Permit CITY OF TIGARD ELECTRICAL PERMIT
11,„,, Permit#: ELC2018 00232
le . COMMUNITY DEVELOPMENT Date Issued: 04/11/2018
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104AB04700
Jurisdiction: Tigard
Site address: 13401 SW BENISH ST
Project: Our Redeemer Lutheran Church Subdivision: None Lot: None
Project Description: Foundation for a new 1,792 sq.ft.modular daycare facility.
Contractor: MODERN BUILDING SYSTEMS INC Owner: OUR REDEEMER LUTHERAN CHURCH
PO BOX 110 13401 SW BENISH ST
AUMSVILLE, OR 97325 TIGARD, OR 97223
PHONE:
PHONE: 503-749-4949
FAX: 503-749-4950
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/11/2018 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 04/11/2018 $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 OAR 952-001-009obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344,
„..9..-:;
Issued By: �� Permittee Signature: ""G( 4,z,'> ---t4n:>
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 Permit Application .,, -,i,- ,---;.--- 1-,, , ,,,i roit twrici: t SI:011,1
iil`,-, - ,' ' , -/..-s-' *Received . 1 4-g, permit#: ize„ oi,,_00,
City of Tigard
Date/B : 4-/ 7 / / m
II
g 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
O Phone: 503.718.2439 Fax: 503.598.1960 .:\i)I) 2 i':'fi• Date/B : Related Permit#: Ipteye „
Inspection Line: 503.639.4175 'II I' Ready Date/By:
kris: IZI See Page 2 for
T I GA RD
Internet: www.tigardor.gov ., „ Notified/Method: Supplemental Information
TYPE OF WO' : , PLAN REVIEW
El New construction U Addition/alteria6n 'f,i' IteMini' `:' ' ' ,'L' Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEG 4 RY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
ED 1-and 2-family dwelling L'A Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system, larger separately derived
0Addition of new motor load of system.
Job#: Job site address: \31p k 1.--)„.„Li 100141'or more. 0"A","E","1-2","1-3",
C>t--
0 Six or more residential units. occupancy.
City/State/ZIP: 1-1,... 0 Z 91 21_7;
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ?'„ r,: , 4.4 0 Hazardous locations. 0 Supply voltage for more than
- - - -;,,,,, .0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: LA - -1.1j' \ FEE SCHEDULE
atZ>T— 0,N.. iti e --z,A4 --i--, Description 1 Qty. 1 Each I Total 1 *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.It or less 168.54 4
Tax map/parcel#:
Ea.addl 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
(with above sq.ft.)
\-4 --
`t--1-------/..t. tVki" -24.") A4,-(.. -c3L-LfLe • k-Pc5-E; of---
Limited energy,multi-family
..." ,- residential(with above s..ft.)
75.00 2
Renewable Energy 0 See Page 2
Kd PROPERTY OWNER 0 TENANT
Services or feeders installation,alteration,and/or relocation
Name: ou 4_ v.tfcx::eivA,E:17_, t...„..) , , -
200 amps or less i 100.70 2
Address: \
201 amps to 400 amps igla 133.56 Emma
7)1/4-k, 4k_t_) Ir.7(::::(Lcr-A-Ic e..y.r....-
401 amps to 600 amps 200.34 2
City/State/ZIP: 7-1:k...... ..v_.° C)(2— Ci'l"Z-l.-5 601 amps to 1,000 amps 301.04 2
1
Phone:(cot).514_c (,L..1(.p I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: tip i e) A .... , CD1,1\.,
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Li APPLICANT 0 CONTACT PERSON
A.Fee for branch circuits with
Business name: Ra ,,..re , c‘./3:15,-taX..,- ' above service or feeder fee,
• 7.42
I
each branch circuit
Contact name: 1\-Lpto 'Zikr..A...,t) ...3
B.Fee for branch circuits without
service or feeder fee,first
Address: CA LkCA3 0 • z,..._ 0lip
branch circuit 56.18
City/State/ZIP: 04. L7\i'C‘u-.._,:_,e CC- a\-7-57 Each addl branch circuit 7.42
Miscellaneous service or feeder not included
Phone:(503) —No_Lt ck Lk ck I Fax::( 63) `1L.VA-kAck ..--6 Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: cv.p, x1.401--)64scsvrx.ocr.L.,-scAtc-itA.e.,.Leek. Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: , pk-i.....k.E., p ,
A-1;c....A1 C, Sign or outline lighting 67.84 2
Address: panel,alteration,or extension.
Signal circuit(s)or limited-energy
0 See Page 2 2
City/State/ZIP:
Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr mm ) 90.00/hr
A#T.
Email: iIndustrial plant(1 hr min) 78.18/hr
e ),(2 (7,
1110 -
Inspections for which no fee is III
IICCB Lic.: 4(6;-1 Electrical Lic.: ii j- _ Suprv.Lic.:34 2§2.5 s. ificall ' "(V i II./ 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 11.111P-401.--
Subtotal: MM.,
Print name: Vex) -.c.:.. .. .-- - 1,:re: 3 7. 0 Plan Review Required(25%of permit fee): IIIMEIII
-we-
State surcharge(12%of permit fee):
Authorized signature:
TOTAL PERMIT FEE: i li.
This permit permit application expires if a permit is not obtained Within 180
I Print name: pc4,9,3 riks 1_,,,,,j‘e3 Date: i--7.1_1•6 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
EPagelectrical2Supplemental Permit Application–oInformation City of Tigard
–
Limited Energy Permit Fees: Renewable Energy Permit Fees:
FEE SCHEDULE'
RESIDENTIAL WORKONLY:
Description I Qty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
100.70 2
5 kva or less
Check Type of Work Involved: 133.56 2
5.01 to 15 kva
El
15.01 to 25 kva 200.34 2
Audio and Stereo Systems*
Wind generation systems in excess of 25 kva:
❑ 25.01 to 50 kva
301.04 2
Burglar Alarm
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Solar generation systems in excess of 25 kva:
Heating,Ventilation and Air Conditioning 3
System* Each additional kva over 25 7.42
>100 kva—no additional charge 0.0 3
❑ Vacuum Systems* Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr
1=1 Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(1/4 hr min)
x ELECTRICAL PETIT FEES:;
COMMERCIAL WORK ONLY; r Subtotal(Enter on Page 1):
Fee for each commercial system:
$75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ A• udio and Stereo Systems
❑ B• oiler Controls
❑ C• lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
El P• rotective Signaling
❑ O• ther:
Total number of commercial systems: —
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13401 SW BENISH ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2018-00232
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor