Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2014-00126
IF G A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/02/2014
Parcel: 15133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE
Project: Westgate Baptist Church Subdivision: CHAPARRAL Lot: 1
Project Description: HVAC system.
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
Description Date Amount
Specifics:, Restricted Energy Permit 06/02/2014 $75.00
12%State Surcharge-Electrical 06/02/2014 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 1 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent$e�rr. Those rules are set h in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a cop direct questions to OUNC by calling 503.232.19 Vor 1.800.332.2344.
Issued By: a� i'" Permittee Signature: lf/Vt. Pi U
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.
Cali 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 FOR OFFICE USE ONLY
•
City of Tigard a Date/B / Permit No.: i
III �i . lri ._-_ :0 i
• 13125 SW Hall Blvd.,Tigard,OR �� Plan Review
■ y1, 1 Other Permit: I .,
Phone: 503.718.2439 Fax: 503. r� r1 '�� Date/B : ` re Q)1,( 0c) )Q
I �k: \� � Inspection Line: 503.639.4175 J i�t3 1-Q Date Ready/By: 1u�s: ® See Page 2 for
Internet: www.tigard-or.gov 0 Y O Notified/Method: %,(b Supplemental Information
TYPE OF W l�` PLAN REVIEW
New construction ❑Addition/alteratio placement
Please check all that apply(submit 2 sets of plans w/items checked below):
`` ❑Service or feeder 400 amps or more ID Building over three stories.
❑ Demolition ❑Other: V - where the available fault current ❑Marinas and boatyards.
CATEGORY OF - -• - exceeds 10,000 amps at 150 volts or ❑Floating buildings.
� less to ground,or exceeds 14,000 ❑Commercial-use agricultural
El J�-1 C I-and 2-family dwelling ommercial/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","1-2","l-3",
73 2 {� I OOHP or more. occupancy.
Job no.: Job site address:
/0 73 U 3(A) /30 ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than
Cl Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name: 0 E5 i G t-rr i tP}_ . 1 0 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.
I Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq.ft.or less 168.54 4
1 Ea.add'l 500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION Or WORK ' (with above sq.ft.)
/Lev'J Limited energy,multi-family 75.00 2
ttv l r Ll ei �yC S t bresidential(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: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) I 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
Ossner signature: _ Date: Branch circuits—new,alteration,or extension,per panel .
A.Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON
,? above service or feeder fee,
7.42 2
• 4
Business name: (bV F Ot3 CONS i KoCClof4 each branch circuit
B.Fee for branch circuits without
Contact name: i err' V,f.ran1 service or feeder fee,first 56.18 2
�� branch circuit
Address: i i 94S SW LyAJN Z l Each add'I branch circuit 7.42 2
City/State/ZIP: �r Miscellaneous(service or feeder not included)
t I Gt[Ytki 0(t e 97��3 Each manufactured or modular
Phone:(spa ) 5,z 7 C7 3 Z I Fax: :( ) dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Re LA-� Lc Signal circuit(s)or limited-energy See r�
E (�'T�b�t panel,alteration,or extension. Page 2 ,'47 s� 2
Address: 1 Y100 r 1 t,5 f Lv y �' Each additional inspection over al allowable in any of the above
City/State/ZIP: f t o p q"7�� Additional inspection(1 hr min) 66.25/hr
POg -(,A/� ! Investigation(1 hr min) 66.25/hr
Phone:(9)3)-7 CQ� Ac I Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.:/.SLjl'7$ Electrical Lic.:CI 3 I Suprv.Lic.4T4'/i5 specifically listed(1/,hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,requir : I 6,14 /e_'_+at
r-�� . , Subtotal: * 75- I:6;e
Print name: 6 �r (Q Date:�Za//y Plan review(25%of permit fee):
State surcharge(12%of permit fee): t Q. °�Authorized signature: ��l TOTAL PERMIT FEE: ti Lj,
This permit application expires if a permit is not ob ained within 180
Print name: A L LA‘46-6- Date: 4 days after it has been accepted as complete.
' Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(11/05/COM/WEB
• Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: 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
n Audio and Stereo Systems* 15.01 tots kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm
25.01 to 50 kva 301.04 2
n Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 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 0.0 3
nEach additional inspection over allowable in any of the above:
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL 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
n Clock Systems
❑ Data Telecommunication Installation
❑ Fi Alarm Installation
HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
L\Building\Permits\ELC_PermitApp_ELR_ERE doe Rev 05/21/2013
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10730 SW 130TH AVE, TIGARD, OR, 97223
Commercial - Electricial Limited Energy
198 Low voltage final
PASS - No C of O
ELR2014-00126
Chip Barnett
Violation Summary:
Inspector Contractor