Permit CITY OF TIGARD 0, ' ELECTRICAL PERMIT
1 04 Pe
s COMMUNITY DEVELOPMENT Permit #: ELC2013 00195
T I G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 � � O Date Issued: 04/01/2013
®/ Parcel: 1S134 DB00300
Jurisdiction: Tigard
Site address: 11065 SW NORTH DAKOTA ST
Project: LDS Church Subdivision: 1998 -067 PARTITION PLAT Lot: 2
Project Description: (4) branch circuits to connect new a/c units and an attic light 4/10/13, Revised to add (1) additional branch circuit.
Contractor: DILIGENT HANDS INC Owner: CORPORATION OF THE
12345 S TOLIVER RD PRESIDING BISHOP /CHURCH OF
MOLALLA, OR 97038 JESUS CHRIST OF L D S
50 E NORTH TEMPLE 22ND FL
SALT LAKE CITY, UT 84150
PHONE: 503 - 349 -0882 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 04/01 /2013 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/01/2013 $9.41
Type of Use: COM Electrical
Class of Work: ALT 1 crt Branch Circuits w /Purchase 04/10 /2013 $7.42
Service or Feeder
Type of Const: 0 ea 12% State Surcharge - 04/10/2013 $0.89
Occupancy Grp: Electrical
Total $96.16
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 - -• • - : 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. • ' ENTION: Or=•on law • fires you to follow the rules adopted by the Oregon Utility N• .. •- • Center. Those rules are set forth in OAR
952 -00 -0010 thr• ugh OAR 152 -r' -009 +. g may obtain a copy of the rules or direct questions to OUNC • ^- at• 2.1987 or 1.800.332. 44.
Iss =d By: �� ����! =i Permittee Signature: i// ��< �_
i
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' r G . 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.
p CITY OF TIGARD ELECTRICAL PERMIT
IN -- 1 COMMUNITY DEVELOPMENT Permit #: ELC2013 -00195
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/01/2013
Parcel: 1 S134DB00300
Jurisdiction: Tigard
Site address: 11065 SW NORTH DAKOTA ST
Project: LDS Church Subdivision: 1998 -067 PARTITION PLAT Lot: 2
Project Description: (4) branch circuits to connect new a/c units and an attic light
Contractor: DILIGENT HANDS INC Owner: CORPORATION OF THE
12345 S TOLIVER RD PRESIDING BISHOP /CHURCH OF
MOLALLA, OR 97038 JESUS CHRIST OF L D S
50 E NORTH TEMPLE 22ND FL
SALT LAKE CITY, UT 84150
PHONE: 503 - 349 -0882 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 04 /01/2013 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/01/2013 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 ' - : ccordance ' . 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. •TTENTION: Oregon -. equi -s ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 *01- 0010th ugh OAR 95 • , 1 -009• •u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19; •r 1.810.332.234
I. ued By: i �r � . - Permittee Signature: /� ✓/
----- 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:
CON RACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' / ✓ ` ` ��� Date: 4//// 3 - 4111V
LICENSE NO. 535
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 Applicat CEIVED Ft)It 01 It . 11 I SI. ON 1.1
City of Tigard Received �i Permit No.: e a0/5. ‘ 90/F5- -
5-
3125 SW Hall Blvd., Tigard, OR 97 8 U 1 201 Plan Review
Other Permit: N� a �_ 666e/fr.
g. Phone: 503.718.2439 Fax: 503.598. 6 Date/By:
y Inspection Line: 503.639.4175 Date Ready/By: luris: Hi See Page 2 for
I I C; :\ It l) g g CI OF TIGARD Notified/Method: Su lemental Information
Internet: www.ti acct -or. ov PP
TYPE git PLAN REVIEW
Please check all that apply (submit a sets of plans w /items checked below):
❑ New construction ., Addition/alteration/replacement
❑ 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 ", "1 -2 ", "I -3 ",
Job no.: I Job site address: I 1 [ 51.) � \ D J , L 100HP or more. occupancy.
1 S w r�
0 Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 1 1lci ,r ok c ! 7 2.Z Z ❑ Health -care facilities. ❑ Supply voltage for more than
/ ,l / ❑ Hazardous locations. 600 volts nominal.
,, r^ J
Suite/bldg. /apt. no.: I Project name: LDS xi 1C,u - .:_ (pr. l _ ❑ Service or feeder 600 amps or more.
J � F' FEE SCHEDULE
Cross street/directions to job site: .$ CA) 1 1041k1 p� 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'l 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
,. t . Cy, �,„� [ y L wt 1i'S A vtol 6) residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
e '" 200 amps or less 100.70 2
'ROPERTY OWNER J ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: LDS AJ Tlcf ed 1 (/1 ee -1 '3 601 amps to 1,000 amps 301.04 2
Address: s!t IMQ_.- Over 1,000 amps or volts 552.26 _ 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 968 _ 1 3 / 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
t2FAPPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
�j t S/ ' '[' c /
Business name: - tot �Q ✓� 1 `G �`Gl �L B. Fee for branch circuits without
service or feeder fee, first 1 56 18 5 (p 2
Contact name: M,(a r iskS branch circuit
Each add' I branch circuit ,3 7.42 21 2
Address: 123 (S 5. 1 0 1 t .-- Miscellaneous (service or feeder not included)
City/State/ZIP: Mod c lo r CA 9 t% ' dwel d lin , m service a s d/ nd/or r feeder er er 67.84 2
el a
Phone: (SO3) 3L4 C --rrZ_ Fax: : ( /U Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E mail:. --P j ve dcv5 L — S 0) i'vt.c)ta 1 k1 , Vim+ Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) Vk I Fax: ( ) is///.3 Inspections for which no fee is 90 / hr
specifically listed (%s hr min)
CCB Lic.: ► 9 5 o1 Electrical Lic.: 69K Suprv. Lic.: 53215 ELECTRICAL PERMIT FEES
// Subtotal: '7 g- 1.1. Suprv. Electrician signature, require. ��� Plan review (25% of permit fee):
Print name: f rkk , Date: 2 3 State surcharge (12% of permit fee): t
TOTAL PERMIT FEE: in . Fr
■
Authorized signature � `' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Ma ,^A._ /e � Date: 3/Lg /�3 • Number of inspections allowed per permit.
1 E
1:\ Building \PermitsLC- PvmitApp.doc 07/01/10 "' 440- 4615T(11/05 /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
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ BuildingTermity \ELC- PermitApp.doc 07/01/10