Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELR2010 -00121
iT j GIRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/15/2010
Parcel: 1S133AD02200
Jurisdiction: Tigard
Site address: 12930 SW SCHOLLS FERRY RD
Subdivision: Lot: 0
Project: Westgate Baptist Church
Project Description: HVAC controls
FEES
Owner:
WESTGATE BAPTIST CHURCH Description Date Amount
12930 SW SCHOLLS FERRY RD Restricted Energy Permit 07/15/2010 $75.00
TIGARD, OR 97223 12% State Surcharge - Electrical 07/15/2010 $9.00
PHONE:
Contractor:
INTERIOR COMFORT SYSTEMS
17200 SE HEMRICK RD
DAMASCUS, OR 97089
PHONE: 503 - 558 -9224
FAX: 503 - 558 -9124
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 O. ' 2- 001 -0100. You m o•tain a co 414 ect questions to OUNC by calling 503.246.6 9 or 1.800.332.2344. j /�
Issued B / _ — 4111.11-11 �f �� Permittee Signature: CliYl /1 l /
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 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 } 0 7 .1 . ` - , ,,
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Y :? ! C of Tigard n L `a ti r� � 7 . I
�Q �� c i Permit No.: e /tY _/ i' .2
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
9 Phone: 503.639.4171 Fax: 503.598.1960 JUL 1 3 2010 Date/B • Other Permiti//F / 0 --60.3„2_
i A kb Inspection Line: 503.639.4175 Date Ready/By: 1M Pi See Page 2 for
Internet: www.tigard- or.gov ,.,._ It s - Notified /Method: Supplemental Information
❑ New construction C Addition/alteration/replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
"v' 'sr'a- " `"" " 1 . x, t„� b* ax-n ° ig exceeds 10,000 am at 150 volts or
Fl
" C`ATE a eU ! ���� exceed ❑ Floating m� agricultural
.ter .. ,,.. oa uild
lase to ground, or s 14,000 Commercial-use agricu
❑ 1- and 2- family dwelling V ommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
a 5fi r: e �
El
system. larger separately derived system.
,y „ , , � J0 ,,. - ,,OR- 1ATI01 t LQC.4 LIILII N ''' i r .a ❑ Mdin o new motor l oad of ❑ °A , "E , "I.2 °, "1.3 ,
.,u« 4 ..�, 6 .c � .,_ , .' ii d:....r r' 3+ T_'v . L s• u'v. ,. �2
Job no.: Job site address: 1 .2.. ' 3 D fu / l 0 1 J rr . / Six or m more. Recreational ion.
�❑ Six or more residential units. ❑ Rocreational vehicle parks.
City /State/ZIP: )
9 72)- ❑ Healthcare facilities. ❑ Supply voltage for more than • A ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more
Cross street/directions to job site: Description 1 Qty. I 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
SC 2<_�..1)E5PN'r�OF �� ? 2 # �x (with above sq. ft.) 75.00 2
.:I t 2 "€� e ....a < .�. -.� 4,0 sac. p va.,a ,�, a'k.,at,•i.. s`_ ,'`� "'> a..., t.�..�:.�.r8
Limited energy, multi- family 75.00 2
C. C b r d i residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
o U p R. 1 200 amps or less 100.70 2
: � 1 0P,ROP RTY e 1 R . - . M Or ` i TENANT ; ll 201 amps to 400 amps 133.56 2
Name: �� 401 amps to 600 amps 200.34 2
'1 / �` 601 amps to 1,000 amps 301.04 2
Address: 2 - 9 o r f -,G ff _ — / il Over 1,000 amps or volts 552.26 2
Ci /State/ZIP: Temporary services or feeders htatallation, alteration, and/or
t3 - relocation
Phone: ( ) Fa ( ) 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
Owner signature: Date: A Fee n hoic h c alteration,
it h , or extension, per panel
;` f�} PLI }r �� QNT' PE RSON S' above service or feeder fee, 7.42 2
'•.� each branch circuit
Business name: ' �� M. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
0 -. - IIIIIIIIMIIIMIIM u MF� Miscellaneous ebrnchircuit 2
Address: cellll anneouus (seervice or feeder not included)
City /State/ZIP: �{{�� Each manufactured or modula 67.84 2
bt.J e. 07... / j /I e d welling, service and/or feeder
Reconnect only 67.84 2
Phone: (s -di) i) s> - %2.2.t Fax: ( (S -03) ,1-„j e.
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
tk' em#7 R . °`` 14 ` '` w '`° `< Signal circuit(s) or limited - energy
Business name: panel, alteration, or extension. ( Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Investigation (1 br min) 66.25/ br
Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) 1111111 Fax: ( ) Inspections for which no fee is 90.00 / hr
r p n �/� L. ' ifically listed ('/2 hr min)
_ Electrical Lic.: . L Su rv. Lic. A it Re CM0AXSlIS MIT .M
Suprv. Electrician signature, required: 1-11 . /D / V Subtotal: 1 5. �"J
Plan review (25% of permit fee):
Print name: a rr D ate: State surcharge (12% o permee):
(,l • �1'u i nt°.1�� J �� 21(1 t h 12% f it fee):
Authorized signature: - TOTAL PERMIT FEE: �L .
�/. `i . 1 ��� _, This permit application expires if a permit is not obtained within 180
Print name: Date: -` days after It has been accepted as complete.
l , f „ N um b er o inspections allowed per permit.
L:\BuildingTennits\ELC -Permi ,. .doc 07/01/10 440- 461 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire larm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits\ELC- PermitApp.doc 07/01/10