Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2013-00493
Date Issued: 08/20/2013
T EG'ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102BD00100
Jurisdiction: TIGARD
Site address: 9905 SW MCKENZIE ST
Project: St Anthony Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 52
Project Description: Replacing damaged service mast on classroom trailer.
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
1 ea Services or Feeders-200 08/20/2013 $100.70
Specifics:, amps or less
1 ea 12%State Surcharge- 08/20/2013 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 OAR 952-001-0090. You a obtain a co of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By - Permittee Signature: a�2
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.
08/20/2013 08:22 5032577121 CAPITOL ELECTRIC PAGE 03/03
i Fill(OFFICE E USE ONl.1
Electrical Permit Application Reee;�ed / �..it "L-.-.._ —oc�r4
City of Tigard Datrlay; b//5 �i, ,••
13125 SW Hall Blvd.,Tigard,OR 97223 AUG 15 2013 Plan Review Other Permit:
p: . ?bent: 503.639,4171 Fact: 503.598.1960 Dstc/9y:
lnspectien Lino: 503.639.4175 CITY OF TIGARD Date Ready/By: ■ Sue Paten Mr TrC::\P.L� Internee www•tigard-or.gov
BUILDING DIVISI01■! N°1ifled/Method: n sou menialtnfarmatian
- -- :�:,�:I sue :, . • �. -•.._._ ._.._:; 7
�,='`m co construction" - „`,Ad Addition/alteration/replacement-. e _ Please cheek all that apply(aubmit 3 seta of plans w/Itema checked below):
J Nom construction )� Addition/alterotlon/repinccment
❑ Demolition ❑ Other: ❑Service or feeder 400 amps or more ❑Building over three stories
.; , ,, nt: i.; m-..l h I ;9!. ,I, where the available fault current ❑Marinas and boatyards
I and 2-a dwelling Commercial/industrial� �1 �.,�cc y.� exceeds 10,000 amps at 160 volta or ❑Floating buildings:
"U i and 2 family dwelling a Master Builder 0 Accessory building less to ground.or exceeds 14.000 ❑Commercial-uso agricutivrat
�] Multi£ntnil ❑ MastcrBurldcr ❑Ot11Cr buildings
1 . ,P:,c .g.of !`I 1 2„: r,u `aron, - ,,; amps for all ether Installations, nfl
fa �1 L� L�h4_�Ja ,LJ�rte. .- �w. - ❑ Fire Pump ❑ installation of 75 KVA or
Job no.: 130090 Job sit°address: 8905 SW MCKenzi9 St. ❑Emergency system larger separately derived system.
_ .— ❑Addition of new motor load of ❑"A "E°,"1•2”,"1-3°,
City/State/ZIP: Tigard,OR. 1 00H or mtxs, ❑ occupancy
❑Six or more residential units ❑ Recreational vehicle parks.
Suitt/bldg./apt no.: Project name: St Anthony [] Hcalth•carc facilities ❑ Supply voltage for more than
Cross Street/Directions to jab site;
❑Harardous locations 600 volts nominal.
U Service or feeder 600 am•a or more
Subdivision: Lot no.: Description __�. QN• V . Total
Tax n 1.arcel
(TM no New residential-single or multl-fikmily dwelling unit.
includes attached garage
.”k• y'0..,'py��t:1 i..:-LL-...,.1,Q _.�1 Q'i.taai G. 1Wai. .,"2,- ...;1... .:i 'i: :�,-„::;:L:F. 5 l6(1.<4- 4
Replace damaged service mast on classroom trailer 1000 ..ft.or Tess
Ea.Add'I 500 sq.ft orportinn 5 33.92 1
1'wi;'a •rnr-I,a Tr.: 'A;..i.._.:v:.::. .; - Limited energy reeldentinl
(with above eq.ft,) 5 75.On 2
Name: Limited energy,muiti•fnmlly
residential(with above sq,ft.) l S 75.00 2
Address; Service or feeders installation,alteration,and/or relocvtion
200 amps or less 1 5 100.70 100.70 2
Ciry156ttc1ZiP. _201 amps to 400 amps - S 133,56 2
401 amps to 600 amps ! S 20034 2
Phone: Fax: •60!amps to 1000 a S 301.M _ 2
ptrer 1000 amps or volts S 552.26 2
Owner lastatlntion: This Installation is being made on property that I awn which is not Temporary services or feeders installation,alteration,and/or
intended for sale,lease.rent or exchange,according to ORS 417.449,670,and 701 pn rY
relocation
2
Owner signature: 36 1
- Date: 200 amps or less I S 59
_
I ,:;:,,,:.>� amps 5 125.08 2
N•': � �1� p:t�pr� 'ti-w:5t-"'Ce ^ti=."•h":'�'.��Lu...'gaol.',;.rn�+(rs°Ti:)Lt'���r��i::r,'.�.c 201 i 401 amps to 599 amps 5 168.54 2—
Business Name: Branch circuits-new,alteration,nr e:tcnsian,per panel
• A.Fee for branch circuits with
Contact name: service or feeder fee,each
branch circuit _ $ 7.42 2
_
Address: r B. Pee for branch circuits
without service or feeder fee,
City/SInte ZIP. first branch circuit 5 56.18 2
Each additional branch circuit: 5 7.42 2
Phone: Fax; Miscellaneous(service or feeder not included)
Each manufactured or modular
8-moll: 2
R, �.u"r'i'k •:1,''a ;..L�:r7i o�°)�' ar'o d `,;&. m :«u.f 1,;:i �;,^. dwelling,service and or feeder 5 67.84 _
"E . { $ 67.84 2
Reconnect only
Business Name: CAPITOL ELECTRIC CO.,INC. Ptkm•or irri: lion circle S 67.84 2
Sign or outline lighting 5 67.84 .— 2
Contact name: Signal circuit(s)or limited-energy Sec
panel,alterations,or extension. _ Page 2 I 2
Addrme: 11401 NE MARX ST. Each addldonansection over allowable in an of the above
Additional inspectional hr min) 66,25/hr
--Fltyl5tare✓lLP: PORFLANDI CR•f37-230-1041 - - —- _ Jnvcstigation(1 hr min)_ , 66.251hr
industrial plant(1 hr min) 78.18/hr
Phone; 503-255.9486 Fax: 503-251-7121 Inspections for which no fee is 90.00/hr
CCB Lie.; 48748 Electrical 1,1e.: 26-496C ISuprv.Lie.: 2865-S s•ecificall listed 1/2 hr min
Suprv.Electrician eIgnatuae,required: C"-' ud i .-� .-. J-(`•IY',y is 7 0�y�� ..”- .. ' ie,::
Subtotal: $ 100.70
�`o Plan review(25%of permit fee),
Print Name: Richard Martin Date: 8120113 State surcharge(12"fi of permit fee): $ 12.08
Authorized signature:
TOTAL,PERMIT FEE: 5 112.78' ('...":157:3:7:1
Richard Martin ran poraaa°ppllatinn aspire:fa permit a°M"btahata'Attila 180
—Print Name: R am nrtcr It hos beau"cctpttd"s e"mpkto,
•Number of insp6ailorea per permit allowed.
44046157(1 fro;ICOMry+rsr
LknuJWin GWermlr\CLC-rem,aArNl"e 10!01104