Permit CITY OF TIGARD ELECTRICAL PERMIT
._ • COMMUNITY DEVELOPMENT Permit #: ELC2013 00329
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2013
Parcel: 2S102BD00100
Jurisdiction: Tigard
Site address: 12520 SW GRANT AVE
Project: St Anthony Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 52
Project Description: Electrical for TI.
Contractor: CAPITOL ELECTRIC CO INC Owner: ST ANTHONY CATHOLIC CHURCH TIGAR
11401 NE MARX STREET 9905 SW MCKENZIE ST
PORTLAND, OR 97220 TIGARD, OR 97223
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
FEES
Quantity Description Date Amount
Specifics: 1 ea Temp Services or Feeders - 06/13/2013 $125.08
201 to 400 amps
3 crt Branch Circuits w /Purchase 06/13/2013 $22.26
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 06/13/2013 $17.68
Electrical
Type of Const:
Occupancy Grp:
Total $165.02
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 0 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: S 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:
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.
06/12/2013 10:47 5032577121 CAPITOL ELECTRIC PAGE 02/02
Electrical Permit ,Application FOR OFFICE USE ()NI.'
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City of Tigard Received
atcBy: `W �' L � 1} �p4 }// 3 Permit no.: LL f _ CX13vZ -�
11 0
13125 SW Han Blvd., Tigard, OR 97223 Plan Review
Ph one: 5 03.639.4171 Fax: 503.598.196g U N Date Other Permit: -01 � / 3 - -
Inspection Linn 503,639,4175 1 2 201 /� )�''�
T 1 G A R D p Date Ready/By: Ju�' +� see Tn. z r.
Internet: www.tIgard-or.gov Notified/Method: CL RappremeernlInformation
CI _
. i ' ,'J'• '' : _8.1 •S�: 4 -. ,� }�� (I • N tE ty�eigitI IV �r{{t W $ i Mlit tt4 V
:+cla' P J..i.i � :itiiM1iLZiZL1k./�.r � ' liits�,� u �1�irZ J ...L �- 1t > aa' d9 �� rY`ti'A• �iFifi/i3 �F9H7��e ^W� �l1MJelY�y�y����3i�H� 'M1 ggyyrr
:1rt', � �, dl��'n
New construction I „ Addition /alteration /replacement Please check all that appry (submit 2 sets of plans w/hems checked below):
U Demolition ❑ Other; U Service or feeder 400 amps or more ❑ Building over three stories
PlitI' AIMi teglIPi.N Vk ' G1 tIPM arlf:K:''p'y414.41VAI. whore the available fault current n Marinas and boatyards
U 1 • and 2- family dwolling a Commercial/industrial I I Accessory building exceeds 10,000 amps at 150 volts or L] Floating buildings
CI Multi- fbmlly El Master Builder U Other tens to ground, or exceeds 14.000 ❑ Commercial -use agricultural
Pik?! WIRIPIPHAli'OMIlar ttSMOM IyYllil'RN gt: af,i:19, 9; °° ?;.'`.Uetilli .1I amps for all other InataVetens. buildings
Job no.: 130090 Job sire nrldress 6Gi�i1 El Fire Pump CI InslaOdtlon of 75 KVA or
,� 67.22) Q j �A n Emergency system larger separately derived system.
\ City/State/71P: Tigard, OR I=1 Addition of new motor load of U "A', 'E', - 1.2 ", "1.3 ",
100HP or more. ❑ occupancy
Suitc/bldgJapt. no.: (Project name; St Anthony Community Center 1:1 six or more residential Unit ❑ Recreational vehicle parka.
❑ Heatlh -cnre facilities n Supply voltage for more than
t.a Cross Surer/Directions to job sits: ❑ Hazardous locations 600 volts nominal.
0 Service or fbeder 600 amps or more
Subdivision: I Lot no.: piglAtiN/WifilliM,MAINFWEAMAKETfiggRi7rOMINTfiligg,lffigritari
Dmcrlptlon Qv. Pee. Tani
Tax map /parcel no.: New raidcntisl • single or muiti•family dwelling unit.
Ffilliibint PADS R,Vi b� .W X9FPRRNMPA ?.. f rrIMP ?AI;''i 4 i"a Inclada uttnched garugc-
Jobsite Temporary Power 1000 ski R. or less • F 161154 4
�,t':r ?T En. Add! 500 sq. ft or portion 5 33.92 I
- i'ilt F 'i =iUMi r�.4� 3 IRxiS(t j gna;!�i i ": n * q : y No :!: S' '',,:., f,imited energy residential
Name: (with above sq. ft)
$ 75.00 2
_ Limited cnerpy, multi- family
Address: residential (with above sq. ft.) $ 75.00 2
Service or feeders Installation, alteration, and /or relocation
City/State/ZIP: 200 amps or lees $ 1 00.70 2
201 amps to 400 amps $ 13356 2
Phone: Fax' 401 amps to 600 amps $ 200.34 2
601 amps to 1000 amps S 301.04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 am -s or volts 5 55226 2
intended for sale, lcasc, rent or exchange, according to ORS 447. 449, 670, and 701 Temporary services or feeders Installation, 'iteration, sod/or
Owner signature: Date: relocation
200 amps or less S 59.36 I 1
i 4i;i,;�j{�: "ill "dik'I 1r'ri!5:frlt}a%' {il, c; f , ! iC w ilia. ffrl0,� 1? "3, r
;a 201 amps to 400 amps 1 I s 125.nR 1 125.08 l 2
Bucinesc Nnmc: 401 amps to 599 amps $ 169.54 l 2
Branch circuits - new. alteration, or extension, per anal
Contact name: A. Fee for hraneh circuits with
service or feeder fcc, each
Address: branch circuit 5 7.42 2
B. Fcc for branch circuits
City/State/71P: without service or fender fcc,
first branch circuit 2
Phone: Fax:
Each additional branch circuit: ; $ 7.42 14.84 2 )...4.
Miscellaneous (service or feeder not Included)
Joe Email: Each manufactured or modular
I V 3:411 M4MITO;R +tn7lafPFedu IM 1 .1 r'li1 lPM dwelling, service and or feeder $ 67.04 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only S 67.04 2
Pump or irrigation circle $ 67.14 2
Comet name: Richard Martin Sign or outline lighting $ 67.84 2
Signal circuit(s) or limited - energy Scc
Address: 11401 NE MARX ST. panel, alterations, or extension. Pape 2 2
Each additional inspection over allowable in any of the above
City /State/7IP: PORTLAND, OR 97220 -1041 Additional inspection (I hr min) 66.25/hr
Investigation (1 hr min) 66.25 /hr
Phone: 5032558488 Fax: 503- 57 -7121 Industt9nl plant (Ihrmin) for 78,18 /hr
Inspections r which nn feels 9n,n(u hr
Lie,: 48748 1 - Iccvienl Lie.: 26.496C , uprv.1.t< s. ccificall listed 1/2 hr min
Suprv. Electrician signature, required: :8 " ..,zstir.rw . c. IltiX IS, .L:.M.M71 rsIZ 5 7 -irj T i' V 1°ldigi4: Mlbt idl
Subtotal: $ ,tr ti I. J7
Print Nnmc; Rlehard Martin Dn • . : r1gri9 . Plan review (25% of permit fcc);
Authorized sigjraluro: - r State surcharge (12% of permit fee); $ . .- 17,666(
e.
TOTAL PERMIT FEE: S - 218:83. j. Ol
Print Name: Richard Martin feu permit apparition entire.* ire permit in ani aewi..d mamaa lira
days Orr It Nu been accepted to complete.
• Number of impaction' per permit nl lowed.
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