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Permit CITY OF TIGARD ELECTRICAL PERMIT a COMMUNITY DEVELOPMENT Permit#: ELC2014-00234 T t G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/02/2014 Parcel: 1 S133AD02200 Jurisdiction: Tigard Site address: 10730 SW 130TH AVE Project: Westgate Baptist Church Subdivision: CHAPARRAL Lot: 1 Project Description: (1)200 amp service,(15)branch circuits and(1)data telecommunications for 2nd story TI to complete classrooms, youth room,science lab,office and(2)restrooms. 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 06/02/2014 $100.70 Specifics: amps or less 15 crt Branch Circuits w/Purchase 06/02/2014 $111.30 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea Signal circuit or Limited 06/02/2014 $75.00 Energy Panel Type of Const: 1 ea 12%State Surcharge- 06/02/2014 $34.44 Occupancy Grp: Electrical Total $321.44 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are sit forth in OAR 952-001-0010 through OAR 952-001-0090. You ma obtain a copy of the it rect questions to OUNC by calling 503.23 1987 or 1.800,3322,22344/4. Issued By: �_ - ( Permittee Signature: 503.23 I 3! (s..J c OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. f` lectrical Permit Application n FOR OFFICE USE ONLY ipl City of Tigard RECEIVED R "� Permit Nu 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ��/� Do y s Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other PermitaW)A j y.—G Q/O/ T 1 G A N D Inspection Line: 503.639,4175 MAY 12 2014 Date Ready/By: furls: Ea See Page 2 for Internet: www.tigard-or.gov Notified/Method: 'PG-- Supplemental Information ^,�. TYPE OF W - .. .-.._ _ "PLAN REVIEW IV ew construction ❑Addition/altet$Ion/T4 1VISION 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 111.11.111 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 150 KVA or JOB SITE INFORMATION AND LOCATION El Emergency system. larger separately derived system. ❑Addition of new motor load of ❑"A","E","1-2","1-3", Job no.: Job site address: 2 I OOHP or more. occupancy. 1073 5 l 130-H, ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: / OR C Z Z 2 3 El Health-care facilities. ❑Supply voltage for more than T ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: / )esrGrt..re ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: �v J 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 Tax map/parcel no.: Ea.add'I 500 sq.ft.or portion 33.92 1 Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) /� Limited energy,multi-family Z la y -FT A 65 i a.crarn S G otss'taan,S residential(with above sq.ft.) 75.00 2 / / Renewable Energy ❑ See Page 2 0 F'fKIES 1 Services or feeders installation,alteration,and/or relocation PROPERTY OWNER ❑ TENANT 200 amps or less I 100.70 2 201 amps to 400 amps 133.56 2 Name: L 1,sC G(1.--r-6--, 6(11"1—1 S'f" C !tt..42 i�-f 401 amps to 600 amps 200.34 2 Address: N/ACC(o30 6.60 `-,Ito as eoat y et 601 amps to 1,000 amps 301.04 2 R Over 1,000 amps or volts 552.26 2 City/State/ZIP: yi cr. t, 9 7 Zz3 Temporary services or feeders installation,alteration,and/or Phone:(S.0 3 ) .5 Z ei 35e7o Fax:( ) relocation 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I 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 circuits-new,alteration,or extension, ter panel CONTACT PERSON A.Fee for branch circuits with XAPPLICANT ( above service or feeder fee, (S Business name: DU walk) Ca\mrao& ior.) TNC, each branch circuit 7.42 2 ,6 B.Fee for branch circuits without Contact name: 6R t erfJ —Du tea. service or feeder fee,first 56.18 2 branch circuit Address: l I q 6 S SW LYNN S'( Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) City/State/ZIP: -r t�hetc Or 9 7 3 Each manufactured or modular Phone: 57 7 / dwelling,service and/or feeder 67.84 2 (So3) Fax: :( ) Reconnect only 67.84 2 E-mail: 46 Row v Yocre,(r.A Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: I' 0 R. Z,Pf K E Signal circuit(s)or limited-energy (/ See panel,alteration,or extension. Page 2 2 Address: Each additional inspection over allowable in any of the above ZCI� Lo �SSby 1 Additional inspection(I hr min) 66.25/hr City/State/ZIP: 7... 021-L1C J' c 7 ZZ 1 ' Investigation(I hr min) 66.25/hr Phone:( ) Fax:( ) Industrial plant(l hr min) 78.18/hr ' Inspections for which no fee is 90.00/hr CCB Lie.: (54 klee Electrical Lie.:c-63 Suprv.Lic.: q,39(— specifically listed(1 hr min) _ ELECTRICAL PERMIT FEES Suprv. Electrician signature,required: / J eir, Subtotal: al;/" Print name: / Date: I Plan review(25%of permit fee): I State surcharge(12%of permit fee): .3�l, 4/y Authorized signature: TOTAL PERMIT FEE: 302/, yy 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. L\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(t1/05/COM/WEB CITY OF TIGARD FEE AND PAYMENT HISTORY s I13125 SW Hall Blvd.,Tigard OR 97223 i 503.639.4171 T I G Vt. ELC2014-00234 - 10730 SW 130TH AVE, TIGARD, OR 97223 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Services or Feeders-200 amps or less 220-0000-43103 $100.70 $100.70 $100.70 Branch Circuits w/Purchase Service or 220-0000-43103 $111.30 $111.30 $111.30 Feeder Signal circuit or Limited Energy Panel 220-0000-43103 $75.00 $75.00 $75.00 12%State Surcharge-Electrical 100-0000-24001 $34.44 $34.44 $34.44 Totals for Fees $321.44 $321.44 $0.00 $321.44 Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount Total Payments: $0.00 Balance Due: $321.44 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10730 SW 130TH AVE, TIGARD, OR, 97223 Commercial - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2014-00234 Chip Barnett Violation Summary: Inspector Contractor