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Permit Support Document CITY OF TIGARD ELECTRICAL PERMIT t IN ' COMMUNITY DEVELOPMENT a Permit#: ELC2016 00921 W 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 WAWA Date Issued: 1 2/06/2016 T[��.L� g Parcel: 1S134BD07200 Jurisdiction: Tigard Site address: 10900 SW 121ST AVE Project: TRINITY EVANGELICAL CHURCH Subdivision: None Lot: None Project Description: PANEL REPLACEMENT. 1/25/17:REPRINTED permit to add(2)branch circuits. Contractor: MIKE'S ELECTRIC Owner: TRINITY CHURCH OF THE EVANGELICA 11070 SW ALLEN BLVD CHURCH OF NORTH AMERICA BEAVERTON, OR 97005 10900 SW 121ST AVE TIGARD, OR 97223 PHONE: 503-649-6991 PHONE: FAX: 503-641-1902 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 12/06/2016 $100.70 Specifics: amps or less 2 crt Branch Circuits w/Purchase 01/25/2017 $14.84 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 01/25/2017 $13.86 Electrical Type of Const: 45 Misc Administration Fee 01/25/2017 $45.00 Occupancy Grp: Total $174.40 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 952-001-0090. You may obtain a e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 5 s p Issued By: —� Permittee Signature: � .y �,-,�.T 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. 1 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. 01/24/2017 9:09AM FAX a 0003/0003 Electrical Permit Applicati CFIVED ,,,,,,„.........,,,„,,N,,, City of Tigard Received �� 74 . +1 13125 SW hall Blvd,,Tigard,OR 97223, 0 17 Uate/n ; ]i't�'` � • Phone: 503."118.2439 Fax, 5(13,598.1112 4 Plan Review Dale/ft ; ellil Inspection Line: 503,639.4Ready rife/© he a: 175 e ) y13 Nee Pogo 2 for 'l'iGARD I Internet: www.ligard•or.guv CITY Of' Div/�(FARD Nou1Wd/Method: Sullldementeitaformaeiun - TYPE ea , !'I�j$3 rsial • r PLAN REVIEW ❑New construction SAddith , (iftht0a eitien( time uhcck IIs that apply Wain'1 SWa of plans w/items ekeltuJ): El Demolition Other: ❑Service or feeder 400 amps or more 0 Building over three stories. where the available fault current 0 Marinas end boatyards, CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 vo116 0r 0 miming buildings. ❑ 1•and 2-family dwelling 'Commercial/industrial ❑Accessory building Zeta to grown!,or exceeds 14.000 0(!ons sterol-nae agrieullurnl 0 Multi-family amps fbr'all other installatiots. buildings. y Master builder ❑Other: ❑Fire pump.- P P ❑Installation of 150 KVA a JOB SITE INFORMATION AND LOCATION - ID Emergency system. larger sepirmaly derived Job i/: Joh site address: / �. �7 ID Amok,.arrow motor load of ayrtam, `1 1 y � � c`A f �1. , /� t00t1Portnoro. ❑„A ,.1..,"1-2",„1 3„ City/Staic/LiE': 'l�l�f•CU I y ❑six or more residential nails. occupancy. ��'� ❑Heoldr care facilities. 17 Recreational MINN parka. Suttefhhlg./apt,II: Project memo %' `: •C. \ �1 OHexnrdut,a location. ClS Ipimly voltage tar meas Aran O Service ur feeder 600 ompa 0r mom 600 volts amnion) Cross street/directions to job site: FEE SCHEDULE Desc defile .'-----1-771 Each I Total I �- _ New residential single-or tnldll-Iimelly dwelling unit,Subdivision: Lot ii: includes attached garage. ' - 1,000 sq.R.or less 168.54 4 Tax map/parcel It: . ..... Ea.add''500 sq.R.or onion 33.92_ _ __ 1 DESf RIP'!'ION OF WORKLimited auorily,residential _- �� 1 t (with above sq.fl.) 75,tM 1 'P ��Vv ` �V Limited energy.multi-family T 75.00 2 5 p\aut,(t„e,{�k t k 5i Z ._ , ,, residential(with shrive sq.f!,) -- - , jat ❑ 'fENAN ' itenewable Energy ❑ See I n e2 ❑ PROPERTY OW li ervices of feeders iinatallatlontalteralion,and/or relocation Name: 1 t,\L 0 amps or less 100.70 2 Address: 201 sumps to 400 amps — 133.36 _ 2 401 amps in 600 amps — 200.34 2 City/Slate/ZIP: - 601 amps to 1,000 amps 301.04 2 Phone;( ) Fax:( ) Over 1,000 strips or volts 552.26 2 Email: "" 'temporary services ur feeders Installnllon,alter:lion,and/or relocation _ Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I intended for sale,lease,rent,or exchange,according to ORS 447,449,670.and 701. 201 amps to 400 amps 125.08 2 Owner signature! - _ Date: 401 amps to 599 amps 168,54 2 • ❑ APPLICANT ❑ CONTACT PERSON Branch new,alteration,or extension,per panel - Business name: A.Fee for branch Circuits wills above service or feeder fee, 7.42 2 `-- ^ a each breitcit circuit Contact tattle: _ B.Fec for branch circuits without — ' • service or feeder fcc,first Address: 56.18 2 branch circuit City/Slatc/L1P: Hach ttdd'1 branch circuit . ---"Z 7,42 Tq,tiifi 2 ”" - Miscellaneoaejservice or feeder not included) Phone:( ) Fax::( ) •l2ach manufactured ur modular Entail: " &tallints,service and/or feeder 67.84 2 _ Reconnect only 67,84 CONTRACTOR Pump ur irrigation circle 67.84 2 Business name: Mollenhauer enterprises DIM Mike's Electric Sign or outline lighting 67.84 2 Signal circult(a)or Ihltitctl.encrgy , 2 Address: � ❑ Sec 1 age 2 11070 SW Allen Blvd unyet,alteration,or extension, City/State/ZIP! Beaverton,OR 97005 Each additional inspection over allowable in any of the above Additional inspection(1 hr Iain) 66.25/hr Phone;( 503)649.6991 Fax:( 503)64 1.1902 investigation(I hr mu,) - 90.00/In Email: )nikeselectric@mikeselectric,biz `- 1 industrial plant(1 hr min) 78,18/hr Inspections for which no fee is 90,00/hr CCR lie.:191091 Electrical I'' - r Suprv.1.ic.: 5781s _spccifcnlly listed(r/,hr min) __ Suprv.Electrician signature,required: �� RLECTRICAL PERMIT FEES Subtatal: il tL'( Print name:Dau_la: R McCaule Date; }•�� _❑Plan Review Required(25°A of permit fee): /#; I 1 State surcharlSe I2%of�rerntit tae): • Authorized signature; �/• • - CILrL_ TOTAL PERMIT FEE;J' This permit implication expires if a permit Is not obtained within 180 Print name: Darryl MolleI -Lauer Date: J7 This after It hoe been accepted as c pit IC. 1 • Ntenbar orhanniellonx "f allowed per permit. s-.. ,6C,, r�/:MG. Qry a' I'WnildinylParnrilsCLC PermuAtpt_5L1(�Ris.doc Rev U6/17n0 It 44n-461sT(11/0f/COM/wt0 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 10900 SW 121 STAVE, TIGARD, OR, 97223 Record Type: Commercial - Electrical Inspection Type: 199 Electrical final Result: PASS- NoCofO Comments: Violation Summary: Inspector Tel: 503.718.2439 Inspection Date: Record ID: ELC2016-00921 Inspector: Jeff Grove Contractor