Permit U CITY OF TIGARD ELECTRICAL PERMIT
2 . COMMUNITY DEVELOPMENT Permit #: ELC2013 -00352
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/26/2013
Parcel: 1S133AD02200
Jurisdiction: Tigard
Site address: 10820 SW 130TH AVE
Project: Westgate Baptist Subdivision: CHAPARRAL Lot: 1
Project Description: (4) branch circuits for TI
Contractor: NORTH LAKE CONTRACTORS Owner: WESTGATE BAPTIST CHURCH
12900 NW LOVEJOY CT 12930 SW SCHOLLS FERRY RD
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE. 503 - 709 -0985 PHONE. 503 - 524 -3500
FAX: 503 - 641 -3168
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 06/26/2013 $78 44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/26/2013 $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 • - ccor•an.- , ith 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 Orego la - ' •- s you to follow the rules adopted by the Oregon Utility • • 'i..- _ n enter Those rules are set forth in OAR
952 •01- 0010 th ough OAR 95 X01 -00' ou may obtain a copy of the rules or direct questions to O NC b . .1=11 I! 03 23 . 987 or 1 800 332 344
I sued By: . Permittee Sign. e: ��' ' -r'' 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 /z
SIGNATURE OF SUPR. ELEC' / / /
1 * • ��
� Date: CO /// /
LICENSE NO. (t5 9 / 5
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 Application �J/ � FOR OFFICE USE ONLY
City of Tigard Date /B , O)t(�� Permit No ELC /,3- 06 35,2,
I II .11 V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone 503 718 2439 Fax: 503.598 1960 Date/B Other Permit 6 „ Acyg ?
TI G A R D Inspection Line 503.639.4175 Date Ready /By loos El See Page 2 for
Internet www tlgard- or.gov Notified/Method Supplemental Information
E OF WORK PLAN REVIEW
❑ New 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 ❑ 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 _fommercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: y - 1 - 1 I OOHP or more occupancy
l d o o ` cS(.J �c�LJ ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: t(/02Q� 6 42G t 7 7,73 ❑ Health-care a Hazardous facilities ion ❑ Supply volts voltage for more than
❑Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: ii as , 1 - 6 4. ❑ 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 I
Tax map /parcel no.: Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
Limited energy, multi- family 75 00 2
EX rON2S, (( Re, (..) (cs Fa /L 6 >r F ,tC.6S residential (with above sq ft )
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation _
%PROPERTY OWNER I ❑ TENANT 200 amps or less 100 70 2
201 amps to 400 amps 133 56 2
Name: /JES P6 erP(11 1 C G 6aJ/ui it 401 amps to 600 amps 200 34 2
Address: z 5 3 0 SGT SC it 0 u Fez a ti, e p 601 amps to 1,000 amps 301 04 2
r Over 1,000 amps or volts 552 26 2
City/State /ZIP: —"F ,,,A.72. toi CQ& Ti ZZ3 Temporary services or feeders installation, alteration, and /or
Phone: (3 o ) 5 Z t4 3 S tstl Fax: ( ) relocation
200 amps or less 59 36 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee, 7 42 2
Business name: ,•- each branch circuit
U T� i 's( �.00I/5 CIZUC r,6A) _1 A/C. B Fee for branch circuits without
Contact name: A - service or feeder fee, first /
branch circuit I 56 18 �( !� 2
� l! ���
Address: / V r? '
/ S (/1) L r tA is r POIZ C t A (, tih Each add'I branch circuit 3 7 42 2k • 24 2
Cit /State /ZIP: / Miscellaneous (service or feeder not included)
y L Ali t 050 (ZZO a Q. c." 51 03 S Each manufactured or modular 67 84 2
r � dwelling, service and/or feeder
Phone: (503 ) S / Z r 7 3 5 Z Fax.. ( ) Reconnect only 67 84 2
E - mail: g IJ etr eil Y f i'4 Pump or irrigation circle 67 84 2
• CONTRACTOR Sign or outline lighting 67 84 2
Business name: A/0 r) + L �^� I PARS - L i1 Signal circuit(s) or limited- energy See
R I panel, alteration, or extension Page 2 2
Address: (29ob M1,1/4l to VE-S -o L' C.:,‘(-- Each additional inspection over allowable in any of the above
City/State /ZIP: PDp'L4►.&S L Ov ( ' ?2'Z Investigation AddInvestigation Investigation on ((I inspection hr mmm) ) hr min) 6625/hr
I 66 25/ hr
Phone: (5 - 707 _0G) 8 5 Fax: ( ) Industrial plant (1 hr min) 78 18/ hr
l [ Inspections for which no fee is 90 00/ hr
CCB Lic.: /S,T 1 8. Electrical Lic.: CI 3 Suprv. Lic.: 4$ 9 C 5 specifically listed (%/ hr min)
1/57/7 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required ! C Subtotal: 7s ,a
Print name: d l,.l, 1 t S Date:6 ( 2/ '3 .6 Plan review (25% of permit fee):
.Q State surcharge (12% of permit fee): q. q
Authorized signature: PERMIT FEE 7 . 8S
/� V _1 \ / This permit application expires if a permit is not obtained within 180
Print name: A. L(�a L ^ Dater
zi. / r3 days after it has been accepted as complete.
�� ` • Number of inspections allowed per permit
I \Bwlding\Pemius\ELC_PermiApp ELR_ERE doc Rev 05/21/2013 440-46 15T( 1 1 /05/COM/WEB
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: , 1 . FEE SCHEDULE ,
Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100 70 2
5 01 to 15 kva 133 56 2
❑ Audio and Stereo Systems*
15 01 to 25 kva 200 34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25 01 to 50 kva 301 04 2
❑ Garage Door Opener* 50 01 to 100 kva 552 26 2
>100 kva (fee in accordance with 55226 2
❑ Heating, Ventilation and Air Conditioning
OAR 918- 309 -0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7 42 3
❑ Vacuum Systems* >100 kva—no additional charge 00 3
El Other: additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly (1 hr min) 66 25/ hr I
Inspections for which no fee is 90 00/ hr
specifically listed (V: hr min)
COMMERCIAL WORK ONLY: ELE C TRICAL PERMIT FEES - ,
Fee for each commercial system $75.00 Subtotal
(SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee)
State surcharge (12% of permit fee)
Check Type of Work Involved: TOTAL PERMIT FEE.
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \ Building \Permns\ELC_PermiApp_ELR_ERE doc Rev OS/21/2013