Permit v CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00516
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/04/2012
Parcel: 1 S133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE
Project: Westgate Baptist Church Subdivision: HAWK'S BEARD TOWNHOMES Lot: 62
Project Description: 2nd story TI /Elevator
Contractor: NORTH LAKE CONTRACTORS Owner: WESTGATE BAPTIST CHURCH
12900 NW LOVEJOY CT 12930 SW SCHOLLS FERRY RD
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE: 503 - 709 -0985 PHONE: 503 - 524 -3500
FAX: 503 - 641 -3168
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 09/04/2012 $100.70
Specifics: amps or less
12 crt Branch Circuits w /Purchase 09/04/2012 $89.04
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Signal circuit or Limited 09/04/2012 $75.00
Energy Panel
Type of Const: 1 ea 12% State Surcharge - 09/04/2012 $31.77
Occupancy Grp: Electrical
Total $296.51
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 r if work is suspended for more the 180
days. ATTE• • : Orego law ires you to follow the rules adopted by the Oregon Utility Notification - 1 Those rules are s- • h in 4AR
952 -001 110 thr•ugh OAR 95 r -009•. • may obtain a copy of the rules or direct questions to OUNC by calling 503.232 or 1.800.332.2344.
Is - ued By: / �� � ��� �L. / Permittee Signature: i LA__
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' AIWA" 1 7 / Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the job she until completion of the project.
• Approved plans are required on the job site at the time of each Inspection.
Electrical Permit Applicati FOR OFFICE USE ONLY
City of Tigard DD a t e / : i // 1 Y
, Permit No.: `��/ ••• * 57
. ° 13125 SW Hall Blvd. Tigard, OR 97223 Plan Revi
Phone: 503.718.2439 Fax: 503.598 0 4 2012 p : Other Permit:
1 1 G A R D Inspection Line: 503.639.4175 Date Ready /By: kris: ® See Page 2 for
Internet: www.tigard - or.gov CITYOFTIGARD Notified/Method: Supplemental Information
TYPE BUYEANGDIVISION PLAN REVIEW
) New construction El 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: 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
❑ I - and 2- family dwelling ,"CommerciaUindustrial ❑ 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 ", "1 -2 ", "l -3 ",
Job no.: Job site address: Y p a t/ S IOOHPormore. occupancy.
�0 7 .J b S W ��) /T ✓( ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: J G/( X10 d i 1 �j � � ❑ Health -care facilities.
❑ Supply voltage for more than
•( ❑Hazardous locati 600 volts nominal.
Suite/bldg. /apt. no.: Project name: / ❑ Service or feeder 600 amps or more.
"`� � t (� � 5r FEE SCHEDULE
Cross street/directions to job site: - Sc ITd(.L5 F till t2y R p 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 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1 •
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
— _2 N6 s tai v GI 4tSSi- c/Doi S residential (with above sq. ft.) _
Services or feeders installation, alteration, and/or relocation
200 amps or less I 100.70 90,70 2
12 OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: i J '( Q nScr Ci4olGllf 601 amps to 1,000 amps 301.04 2
Address ! , r 3 4i S i SotfoceiS Foray g p Over 1,000 amps or volts _ 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: , 1 cemzn d ,2 Ls c '')12.3 relocation
Phone: (So S) 5 Z c/ - 3.50t Fax: ( ) 200 amps or less 59.36 1
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
p APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: / •� B. Fee for branch circuits without
8 (11f� raw C�avS; +ZUC rlaly /NC service or feeder fee, first 56.18 2
Contact name: ZR lrt� u,bN
branch circuit
Each add'I branch circuit i 2 7.42 I( y .oq 2
Address: (4 775 s c.,) L/,-K 0- T 2. wt. Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State /ZIP: L. irA g 0 oz 0 O/2. S ze J75-- dwelling, service and/or feeder
67.84 2
Phone: � 3) �'7 L •� 3 S Z Fax: : ( )
( Reconnect only 67.84 2
5
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy 757- 2
Business name: panel, alteration, or extension. ' Page 2
/V ' otkriet -boe (, 4/rite. G reelS Each additional inspection over a towable in any of the above
Address: I 72too N 1.40A1 -.175`11 e Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State /ZIP: Po ?-LA,,b / 97225? Industrial plant (1 hr min) 78.18/ hr
Phone: 603 ) 709 , 0 95 Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.:/ 90 Electrical Lic.: (,13 Suprv. Lie.: 4 %9 f
l S ELECTRICAL PERMIT FEES
A ' Subtotal: L &6 • /41 Suprv. Electrician signature, required0 W Plan review (25% of permit fee): .— —
Print name: r . L ji 1 i Q i'vt f Date: 9_ `T _ t -Z State surcharge (12% of permit fee): , 77
/ TOTAL PERMIT FEE: o9 , 5/
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doe 07/01/10 440- 4615T(I I /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:
r 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 Alarm 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