Permit V CITY OF TIGARD
PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00395
zn Date Issued: 07/30/2010
6GARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S101 BB01400
Jurisdiction: TIGARD
Site address: 12178 SW GARDEN PL, BLDG# 3
Subdivision: PARK 217 Lot: 0
Project: Colossae Church
Project Description: Electrical for TI.
Owner: FEES
WALTON CWOR PARK BC 8 LLC Quantity Description Date Amount
BY TTA/EPROPERTYTAX DEPT 325, PO BOX
4900 6 crt Branch Circuits 07/30/2010 $93.28
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/30/2010 $11.19
Electrical
Contractor:
RELIANT ELECTRIC OF OREGON LLC
20200 SE OLDENBURG LN
SANDY, OR 97055
PHONE: 503 -701 -4562
FAX: 503- 668 -4190
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.47
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 952- 001 -0100. You r obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344
Issued By JG� ��� _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 503.639.4175 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.
JUL -29 -2010 08:12A FROM: RELIANT ELECTRIC 503668 TO: 5035981960 P.1
Electrical Permit Application a s )1. () 11 1 c 1 (, I c U\ I,
74 Cit of Tigard R (a g P Nn.: t-cgO( — j
13125 SW Hall Blvd., Tigard, OR 97223 •
II Phone: 503.639.4171 Fax: 503.598.1960 JUL 2 9 2010 . ,.: Other Permit i I Q— f
Inspection Line: 503.639.4175 Data Ready/By:
Internet: www.tigard-or.gov CITY OF TIGARD xofl'6°mMsthed: �'� =t ",.'
TYPE of *WILD DIVISION PLAN REVIEW
❑ New construction 4ddition/alteration/replacement Please check all that apply (submit a sets of plans wrtems checked below):
❑ Service or feeder 400 amps or more ❑ Balding over throe stories.
❑ Demolition ❑ Other:
where the avertable fault current ❑ Marinas and boatyards.
CATEGQRY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings
❑ I- and 2-family dwelling COmmerciallindustdal etas to ground, or exceeds 14,000 ❑ Commercial -use agricultural
y g ❑ Accessory building amps for all other installation". buildings.
❑ Multi- family 0 Master builder ❑ Other. ❑ Fire pump. 0 installation of 75 KVA or
JOB SITE JNPORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition drum motor load of ❑ "A "E", "1 -2 ". "1 -3 ".
_t „„ HP or mole occupancy.
Job no.: rob site address: 1 2)1 (ujJ � ktC c .. a six 100 cs more,1catial unite. o creational vehicle parka.
City/State/ZIP: I 01? ❑ Healthcare facilities. 0 Supply voltage for more than
. D Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 13 3 Project name: C 0 SSA C�t;1r(Gtl °Service or feeder 600 amps or more.
1 FEE SCHEDULE
Cross stfeet/directions to job site: Description 1 Qty. 1 P.a. 1 Tend 1 •
New realdentW single- or mutd- family dwelling unit
Includes attached garage.
Subdivision: 1 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 67.84 2
DESCRIPTION OF WORK (with above so. It)
Limited fam
n � �.,� /� �/� ,,� L mited energy, multi - ily 67.84 2
1'I t l rU y'C I dip t7{ residential (with above sq. ft)
Servkea or feeders its alteration, and/or relocation
200 amps or leas 100.70 2
0 PROPERTY OWNER 1 0 TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 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: Branch drains - crow, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feedar fee,
WI w �--�-•��� each branch circuit 7.42 2
Business name: (2 I � s� .e t i1 I a nre_lekt B. Fee for branch circuits )
Contact nemc: 13 1 11 `� a rrth G[. rY1 wl st branch ch circuit
service or feeder fee, 56.18 5 g 2
1 `' , first branch circuit
Address: 207-00 5 F/ � .. Qr) i _ �' 1 1)-) add'l bsanoh circuit 5 7A2 j/Q 2
Vv Mlseelleneoua (service or feeder not included)
City/State/ZIP: / j 4 4 4 7U Each manufactured or modular 67.84 2
��LL
dwelling, service and/or feeder
Phone: j) 0 / i i F lu,' Fax:: '.) / / 1, — • 0 Reconnect only 67.84 2
E re 10 i , . zn , col. (Pr" Pump or irrigation Witte 67.84 2
C CTOR Sign or outline lighting 67.84 2
Signal aircuit(s) or limited-
Business name: energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/Stet/ZIP: .'t���� "I�1 j V f r Each additional inspection over allowable in any of the above
Per inspection 66,25
Phone: ( ) `' Fax: (' ) Investigation per how (1 hr min) 66.25
CCB Inc.: 1 O 2_1 Electrical Lic: _ . i S • a S Industrial plant per hour 78.18 _ -
Suprv. Electrician signature, required )� �� ELECTRICAL PERMIT FEES
.. A, ,.
Subtotal: �j/� r
Print name: 0 5 Y a e Date: J�- I / -- Plan review (25% of permit free):
r State ataabargo (12% of permit fee): 1 7 ...
Authorized signat TOTAL PERMIT FEE: o f ">n T o 1 4r it 1
Print name: g-1) 5.e t) ntifrafi-l—ketrri D a te: 7 ✓ 0 p eft app after es if a permit is r c o p e . wltMn 160 ` J days after it has been accepted u eampkte.
• Number of inspection allowed per permit.
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