Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00294
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2012
Parcel: 2S103AA00101
Jurisdiction: Tigard
Site address: 10865 SW WALNUT ST
Project: Fowler Middle School Subdivision:)O SUPPLEMENTAL PLAT NO.1: ANNE Lot: 7 -6
Project Description: 1 ck + 10 additional for Science room
Contractor: PARKIN ELECTRIC INC Owner: TIGARD - TUALATIN SCHOOL DISTRICT
14001 FIR STREET ATTN: BONITA MAPLETHORPE
OREGON CITY, OR 97045 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503 - 657 -4958 PHONE:
FAX: 503 - 557 -1059
FEES
Quantity Description Date Amount
11 crt Branch Circuits wo /Purchase 05/21/2012 $130.38
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/21/2012 $15.65
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $146.03
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 R 2 -001 -0 90. You may obttain copy f the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � `-C-a� Permittee Signature: old rl Ph./ l.A' D!.L
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.
From: 05/17/2012 14:42 #413 P.002/002 -1,7:: op—
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Electrical Permit Application MAY 17 2012 FOR OFFICE USE ONLY
Received
City of Tigard Da R • Permit No,: ���- r
1, • " if r-' ,�,6� f : F
13125 SW Hall Blvd., Tigard, OR 97 ., �. / t ) Pisa Review
2 : Phone: 503.718.2439 Fax: 503.528 1 ?60 : \ :! ' t i''% , hH ,, Date/B : Other Permit:
TtGA 0 Inspection Line: 503,639.4175 v "- " '• -^ %:y +E DateReady/By: ® See Page2 for
Internet: www,tigard or,gov Notified/Method: Supplementallydotnradon
❑ New construction
k _
;: €7' : TXRE -O WORK � . , . .
. s�: REVISW�= ,� -
,. ,,. ..,_, ...4 -.�. .. _. _ -., .r.. — .N...:. ��_ mss +.. - _, �, ° ; t .+
'4 4... , : . �. - =? ,� =r„'
r 1 -Addition/alteration/replacement Please check all that apply (submit a 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.
'. >r s;; ji = - "•?s,,, s,';•.:. ex 150 Its or ❑ o buildings.
: u - ' -� � `' r °` ^,i � . y/� �s � - � "1 ,; ; ,, r .� t r "� - �"fi exceeds vo r Floating mg
'.r =P. ">. u' a • :2 -it' ia/'. �C - i -. - - . '.. - -- , ` -;�,'. -- ..-..r .x: ->.:, r„ 44. .s +._, 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. ❑ Fife pump. ❑ Installation of 75 KVA or
., Yy 4 ,. -v:,. „• ,,,, :. ;:. .,; �- - CI Emergency system. larger separately derived system.
-= •.- :::: ��;� , r ,- �_i': "; __ ":?'�r%.;;.�!}'t�� .�.::.: +,a,;f < =:_: r�= .;'Li >..:.�; r; ❑ Addition of new motor toad of ❑ ..A• :•E "i -2 "1-3
Job no.: I Job site address: / 0 g6 $' S ti _ n t..#- SIB' 1001 moo m°re. Re tin•
0 Six or re residential units. ❑ Recreational vehicle parks.
City /State/ZIP: T l Q DR ❑ Health facilities. El Supply voltage for more than
/
V '7 ❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: Project name: ❑Service or feeder 600 amps or more.
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total I •
New residential single- or multi- family dwelling unit
Includes attached garage.
Subdivision: I 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.:
,::, e , ;as: Ual 7
", , .:,.: . �� 5.00 2
Limited energy, residential
-.� :,: -h - ; ''�` _p1s1 'QF q! s,. +,; ;�;, . :3 , �: =_s . � (with above sq. B.) f Gel 0 f112,AI`!0.- - -(,f vfo p,7ie 4 r Limi -f q 75.00 2
residential (with above sq. ft.)
Services
' S Q ps Installati : ° 0 relocation 2
feeders o° teratio or re n
.PR PE R Tl t• 00 — . :� ® w -,, < a= :�• ' -: GS=: � 201 am ps to 400 amps 6
;:.' > „ ':; �� . Q - �.:.. - . >�- _ ..Rs.r,: `a� 2 x � '�va.,.= :�=o . r,. _ ,�. '11;'..r.�!1!�PP ~� ' ',_ - iY : ,,
Name `Y f (!W /ei 1 S _ / _ _ () 401 amps to 600 amps 200.34 2
v�tv�. 601 amps to 1,000 amps 301.04 2
Address: / D 8 6 S Set ) t� - ,f f .��L Over 1,000 amps or volts 552.26 2
n n G� Temporary services or feeders installation, alteration, and/or
City / State/ZIP:
'Tiff ac / 0 I ` / 7g9-3 relocation
Phone: ( ) Fax: ( ) 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
401
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. amps to 599 amps
168.54 2
Branch circuits- new, alteration, or extension, rpanel _
Owner signature: Date: A. Fee for branch circuits with
i zfim3 - = t •�.. —._ ., fti,.: above service o feeder fee
: APiLI AN`! , :t 5 ,?. ,.:5- , : � :StACT' 1V >.., y - 7.42 2
r
;. _ _.,, .,._ ,.,,. _ _. .. .,..: -, :,:: ea branch circ uit
Business name: B. Fee for branch circuits without
service or feeder fee, first I 56.18 .c6./e3 2
Contact name: branch circuit
Each add'i branch circuit /0 7.42 7y, do 2
Address: Miscellaneous (service or feeder not induded)
City / State/ZIP: Each manufactured or modular 6/.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
i$ - - _
Sign or outline lighting 67.84 2
CONTRACTOR
. <_ e: . . ..:._ . . . : a ... . , : _ , . _ �., _ \ : , , ., ., .. A Signal circuit(s) or limited-energy
Business name: Parkin Electric panel, alteration, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: 14001 Fir Street Additional inspection (I hr min) 66.251 hr
City / State/ZIP: Oregon City, OR 97045 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 657 -4958 �, I Fax: (503)557-1059 , Suprv. Lic.: 4241-S tdt 1 i 3 �� for which �� 90.00/ hr 05 hr
, CB Lic.: 35151 1 d� Electrical Lic.: 34 -4C A z ��. ;z_;;;; I ; a , C : ` ,, ,, a = = <
al: , ;30- >;
i1,t PkR,I�T�
Suprv. Electrician signature, required: ,,,,-7 Subtotal: 3(�
Plan review (25% of permit fee):
Print name: David B Parkin Date: State surcharge (12% of permit fee): 1 S. 6
Authorized signature: TOTAL PERMIT FEE: ' 1 or i
This permit application expires it a permit is not obtained within 180
Print name: Date: days after It has been accepted as complete.
N um b er o f inspections allowed per permit.
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