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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit#: ELR2017-00226 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24/2017 Parcel: 2S 102 B D01600 Site address: 9845 SW WALNUT PL Jurisdiction: Tigard Project: Tigard United Methodist Church Subdivision: FREWING ORCHARD TRACTS Lot: I Project Description: HVAC system. Contractor: HUNTER DAVISSON INC Owner: TIGARD UNITED METHODIST CHURCH 1800 SE PERSHING ST 9845 SW WALNUT PL PORTLAND, OR 97202 TIGARD, OR 97223 PHONE: 503-542-3628 PHONE: FAX: 503-542-3654 FEES Description Date Amount Specifics: Restricted Energy Permit 10/24/2017 $75.00 Type of Use: COM 12%State Surcharge-Electrical 10/24/2017 $9.00 Class of Work: ALT Total Number of Systems: 2 Audio&Stereo: 0 Boiler Controls: 1 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 $84.00 Other Desc: Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 52-0. !!!9. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 32.1987 or 1.800. 2344. Issued By: Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4176 by 7:00 a.m.for the next available Inspection date. This permit card shall be kept in a conspicuous place on the Job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application R ' EI FOR OFFICE USE ONLY IICity of Tigard Received —� ' •1113125 SW Hall Blvd.,Tigard,OR 97223 `7 Date/B : Ca J L� Permi[No.: t ' Phone: 503.718.2439 Fax: 503.598.1960 Q C' 2 i/ Plan Review Other Pearl.*LC_.ZUi?"641• L Ti G A R D Inspection Line: 503.639.4175 CITY O F --'G p�is ,ate Read/B 161 See Page 2 for Internet: www.tigard-or.gov P1 Ready/By: Juris. 0.1 .t'u.t TYPE OF w3UILDING �DiV{$I• 5 ethad SupplementalIntormation ���T jLAN`REYIEW.° ❑New construction "J Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below): ❑Demolition 0 Service or feeder 400 amps or more ❑Building over three stones. Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling Commercial/industrial ❑Accessory less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑Multi-familybuilding amps for all other installations, buildings. 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system. '7146 0 Addition of new motor load of ❑"A","E","t-2","1-3", Job no.:19a c .. Job site address: I1 46 S-IA/ Wa.t,/3f Act ce100HP or more. occupancy. ❑Six or more residential units. 0 Recreational vehicle parks. City/State/ZIP: Is ,d lJ� F20202? 0 Health-care facilities. 0 Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name:719°`. 1M !/1/ut �/ ' t 0 Service or feeder 600 amps or more. Cross street/directions to job site: h FIE SCHEDULE -' Description I Qty. r Fee- I •Total New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4 Tax map/parcel no.: Ea.add'I 500 sq.ft.or portion 33.92 1 Limited energy,residential DESCRIPTION OF WORK (with above sq.ft.) 75.00 2 Zo !� j,_ Limited energy,multi-family 75.00 2 'v �O �a D, �// C 6)/V Tv w /U(' residential with above ..ft.) (},� SMC ‘o/le' r N Renewable Ener, ❑ See Pae 2 r `y`� %ii�VV/ ��/ . Services or feeders installation alteration and/or relocation PROPERTY OWNERI ❑ TENANT 200 amps or less - 100.70 2 Name: aJ C Chi / � 201 amps to 400 amps 133.56 © flu �� d / Com'! Address: g8`tfs' J"�/ ',` / 401 amps to 600 amps 200.34 vV G GN1�� /Tot LQ 601 amps to 1,000 amps II 301.04Il City/State/ZIP: 0,<C7 Q� a Over 1,000 amps or volts 552.26 Temporary services or feeders installation,alteration,and/or Phone:(.5-0?) 70 g-sv 7,7 I Fax:( ) relocation Owner installation:This installation is being made on property that I own which is not 2010 amps or less 59.36 l intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps H125.08 2 Owner signature: 401 amps to 599 amps 168.54 2 Date: Branch circuits—new,alteration,or extension, .er panel 0 APPLICANT I El'CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, Business name: 4.1 „-/2a ji s-s-o PI, ,S(L• each branch circuit 7.42 2 A( s-1,1e., jack t B,Fee for branch circuits f rstthout Contact name: /C service or feeder fee,first branch circuit 56.18 Address:/jam 0 g` Persil; S - Each add'1 branch circuit 7,42 _© City/State/ZIP: �� 1.2X �� © Miscellaneous service or feeder not included Each manufactured or modular 9 Phone:(5a) 72 ,td�g I Fax::( ) dwelling,service and/or feeder • 67.84 2 E-mail: `7 Reconnect only 67.84 2 c., t S® t W Cake) Pump or irrigation circle 11111 67.84 _© CONTRACTOR Sign or outline lighting NE67.84 —© Business name: . / i‘u, Signal circuit(s)or limited-energy , See panel,alteration,or extension. Page 2 -'?S✓ 2 Address: Each additional inspection over allowable in any of the above City/State/ZIP: Additional inspection(1 hr min) 66.25/hr Investigation(1 hr min) 66.25/hr Phone:( ) I Fax:( ) CD l I zQ Industrial plant(1 hr min) 78.18/hr CCB Lic.: /"‘,/a Electrical Lic. l Y Inspections for which no fee is:.4 Suprv.Lie.: 4.7(13 L s.ecificall listed %s hr min 90.00/hr Suprv.Electrician signature,required- ELECTRICAL RICAL PERMIT FEES �~ __...,..—.AL Subtotal: Print name:• ; 1,,,2 7,>‘,,[�r Date: Plan review(25%of permit fee): J C State surcharge(12%of permit fee): Authorized signature: 1 TOTAL PERMIT FEE: Print name: �.�jQ ^ Date; Q '�Q� /� This permit application expires if a permit is not obtained within ISO `V U "YJ f days after it has been accepted as complete. * Number of inspections allowed per permit. 1:1BuildiWermits1ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 9845 SW WALNUT PL, TIGARD, OR, 97223 Record Type: Record ID: Commercial - Electrical Limited Energy ELR2017-00226 Inspection Type: Inspector: 198 Low voltage final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor