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Permit • • �t CITY OF TIGARD ELECTRICAL PERMIT 11 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00626 TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/01/2012 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, (6) branch circuits Contractor: NORTH LAKE CONTRACTORS Owner: WESTGATE BAPTIST CHURCH 12900 NW LOVEJOY CT 12930 SW SCHOLLS FERRY RD PORTLAND, OR 97229. TIGARD, OR 97223 P PHONE: 503 - 524 -3500 HONE: 503 - 709 -0985 FAX: 503 - 641 -3168 FEES Quantity Description Date Amount 6 crt Branch Circuits wo /Purchase 11/01/2012 $93.28 Specifics: Service or Feeder 1 ea 12% State Surcharge - 11/01/2012 $11.19 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $104.47 • 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. ATTENTIO • on law r�equui(rees you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 th ugh OAR 2- 001- 0. You may obtain a copy of the rules or direct questions to OUNC by calling 50 2.1987 or 1.800.332.2344. Issued By: Permittee Signature: !G�' 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' `j� , /II /r- 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 ApplicatRECEIVED FOR OFFICE USE ONLY • B City of Tigard Received iii Permit No.: Other Permit: � /ly' t0 t010/01-'.66e0' / 1 DateB ° 13125 SW Hall Blvd., Tigard, OR 97 40V 0 1 .2012 Plan Review / Q /. Phone: 503.718.2439 Fax: 503.598.1960 Date : T I G A R D Inspection Line: 503.639.4175 an( ( *TIG� Date RcadyBy: tuns: ® See Page 2 for Internet: www.tigard- or.gov l.11 1 Notified/Method: Supplemental Information 13UILDINGD NISION TYPE OF WORK PLAN REVIEW RNew construction ❑ Addition /alteration /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 0 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 ❑ I- and 2- family dwelling Ni 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 El Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E "I -2 ", "I -3 Job no.: Job site address: gyp')3 ' 0 Sl) KU IOO or more residential units. ❑ Recreational vehicle parks. elty /$tate /ZIP: / 7 ❑ Health -care facilities. ❑ Supply voltage for more than �l t © . (�� ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: I Project name: 43 F � ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I • 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 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 A n-t �ozd� I C L AS arc residential (with above sq. ft.) N / Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 X PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: lni % 1-6 it A n - P l S f C Ti' Jq.c kt 601 amps to 1,000 amps 301.04 2 Address: 1 2 c -AD . 5 G trtocLS c^ CI` Y� �, e6 r/Jb l � Over 1,000 amps or volts 552.26 2 City /State/ZIP: r"( Temporary services or feeders installation, alteration, and /or ' S t G-/rLb 6 Q � i'7 ZZ3 relocation Phone: (5(k3 ) � 7Z 735 Z Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 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: d TX jib 1•4 CO") 5i SNG B. Fee for branch circuits without I service or feeder fee, first Contact name: P. O branch circuit 56.18 Cif ,t � 2 Each add'I branch circuit 1 I 7.42 I • t0 12 Address: I 4 7 ?t si,u LtK,*s pn2�� "KL v Miscellaneous (service or feeder not included) Each manufactured or modular City /State /ZIP: L c � 7 6: K 0 S � Q a � C j ' O 335 dwelling, service and/or feeder 67.84 2 Phone: (�Q 3 ) , ` Z L 35 -z Fax:: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Q D I? (-4"1'U61 47 Y066 , Ce M Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: LL / �/ panel, alteration, or extension. Page 2 2 I ` "�T l F^��� '�� 2 C S � � C Each additional inspection over allowable in any of the abov Address: 12900 Nw LoVeSte)`E Cx- Additional inspection (I hr min) 66.25/ hr City /State /ZIP: Po Kr- N LA b O Q q ��Q Investigation (I hr min) 66.25/ hr 1� % 1 Industrial plant (I hr min) 78.18/ hr Phone: ( - 60 ' l ' 79 $ S Fax: ( ) Inspections for which no fee is specifically listed (/2 hr min) 90.00 / hr CCB Lie.: f 5q / 73 Electrical Lie.: C i 3 Suprv. Lie.: 1.goi ( S ' ELECTRICAL PERMIT FEES iI Subtotal: Suprv. Electrician signature, required: Z. C e� c li,./Lz.. (J Plan r eview (25% of permit fee): Print name: a d 4 k , V , Q fps Date: I/a ,,,-3 ( ( Z State surcharge (12% of permit fee): /I. 1 7 TOTAL PERMIT FEE: b . 17 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: * Number of inspections allowed per permit. 1:\ Building \ Permits \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 ❑ 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 ❑ Fire Alarm Installation ,< HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling Fl 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