Permit CITY OF TIGARD ELECTRICAL PERMIT
' • COMMUNITY DEVELOPMENT Permit#: ELC2013-00474
I G AR O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2013
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Parcel: 2S102BD00100
Jurisdiction: Tigard
Site address: 12520 SW GRANT AVE
Project: St Anthony Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 52
Project Description: (1)200 amp service to connect and install ground for relocated classroom modular.
Contractor: CAPITOL ELECTRIC CO INC Owner: ST ANTHONY CATHOLIC CHURCH TIGAR
11401 NE MARX STREET 9905 SW MCKENZIE ST
PORTLAND, OR 97220 TIGARD,OR 97223
PHONE: 503-255-9488 PHONE:
FAX: 503-257-7121
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/08/2013 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 08/08/2013 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 0 9 01-009 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: o Permittee Signature: Q� ���/e�//z) ,,.
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 the next available Inspection date.
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 Applicatio FOR OFFICE USE ONLY
Received
City of Tigard V E Date/By:
5/,:f/3 ,Permit noaj/f /1/ ? 040 4/7 E� �-C �(J �/
UPI ■ 13125 SW Hall Blvd.,Tigard,OR 97 Plan Revie yy /
1 g Phone: 503.639.4171 Fax: 503.598.1960 Au G 8 2.013 Date/By: OtherPermit�U��/3 _(/00(0.7
T I C A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: �!�/ U See Page 2 for
Internet: www.tigard-or.gov CITY OF TIG�R® T
1, }�`(� 1 1 Notified/Method: r/ Supplemental Information
TYPE OF WORK BUILDING DIVISIO 4
PLAN REVIEW
U New construction U Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑ Demolition ❑ Other: ❑Service or feeder 400 amps or more ❑Building over three stories
CATEGORY OF CONSTRUCTION where the available fault current ❑Marinas and boatyards
U I-and 2-family dwelling U Commercial/industrial Li Accessory building exceeds 10,000 amps at 150 volts or ❑Floating buildings
❑ Multi-family ❑ Master Builder ❑Other less to ground,or exceeds 14,000 ❑Commercial-use agricultural
JOB SITE INFORMATION AND LOCATION amps for all other installations. buildings
Job no.: 130090 Job site address: I� q ❑ Fire Pump ❑ Installation of 75 KVA or
/��� �tA 6Q��FS� ❑ Emergency system larger separately derived system.
City/State/ZIP: Tigad,OR. ❑Addition of new motor load of ❑"A","E","1-2","1-3",
100HP or more. ❑ occupancy
Suite/bldg./apt.no Project name: St Anthony ❑Six or more residential units El Recreational vehicle parks.
❑ Health-care facilities ❑ Supply voltage for more than
Cross Street/Directions to job site: ❑ Hazardous locations 600 volts nominal.
❑ Service or feeder 600 amps or more
Subdivision: Lot no.:
FEE SCHEDULE
Description I Qty. I Fee. I Total I "
Tax map/parcel no.: New residential-single or multi-family dwelling unit.
DESCRIPTION OF WORK Includes attached garage.
Connect,install service ground for relocated Classroom Trailer(PGE overhead feed) 1000 sq.ft.or less $ 168.54 4
Ea.Add'I 500 sq.ft or portion $ 33.92 1
❑ PROPERTY OWNER I U TENANT Limited energy residential
Name:
(with above sq.ft.) $ 75.00 2
Limited energy,multi-family
Address: residential(with above sq.ft.) S 75.00_ 2
Service or feeders installation,alteration,and/or relocation
City/State/ZIP: 200 amps or less 1 5 100.70 100.70 2
201 amps to 400 amps _ 5 133.56 _ 2
Phone: Fax:
401 amps to 600 amps 5 200.34 2
601 amps to 1000 amps 5 301.04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts 5 552.26 2
intended for sale,lease,rent or exchange,according to ORS 447,449,670,and 701 Temporary services or feeders installation,alteration,and/or
Owner signature: Date: relocation
200 amps or less $ 59.36 1
U APPLICANT I Li CONTACT PERSON 201 amps to 400 amps $ 125.08 2
Business Name:
401 amps to 599 amps $ 168.54 2
Branch circuits-new,alteration,or extension,per panel
Contact name: A. Fee for branch circuits with
service or feeder fee,each
Address: branch circuit 5 7.42 2
B. Fee for branch circuits
city/State/ZIP: without service or feeder fee,
first branch circuit $ 56.18 2
Each additional branch circuit: 5 7.42, 2
Phone: Fax: -
Miscellaneous(service or feeder not included)
e-mail: Each manufactured or modular
CONTRACTOR dwelling,service and or feeder _$ 67.84 2
Business Name: CAPITOL ELECTRIC CO.,INC. Reconnect only $ 67.84 2
Pump or irrigation circle $ 67.84 2
Contact name: Richard Martin Sign or outline lighting $ 67.84 2
Signal circuit(s)or limited-energy See
Address: 11401 NE MARX ST. panel,alterations,or extension. . Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: PORTLAND,OR 97220-1041 Additional inspection(I hr min) 66.25/hr
Investigation(I hr min) 66.25/hr
Phone: 503-255-9488 Fax: 503-257-7121 Industrial plant(I hr min) 78.18/hr -
Inspections for which no fee is 90.00/hr
CCB Lie.: 48748 'Electrical Lic.: 26496C ISuprv. ic.: 2865-S specifically listed(1/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: C'� Subtotal: $ 100.70
Print Name: Richard Martin Date: 08/07/13 Plan review(25%of permit fee):
Authorized signature: yo State surcharge(12%of permit fee): $ 12.08 /
TOTAL PERMIT FEE: $ 112.78 c
Print Name: Richard Martin This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
•Number of inspections per permit allowed.
I:\building\Permits\ELC-PermitApp.doc 10/01/09 440-461 5T(I I/05/COM/WED