Permit t ELECTRICAL PERMIT
CITY OF TIGARD
'7, "; COMMUNITY DEVELOPMENT Permit #: ELC2010 -00289
f Date Issued: 06/15/2010
T 1 G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE
Subdivision: Lot: 0
Project: Westgate Baptist
Project Description: Kitchen TI.
Owner: FEES
WESTGATE BAPTIST CHURCH Quantity Description Date Amount
12930 SW SCHOLLS FERRY RD
TIGARD, OR 97223 1 ea Services or Feeders - 200 06/15/2010 $100.70
amps or less
PHONE: 25 crt Branch Circuits w /Purchase 06/15/2010 $185.50
Service or Feeder
1 ea 12% State Surcharge - 06/15/2010 $34.34
Contractor: Electrical
NORTH LAKE CONTRACTORS
12900 NW LOVEJOY CT
PORTLAND, OR 97229
PHONE: 503- 709 -0985
FAX: 503 -641 -3168
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $320.54
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 - - dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 -001 -0100. You may o a • e rules or •: rect_q uestions to OUNC by calling 503.2 .6699 or 1.800.332.23
Issued By: ` P ermittee Signature: , r
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.
CaII 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.
.Electrical Permit Application ���9 ,� 1 ''a OR 0Fl 1cfi1::U51 0N� , : ; 5 re d Z1" " .�
: n C of Tigard ��� r Received t0 /� /O �L.C�D 1G -CX� hn; y Permit No.:
1312 SW Hall Blvd., Tigard, OR 97223 plan R few
; '' .i B Phone: 503 .639.4171 Fax: 503.598.1960 ` \w\ ° ate Other Permit: ,Q ' 0Gt --cj i3 )
I l fi. aVl.f1 Inspection Line: 503.639.4175 J� G GN,g Ready/By: Juris: '® See Page 2 for
l
. t . Internet: www.tigard- or.gov o1 � �1�D Supplemental Information
TYPE OF WORK 01, Please check all that apply (submit 2 sets of plans w /items checked below):
• NNC PLAN REVIEW
VNewonstruction ❑ Addition/alteration/re a me n t
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATI El Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "1 -
Job no.: Job site address: yy�� 100HP or more. occupancy.
o 7 J" U ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 1 t� p 1 O12 9 7 Zz 3 ❑Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 1 CS G,. f'E ' a l ^ - „ ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: � �� Description FEE SCHE . 1 Fee
1 Total 1 ”
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 67.84 2
. DESCRIPTION OF WORK (with above sq. ft.)
� I Limited energy, multi- family 67.84 2
/ 1
Crc I'le & 7 FeLLCOS rt t, P ('t R{' LL i T residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 U)0. 7t) 2
V PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
r V ' • 401 amps to 600 amps 200.34 2
t%
Name: tSi , o /rrV 6&3p (1 S % C t'tua -G 14. 601 amps to 1,000 amps 301.04 2
Address: t 2- i p Spy S. C ltnLC.S ci-F122 Y m Over 1,000 amps or volts 552.26 2
�
City/State /ZIP: �- �Y Temporary services or feeders installation, alteration, and/or
D O 0,6, Ct 7 Z� 3
Phone: ( S Z N 3 5 (5' ) S� 11— CO 200 amps or less 59.36 1
S� 3) Soo Fax: L 1 5
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee, L ��
❑ APPLICANT CONTACT PERSON each branch circuit 25 7.42 ice 2
Business name: ' B. Fee for branch circuits without D
(��` S �M O � I �� service or feeder fee, first
Contact name: branch circuit 56.18 2
R 1 /1r U O J Each add'I branch circuit 7.42 2
Address: j t 7 5 5 L t?rt 6- ��L..t� ;
� L vtJ Miscellaneous (service or feeder not included)
Each City/State /ZIP: (�irK 6 � v)€(.,..0 0 a_E c t � o2 S dwelling, service and/orfeeder 67.84 2
Phone: (S03) &'? Z 7 39 Z Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: O R $ S 00 YeittOo _ Ca. -■
Sign or outline lighting 67.84 2
CONTRACTOR . Signal circuit(s) or limited- energy
Business name: A/ (3 ( i 4G �C� panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: t ? g_TLA 6 t op_ c i 722_ Industrial plant (1 hr min) 78.18 / hr
Phone: (503 Fax: 03 Inspections for which no fee is
7 3f. specifically listed (% hr min) 90.00 / hr
CCB Lic.: I c(,./ 17 3 Electrical Lic.: a 1 Suprv. Lic.: 491 ELECTRICAL PERMIT FEES •
Suprv. Electri si c ture, required 7 t . �° &J e� ' (� Subtotal: a �(p . ,k) i Plan review (25% of permit fee):
Print name: t i t'' „ Date:( S ' O
G � ' (� � State surcharge (12% of permit fee): '''')9 , '3 if
TOTAL PERMIT FEE: 3 a0 h �
Authorized signature: "r I'7 r i 1
This permit application expires if a permit is not obtained within 180
/ Date: a-il� c, days after it has been accepted as complete.
Print name:
-�-i- L C L Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09 /1 5 440- 4615T(11 /05 /COM{WEB