� �lU j�ti �,� \ t.
_ " - tt State surcharge (12% of permit fee): }L ' .' . I, j
gn
Authorized signature: - �tit i' f 1, ' 1
TOTAL PERMIT FEE: )3'7 ]t
1 • t . • f 110
This permit expires if a permit is not obtained within 1
Print name: \-. t, sG,', Date: \ Q, _ • 1 a days after it has been accepted as complete.
• Number of inspections allowed per permit.
I'Ssildingd.c-minlELC -Pc miiApp.cloc 10/01/1i3 44C- 4615T(t 1105/goM/wnr7