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Permit i 1 C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00635 I DEVELOPMENT SERVICES DATE ISSUED: 8/29/2005 � rll 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102BD -01600 SITE ADDRESS: 09845 SW WALNUT PL ZONING: R -12 SUBDIVISION: FREWINGS ORCHARD TRACT LOT : D -I JURISDICTION: TIG Project Description: Branch circuits to (4) furnaces. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 3 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: TIGARD COMMUNITY METHODIST STAR ELECTRICALSERVICE CHURCH PO BOX 1784 9845 SW WALNUT BEAVERTON, OR 97075 TIGARD, OR 97223 Phone: 503 - 639 -3181 Phone: 503 - 579 -9201 FEES Reg #: ELE 26 -963C 153627 Description Date Amount LIP SUP 43I3S 3135 [ELPRMT] ELC Permit 8/29/2005 $66.80 [TAX] 8% State Surcharge 8/29/2005 $5.34 REQUIRED ITEMS AND REPORTS Total $72.14 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questi s to OUNC at 503 - 246 -6699 or 0- 2 -2344 Issued By: G � Permittee Signaturwr OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. • El Electrical Permit Application rolz OFFICE us ()NIA City of Tigard � ���0��'� n B� �� PermitNo.' _ /M. 3$ 13125 SW Hall Blvd_, Tigard, OR 9722 Plan Rem Phone. 503.639 4171 Fax 503.598.1960 'A' t. • 1 I .`, • oaten Other Permit. �'•r . Inspection Line: 503.639 4175 AUG 2 9 20 �' ='' I J D ate Rea ® Page 2 for Internet: www.ci.tigard.or.us Notified/Method. Supplemental Information TYIJ FOVOB ARD PLAN REVIEW ❑ New construction E`Ad WUd i &d /i hQnent Please check all that apply: ❑ Demolition ❑Other: ❑ m Service over 225 amps, com'I 0 Hazardous location ❑Service over 320 amps — rating DBuildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential ❑ 1 - and 2- family dwelling Cet Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi- family ❑Master builder ❑Other; ❑Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: 7 ii 5 7 w W 41 ti 0 ( pi ❑ Health -care facility DOther: / Submit 2 sets of plans with any of the above. City /State/ZIP: "----1 Is; 6 � J n 0 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: i� FEE* SCHEDULE Description I Qty. I Fee. I Total Cross street/directions to job site: New residential single- or multi- family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75 00 2 P. DESCRIPTION OF WORK Each manufactured or modular ^ dwelling, service and/or feeder 90.90 2 Ir � '�- , • , T ��� ,_ Services or feeders installation, alteration, and/or relocation (! 64. 200 amps or less 80.30 2 14 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 L 401 amps to 600 amps 160.60 2 Name: et NI 7 / d /4 fi Yl I c Li ore re )-1 601 amps to 1,000 amps 240.60 2 Address: 9 Q L j 5 1 WA- ` 4 u i ► T + • Over 1,000 amps or volts 454.65 2 0o I Reconnect only • 66.85 2 City/State/ZIP: -- 1"` ) , „ .a . d ) 9- 7 g V Temporary services or feeders installation, alteration, and/or / relocation Phone: ( ) 2 _ -3 ( g / Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel 4_ APPLICANT I ❑ CONTACT PERSON A Fee for branch circuits with �, � service or feeder fee, each Business name: branch circuit 6.65 2 • � a,z-4 , l,�lea f .S,� /C. 1�e B Fee for branch circuits ontact name: (, 0 t ./ m 1 / , .. ( gL wuhout service or feeder fee, 46.85 44 2 Address: �/]] U Q each branch circuit al p v o / .N U/k 1 7 0 75 Each add'l branch circuit 3 6.65 /q q5 2 City/State/ZIP: 12 / 9 a vn r " N, QA 9 7 a �" Miscellaneous (service or feeder not included) Phone: (f05) ) 97 9 .__. 9 AO/ Fax :: ( ) / Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or r Z"- / extension. Describe: Paget 2 Business name: /- 41:2C/31/(7.e4 L j�,� ��/�' ` ��C Address: // - � Q Q) ! ! � 9 L ! Each additional inspection over allowable in any of the above Y • 0 • / � Per inspection 62.50 City/State/ZIP: g p r / i/ 1'/`/ '( �] `7 Investigation per hour (1 hr min) 62.50 Phone: 0703) -7 q 9Q 0/ Fax: ( ) Industrial plant per hour 73 75 ELECTRICAL PERMIT FEES* CCB Lic.: 6.027 �5 5 Electrical Lic. � 993e Suprv. Lic.: 113/3S' Subtotal t�p gp Suprv. ElectrElectrician signature, required: �/ BS I ...r- �� / �, Plan review (25% of permit fee) 5 . , Print name: © G /l Date:. ( n p /�. State surcharge (8% of permit fee) 5.,34- ` s? �( TOTAL PERMIT FEE 7A ,/ Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tn- County Building Industry Service Board •• Number of inspections per permit allowed. i \Building\Per mns\ELC- PermnApp.doc 12/03 4104615T(1W02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: i Fee for all residential systems combined ... $75.00 Check Type of Work Involved: El Audio and Stereo Systems* El Burglar Alarm ❑ Garage Door Opener* El Heating, Ventilation and Air Conditioning System* El Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) • Check Type of Work Involved: ❑ Audio and Stereo Systems El Boiler Controls ❑ Clock Systems • El Data Telecommunication Installation El Fire Alarm Installation El HVAC El I nstr umentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* El Medical • El Nurse Calls . El Outdoor Landscape Lighting* El Protective Signaling • El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i \Buildmg\Petmits\ELC- PetmitApp doc 04/03 r Off OF TIGARD . BUILDING DIVISION • PERMIT #: ELC2005 -00635 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/29/2005 Phone: (503) 639 -4171 t Inspection Requests (24 Hrs.): (503) 639 -4175 I �.. INSPECTION WORKSHEET FOR DATE: 8/30/2005 TIME: 7:07AM PAGE: 17 SITE ADORES . 09845 SW WALNUT PL CLASS OF WORK: SUBDIVISION: - NGS ORCHARD TRACT LOT #: Di TYPE OF USE: PROJECT NAME: ,. • D UNITED METHODIST CHURCH DESCRIPTION: Bran ' cuits to (4) furnaces. OWNER: TIGARD + • UNITY METHODIST, PHONE #: 503 -639 -3181 CONTRACTOR: STAR ELEC ALSER VI CE PHONE #: 503 -579 -9201 Inspection Request Scheduled For: Date: 850/2005 Pour Time: Code # Inspection Description onfirm - Contact # Message 145 A/C or heating unit ' it 014 ' 503-579-9201 Y Pic\ fktt■q`—. Corrections /Comments /Instr cti IM� Nb .. LAS 4F S s a 4 coi. PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: v 1 L Date: O ' - Co Phone #: (503) 718- AL____