Permit •
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2009 -00024
COMMUNITY DEVELOPMENT DATE ISSUED: 1/16/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S1 10 B D -00100
SITE ADDRESS: 11511 SW BULL MOUNTAIN RD ZONING: R -2
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: ST JAMES EPISCOPAL CHURCH
Project Description: Lighting retrofit.
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 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:
ST JAMES EPISCOPAL CHURCH FIREFLY ELECTRIC COMPANY
PO BOX 23033 PO BOX 396
TIGARD, OR 97223 BEAVERTON, OR 97075
Phone: Contact #: PRI 503 - 649 -2427
FAX 503 - 642 -7049
FEES
Description Date Amount Reg #: ELF CI76
TAX] 12% State Surchar 1/16/2009 $8.02 LIC 170745
IELPRMTI ELC Permit 1/16/2009 $66.80 SUP 5208S
Total $74.82 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 =! s. . ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 9. - 001 -0010 t gh 0' ' • 52- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
/ )
Iss I d By:
I /` I� �� � 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 SUPPR. ELLEC'N: _`i . 11 DATE: 1 — 0 1
LICENSE NO: ;J (J✓5
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 FOR OFFICE USE ONLY
Received /,, q e — tJ�
City of Tigard Date /By: ( Re V ! Permit No. gL e 0 2 ii
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C .. Phone: 503.639.4171 Fax: 503 598.1960 Date/By• Other Permit: •
TIGARD Inspection Line: 503.639.4175 Date Ready/By. runs HI See Page 2 for
Internet: www.tigard- or,gov Notified/Method: / (0, Supplemental Information
TYPE OF WORK ' ' " . " PLAN REVIEW . ' -
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction J Addition /alteration /replacement
❑ 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` LOCATION . ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I - "1 - ",
Job no.: Job site address: 1 15 I( W L 3, 41 / 4. . \Rd , or more. occupancy.
❑ Six Six o or r more residential units. ❑ Recreational vehicle parks
City /State /ZIP: T'' Q O � 'L Z t { ❑ Health -care facilities. ❑ Supply voltage for more than
J CI Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: --- �f} L.5 g'( teit(.. ❑ Service or feeder 600 amps or more
job site: FEE- SCHEDULE
Cross street/directions to
J 0 Ru 1 d id Description I Qty. I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
:, , DESCRIPTION.. OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
L Q� 1'., ,� 051 ■ I l Q,X t ' S 191AS , oc cAT cy s -e m $o r 5 residential (with above sq. ft.)
J Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
,, ❑ P OWNER ❑ TENANT' , ' ' ' 201 amps to 400 amps 106.85 2
Name: �`aM� S E ' p t SCe p I C� W Y 401 amps to 600 amps 160.60 2
f 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I 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 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT': �% ' ❑ CONTACT PERSON ' above service or feeder fee, 6.65 2
f t r E� L Fee circuits
without service or feeder fee, 46.85 /g . 35 2
Contact name:
Z1/4,1c A (i„t.5.1--f a,.t. first branch circuit
Address: eo elox -3a,6 Each add] branch circuit 3 6 65 I9 ,15 2
Miscellaneous (service or feeder not included)
City /State /ZIP: aVP- r - 4 - ovv O R q -.01- s Each manufactured or modular 90.90 2
(so 3) c ( et 2 L3 11- e� 61 2 Reconnect in e t on y and /or feeder
Phone: Fax: ( 3 O 4 Reconnect only 66.85 2
E -mail: W ■ r ea c r e ri Y .. ,Q w c ; I . r o,•n Pump or irrigation circle 53.40 2
• • ' CONTRACTOR, Sign or outline lighting 53.40 2
Business name: [; (y Signal circuit(s) or limited-
t'1 �e c t energy panel, alteration, or
Address: Po Box, 30t 6 extension. Describe: Page 2 2
City /State /ZIP: 62AVe- ( OYk q d S Each additional inspection over allowable in any of the above
Phone: ( � o '3) 6 y a 2 �j Fax: ( 5.031 Per inspection 62.50
2 T' 7 h � 2 . T� 9 Investigation per hour (1 In min) 62.50
CCB Lie.: I ' t .,- 7 . (,/ 5 Electrical Lie.: C' 7. 6 Suprv. Lie.: 5--Zbg ,s Industrial plant per hour 73.75
ELECTRICAE PERMIT' FEES
Suprv. Electrician signature, required: Subtotal: 66 , $ 0
Print name: Date ( -( _ l� Plan review (25% of permit fee):
�/ {` State surcharge (12% of permit fee): 3,
Authorized signature: 0 TOTAL PERMIT FEE: 79 32_
This permit application expires if a permit is not obtained within 180
Print name: z ,,,L, L, A S I Date l (6 -p This days after it has been accepted as complete.
JJ / • Number of inspections allowed per permit.
I:\Building \Permits \ELC- PermitApp doe 05/23/06 440- 4615T(1 t /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r RESIDENTIAL WORK ONLY: __
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑
•
Garage Door Opener* •
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other: •
f :COMMERCIAI: WORKONL Y:
-� -� °-- °
:.;,
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
Ti Audio and Stereo Systems
❑ Boiler Controls
Ti Clock Systems
n Data Telecommunication Installation
Ti Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control* •
Ti Medical
Ti Nurse Calls
Ti Outdoor Landscape Lighting* •
Ti 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 03/23/06