Permit „ CITY OF TIGARD ELECTRICAL PERMIT
• � COMMUNITY DEVELOPMENT Permit #: ELC2009 -00265
TICARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
Parcel: 2S111BCO2800 •
Jurisdiction: Tigard
Site address: 10445 SW CANTERBURY LN
Subdivision: Lot: 0
Project: Calvin Presbyterian Church
Project Description: Reconnect furnace.
Owner: FEES
PRESBYTERY OF PORTLAND THE Quantity Description Date Amount
CALVIN PRESBYTERIAN CHURCH, 10445 SW
CANTERBURY LN 1 crt Branch Circuits 06/04/2009 $46.85
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/04/2009 $5.62
Electrical
Contractor:
HARVEY ROSE ELECTRIC SERVICES
PO BOX 128
NORTH PLAINS, OR 97133
PHONE: 503 - 789 -3284
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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 ' ccordance, with approved r -ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TTENTION Oregoh. -•uire yo to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 1 -0010 through OAR 952 =1 -0100. o - y obtain a copy oft rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. .
Iss ed By: Permittee Signature: y f a19S
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' 1F , , i/ `�,�� 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.
Electirical Permit Applicati CEIVED FO OFFICE LJSE O 4 .Y
City of Tigard 4 Received
� � 0 2009 Date /By: Permit No.:Et e,009���
. ' 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503 639.4171 Fax: 503.598. 1 TIGARD
4 Date/B / yet. Other Permit. /yet. j9—ao
T1G AltD Inspection Line: 503 639.4175 CI1 1 OF Date Ready/By: Internet: www.tigard- or.gov Supplemental See Page l for
I
BUILDING DIVISION Notified/Method: Supplemental Information
` t ,xx.. i ' '�,�: e :•}; :;: ^.aka,: z Vr.N;i'; t' =,ay.„t, - : ' :.`. �z I e t "^`- ,,"' twk .;.yo:ss>,"
.�. t -�r;�'n." �^§�+� �`„ e - ^��: � „� -i .s x.Yni^ ,.�'� '' . >a ry '. r'a
:?4 )' '?�i =:, $ ^L $ - Je f. s « kri '.Y- S'i A "x "..v rX ti'cd- :i::,44. p"°fx - .£r "t 'rgr, . _;,-=m 4
., ar��TYPE, OT=WORK . � � .- k. > + - ,� � -:k ,,t. `_, ,P,- LAiV; "R -EW
�g � ,.fit
..v �..., ��c ay..+� ^e� ��.ar.irJ .,. ...;_,�.a�.es'�4}a� , -._ s?r.e� �;�'- '�.,;r, " a .a.r�ari �- �r,�•. ..v ... _.,� �%+'�'c
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
�w „r�; •s -,. =�%t.
.:>� avrs"a§ *,� + °;�� > - -u = -� m. ��> r?= �,- = °- �;fi�- ��*a - ^r «.zz »:,- -::. - where the available fault current El Marinas and boatyards.
z n µ - ` = exceeds 10,000 amps at 150 volts Floating buildings.
°' 'r CAT' GOR1 °z ,.t., p o is or ❑ Flo ti g
� � -� ; � : � :,,�.�. � h:�.... , r �OF�. CONSTR•IJCTIO ,� :z -:, � g
•.� s 3 : s_, . .... < ._�... r :, r `� 'r�`, less to ound or exceeds 14000
gr , ,
0 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
',,:; ya,,,i,. , a: .4,, I s r , > t = x.- v . , ,, + = ,m , - � . g; ; ,; _: ❑ Emergency system. larger separately derived system.
w, sv IT ,I A = ANFAV A W,Iii: s =' ` .. t -,_ . .
R.. « «. . ,� __. r , �.N� a��. r � = ��m� c.,., =«#..r >_ � . , , _ ,,..�„ ,., a`�1 r�rx Addition of new motor load of
,
— ,��,6•�: �c�. >:,�_� :_�,� r.�n_�,�a. s x ❑ o o ❑„ ., „ 2 „ <,
Job no.: Job site address: 7 a e' ? � ii • j �z t x or or more occupancy
fry 9 �V� �J ❑ Six or more residential units. 12 Recreational vehicle parks.
City /State /ZIP: t l - / 0 Health-care facilities. El Supply voltage for more than
5 a' ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
� f I �� a:..-' a ti a, ':^,~' , r F ET,SCHF,DULE ' t ; r <= .;,
�t
Cross street/directions to job site: L(/,1 q 1 ' Description I Qty. I Fee. I Total I *
W rJ 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
; :,e « :.z::: t'4- : ttr ^ .; .,:V- -,,,.« ._:.,,.:._na• .:<.,L..b «•,�.:..,::: -:<<:• :.- Limited energy, residential
t; ',:., 'r =`g_: ” *DESCRIPTIO 4ggiW 4O >f``v% s x�'f, y s_::4igq `' 1 ` (with above 75.00 2
._ :...,. -ws� `'sw� -�e>. <..9,__ - �c,w,�:'S's.. ��,awwe.>„ -.� w.- _..e.,. „:. h..: ail `.k- �wKr_.a!'��sv- :�3-�x -e. :'i= ':;,„'sn;�t� ^E.,.L= 7.(z�.' ( bo sq. ft.)
Limited energy, multi - family 75.00 2
6 CO VI En "'C.• "'C.• / J L( ri / Ce residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
,_ !RE RT1 OW .�g i it f " , 9 ®T J i f in 201 amps to 400 amps 106.85 2
y 401 amps s to 600 amps s 160.60 2
Name: e,,, \; , l - ( � 601 amps to 1,000 amps 240.60 2
Address: [t�� lJ 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
1M: FYtu �l`�'.4£, .. xr.££ �^ .�:a: . ...i• "xa� " �} n ' S L S:tp �r .. ;,.. t � , - > MxdAd,> k: - e ; v�.
T,r,APPtC [CANT « "Hi .d ` _ CONTACT' PER 4 above service or feeder fee,
` each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit 1 46.85 (1 f7-- 2
Address: Each add'I branch circuit 6.65 !! 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
•
dwelling, service and /or feeder 90.90 2
Phone: ( ) - Fax: : ( )
Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
%,, ax"4e'2: ��E:�ms�±.P' {3ti�' \:..- _ ._�&: f r,, °`;1a. , s°;t ei .•,,eh:< k .*.v:. �.0 1e?'•i�� i.;::� „�,pp:
. , t:'jt,,z�; -., ,��_ at ;F VQN1'r :d:(sTt ; ;ta -'” a t } ; Si or outline lighting 53.40 2
Business name: ��� ��� Signal circuit(s) limited- ,
�qV(/ G sw /G energy panel, alteration, or
Address: /;_ g extension. Describe: Page 2 2
City/State /ZIP: ,\'74 " , C ,O. 7 / 33 Each additional inspection over allowable in any of the above
Phone: ( s 03 2, / Fax: ( Per inspection • 62.50
i , t `1 Investigation per hour (1 hr min) 62.50
CCB Lic.. O �" Electrical Lie. 2 Suprv. Lie.: S Industrial plant per hour 73.75
< % lJ �—
7lJ! t ' " <4 E,1tECTR k AL *PERM1'T FEE ._ `'
Su signature, required: P g Q /I / �/f�J1 (D j) I 0 Subtotal 94,g�
Suprv. Electrician nature, re
Print name V L t Date: 7r Plan review (25% of permit fee): .®—
`� vt 1/ T � (���
State surcharge (12% of permit fee): '5, �11.,
Authorized signature: ✓ TOTAL PERMIT FEE: 5A i /
This permit application expires if a permit is not obtained within 180
Print name. Date days after it has been accepted as complete.
Number of inspections allowed per permit
1 \Buildmg\Permits\ELC- PermitApp doc 05/23/06 440- 4615T(I 1 /05 /COM/WEB
Electrical Permit Application - City of Tigard Other P "'
Page 2 - Supplemental Information Total number of commercial systems:
LIMITED ENERGY PERMIT FEES: '-No licenses are required. Licenses are requir
for all other installations
Fee for all residential systems $75.00
combined
Check Type of Work Involved:
Audio and Stereo Systems
Burglar Alarm
Garage Door Opener
n Heating, Ventilation and Air Conditioning
System'
Vacuum Systems'
I I Other:
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
I I Audio and Stereo Systems
I Boiler Controls
Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
n HVAC
n Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control*
Medical
Nurse Calls
Outdoor Landscape Lighting" -
Protective Signaling
1' \ E3uilding \Permits\ELC- PermitApp.doc 03/23/06