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Permit Sy�f r}�SN`�Y ELECTRICAL PERMIT to „ CITY OF TIGARD COMMUNITY DEVELOPMENT PERMIT #: ELC2008 00150 ' DATE ISSUED: 3/17/2008 p � iff aARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S136DB-00501 SITE ADDRESS: 11611 SW PACIFIC HWY ZONING: C - G SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: UNION GOSPEL MISSION Project Description: Panel change. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA /SPEC OCC: Owner: Contractor: UNION GOSPEL MINISTRIES OF PTLD WEST SIDE ELECTRIC CO INC c/o FRANCESCHI, JEROME + GENEV 1834 SE 8TH AVE FRANCESCHI, KENNETH + BARBARA PORTLAND, OR 97214 SAN RAFAEL, CA 94903 Phone: 503 - 639 -6488 Contact #: FAX 503 - 736 -0677 PRI 503 - 231 -1548 FEES Description Date Amount Reg #: ILL; 26 -135c ifLPRMTI EL,C Permit 3/17/2008 $80.30 L.IC 13306 I"I'AXI 12% State Surchar 3/17/2008 $9.64 SUP 4654S Total $89.94 REQUIRED ITEMS AND REPORTS This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By: • i ; - Permittee Signature: �� 71,/ Colt 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'N: DATE: LICENSE NO: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. F [el tt heal Permit Application , FOR OrCICE USC ONLY �.,� City of Tigard Y-- �° EIJED aecuvcd .. ., .. . . .�. -- � ...: r ,..; .. , a t \ 4 '" 13125 SW Hall fl"vd., Tigard, o i #_ ' Plan R �� /r Permit No.: E $ — c r!(�?� Plan Review •1; Phone: 503.639.4171 Fax: 5 t . 60 "' Inspection 3 Date/By: Other Permit: e n Line: 5. 639.4175 4 [V ,JL �� f\RDI MAR Date Ready /By: Jens: ' El Sec Page 2 for • x:`. ,, =:i Intcrncc www.l or,gov NotilicdAtethod: ,�� /�C. " i Its 11 t]l� TY PE OF Supplemental lnformatimt '�L71 Y'" . / .rz" ° t . "\I PLAN RL +'V1E\1' ❑ New construction ii7.4 Addition! 41 '1 t rtla Clllent Please check all that apply PP Y (submit 2 sets of plans w /teeter checked below); ❑ Service or feeder 400 amps or more ❑ Building over three stories. El Demolition ❑ Other: r . where the available fault current ❑ Marinas and boatyards. • CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. ❑ ! - and 2 - family dwelling Commercial /industrial ❑Accessory building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural amps for all other installations. buildings. ❑ Multi tnnily ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency systnut• larger separately m lydcrivalsystc JOH SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "4" ^L " "' 12" ' 1 3" Job no.: V3? — 1 44 Job Site address 11[01( ? w {aCGr J c G t "- / t0011P or more. occu ant P' Y. r ) ❑ Six or more residential units. ❑ Reneational vehicle parks'. City/State/ZIP: \ ( � c / - q. 7,73 ❑Health - care facilities. ❑ Hazardous locations. ❑Supply voltage for murc than ♦ 600 volts nominal. Stli le /bldg. /apt. I10.: Project I1ame: / 1 , /__ \ M r r 0 or feeder 600 amps or more. Cross street/directions to job site: FEE ; SCIiG 1.L ----- - na,criptlun 1 Qty. 1 Fee. 1 Turd 1 • New residential single- or multi - fancily dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or Tess { 145.15 4 Tax map /parcel no.: Ea. add'l 500 sq. 11. or portion 33.40 1 Limited energy, residential • DESCRIPTION OF WORK • (with above sq. ft.) 75 -00 2 Limited energy, multi-family l 75.00 2 y "� r, r?. residential (with above sq. ii.) Services or feeders installation, alteration, :std /or relocation 200 amps or less I 80.30 g (0,3v 2 PROPERTY O\VNER ❑ 'TENANT; 201 amps to 400 amps 106.85 2 Name: a ( r Y� tdtn SQ t� ����Sr Ito 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: GLV, � _— Over 1,000 amps or volts 454.55 2 City /Stale /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( 5v,) /_ 7 p( 61.46 Q Fax: ( ) 200 amps or less _ I 66.85 I 1 Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps f 133.75 I 2 ; Owner signature: Date: Branch circuits — nets, alteration, or extension, per panel - -" A. Fee for branch circuits with • © A1'1'LJCAN'1' ❑ CONTACT PERSON above service or feeder fee, each branch circuit 6-60 2 Iusiness name: \VEST SIDE ELECTRIC CO. 13, Fee for branch circuits Contact name: GLENN GROSSMAN without service or feeder fee, 46.55 2 first branch circuit Address: 1834 SE IVE. , 8" Each add'l branch circuit 6.65 2 Miscellaneous (service or feeder not included) City /State /ZIP: PORTLAND, OR 97214 Each nlanufaci red or modular 90.90 .� 2 Phone: (503) 231 - 1548 Fax: : (503) 736 - 0677 dwelling, service and /or feeder Reconnect only 66.85 2 E -mail: GLENNG «WESTSIDEELECTRIC.COIVI Pump or irrigation circle 53.40 2 1 ' • CONTRACTOR Sign or outline lighting 53.40 . 2 Business name: WEST SIDE ELECTRIC CO. Signal circuit(s) energy panel, alterer limited- or Address: 1834 SE et AVE. extension. Describe: Page 2 2 City /State /ZIP: PORTLAND, OR 97214 Each additional inspection over allowable in any of the above • Per inspection 62.50 Phone: (503) 231 -1548 1 Fax: (503) 736-0677 Investigation per hour () hr min) 62.50 CCI3 Lic.: 13306 Electrical Lic.: 26 - 135c Suprv. Lic.: 4654S Industrial plant per hour 73.75 / ,Z �/ }� - ELECTRICAL PERMIT tT FEES Suprv. Electrician signature, required: G / Lam Subtotal: R 0. 7, Print name: RANDALL ROBERTS Date: ! N 1 (� Q Plan review (25% o1'permit fee): [ t U State surcharge (12% of permit fee): 7 r G (.[ Authorized signature: • TOTAL PERMIT FEE: 14 Print came: This permit application expires if a permit is not obtained witiiilf 180 Date: . •; days after a has been accepted as complete. Number of allowed per permit. 1:■Baildieg ',Penults \ELC- PcnuitApp.doc 05/23/do 440 46151(11; /COM /WL•tl Z/ Z 9006 05.6£-£6 L8661£Z£05