Permit n CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00507
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/28/2012
Parcel: 2S 111 ACO2700
Jurisdiction: Tigard
Site address: 14650 SW 97TH AVE
Project: Twality Middle School Subdivision: PINEBROOK TERRACE Lot: 67
Project Description: (1) branch circuit to disconnect and reconnect boiler
Contractor: CASCADE ELECTRICAL LLC Owner: UNION HIGH SCHOOL DISTRICT
PO BOX 160 NO. 3 JT
BRUSH PRAIRIE, WA 98606 00000
PHONE: 360 - 518 -0905 PHONE:
FAX: 360 - 666 -0135
FEES
Quantity Description Date Amount
1 ea 12% State Surcharge - 08/28/2012 $6.74
Specifics: Electrical
1 crt Branch Circuits wo /Purchase 08/28/2012 $56.18
Type of Use: COM Service or Feeder
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 OA 95 - 001 -00.0. You may obtain a cop of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ` I Ad A A _ 7 ,J / ` Permittee Signature: v I t , � , ' AfPL/ 1
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.
Aug. 27. 2012 4:02PM 360 -6 -I No. 4749 P. 1/3
Electrical Permit Application i., 4, FIVE FOR OFFICE USE ONI,1'
City of Ti AUG 2 7 2012 Dalem• S : °. r Permit N. ..-L.e X — eact.
II
4 13125 $W Hall Blvd, Tigard, OR 97223 Plan Review
I. Phone: 503.718.2439 Fax: 503.598.196� Da Other Permit:
I' I ,t It. t Inspection Line: 503.639.4175 I�I of TI Dau Read y/8y . See page 2 for
Internet: www.tigard.or.gov DUILD NG DI SIO N otifted/Method EMI Supplemental Information
*New construction ! . • ddition/alterationlre lacement ply check all that apply (submit 2 sets ofptaos wrtems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault cwrent ❑ Marinas and boatyards.
:•::: :
;::i::•.VE: :.: .. t ::.. ;........ =:': ii:1"_ ':= i' :=:'.:': �:'ii.:' = d 10 exceeds amps at ISO voila or Floating btu
s.
..........._.....:...:. ............G,ii'YJ�GQYflsr�. R!�. �!, bixkl;!( 1CM�[ C1N-;---:::-::-:..: r:::::::,- ::::� ::._.-- :_:,:,:' ...:�::; 000 P ❑ g g
: . ........::..._ .... _.:.__.::....- ..........::::: >. less to
ground, or exceeds 14.000 ❑ Cotnmeteial -use agricultural
0 1- and 2-family dwelling 10 Commercial/industrial D Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
e' ;± r' °r •' si ' : 15 - - - 4' -',', a Emergency system. • larger separately derived system,
t,
f�'A.,d..'..:,• ... ,. .r ,. .t: .' „ ∎i; Y(i FG I ; t = 1 ' 6: 7 21f
c:r:' 'i;I 1V •9 N,Dl' - I: O_ "s''1
1 ,.. . t� ,k p;;!�iF�?�'- : •: ; " - ;: �i.,:B` .t Q �s v : . , . fi, � ❑ Addition of new motor load af ❑"A,,,,B,, "1 "1
Job no.: C702 l Job site address: 14650 SW 97 Ave. 10081 or MOM. occupancy.
❑ Six m MOr0 residential nails. ❑ Recreational vehicle parka.
City/State /21P: 97224 ❑Health -care facIIities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
• Suile/bidg. /apt. no.: Project name: Twalily/I'igard Boilers 0 Service or feeder 600 amps or mote. • - " - - _- .__1c_ ':,$$ 8r?±D1 1;..iiij',i` 1?.yi.lr4i..!i ? ,!i........'`:
Cross street/directions to job site: North of SW Sattler Street on 97 Ave. D.ICNptton 1 Q. I ire. 1 TOW I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R or less 1 168.54 4
Tax ma ! steel no.: Ea. add'l 500 sq. R or portion 33.92 1
p p Limited energy, residential
:::.::;;::::x::'::;::.:; ::.'_.::.:.':.:_::::e :...- ,..._.. _,- . ;... ;.........,: ::::r:;:_:. 75.00 2
.. ._:.:.:::::..
,::::::.::........ (with above , 1t.)
::':: t'::: s: r; �:=:_;;`: �: i'':�: : ::: ;: ;p ; ;:i =t::; t::: =-:t Y.S O�.O�...vl!Olt�''-; ( ; ;: ;i:•.i::�' :.:_r =t:': -t �'t ;'. ;-; ( Sq
Limited energy, multi - family 7500 2 •
Disconnect and reconnect Boller residential (with above sq. ft.)
Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2
,,..i ; ;::t ,, ::;'.t: ::.::::_:::: E: 201 am to 400 a
....._ ............ � : ;PIZOPEIET'Yr.UWbfER::, ;:_: ;-= 1-41.4 -- ps InAs 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on properly 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. Pee for branch circuits with
......_ .... ...... .t ... . ....:
. ..: , 742 2
��
above sernceor to
:'.. .....,' .... ..... ............................ ...., ......... '::'.:,: eac branch circuit '
Business name: 8. Fee for branch circuits without
service or feeder fee, first 1 5618 56.18 2
Contact name: branch circuit
Each add'1 branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/Slate/ZIP: Each manufactured or modular 67.84 2
duelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E -mail: • Pump or irrigation circle 67.84 2
9 84
. ...,...., i:.i: , ",. /, .....,.il,�. '} . 4 .' ,,.'T1'ii -- - ......................................................... 67.84 2
. ........ ................ .....; _:: .: ;.- :..... _::;,::.;;:: : ten Or outline lighting
s:..it'_t ; , >;::,c,atas), ,.c.fk.,�• ;!.! r„ ti.;: jg9`{ i`g C. O1'4 7f ItAG` fOA :-_:i::::::_'i:R'::::E:
,,.,.l,..t.,.... t.r., ....:. ...: . ..•....,..,,... r.....:,...., ., s........,.......... ...._............_............. _................. S circui[(s) or limited-energy
Business name: Cascade Rlectrical, LLC panel, alteration, or extension. Page 2 2
— Each additional inspection over allowable in any of the above
Address: PO Box 160 • Additional inspection (1 hr min) 66.25/ hr
City /Slate/ZIP: 98606 Investigation (1 hr min) 66/51 hr
Industrial plant (1 hr min) 78.18/ hr
M Phone: (360) 518 -0905 I Fax: (360) 666 - 0135 Inspections for which no fee is 90.00/ hr
specifically listed (%hrmin)
CCB Lic.: 158047 I Electrical Lic.: 37 -1027C I Suprv. Lic.: 4730S "" ` - " —
Subtotal: 56.18
Suprv. Electrician signature, required:
Plan review (25 %ofpctmit fee):
Print name: Dan Lindberg I Date: 08/27/2012 Slate surcharge (12% of pemiit fee): 6.74 0,9 TOTAL PERMIT FEE: 62.92
Authorized signature: -
This permit application expires it n permit Is not obtained within le0
• days after le has been accepted as complete.
Print name: Dan Lindberg Dale: 08/27/2012 • .
' Number of inspections allowed per permit
•
r: tBu itdim1PemwL1ELC- Penni,Acn.dne 07/01/10 4404615T11ll05/COM /WEB
n CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00507
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/28/2012
Parcel: 2S 111 ACO2700
Jurisdiction: Tigard
Site address: 14650 SW 97TH AVE
Project: Twality Middle School Subdivision: PINEBROOK TERRACE Lot: 67
Project Description: (1) branch circuit to disconnect and reconnect boiler
Contractor: CASCADE ELECTRICAL LLC Owner: UNION HIGH SCHOOL DISTRICT
PO BOX 160 NO. 3 JT
BRUSH PRAIRIE, WA 98606 00000
PHONE: 360 - 518 -0905 PHONE:
FAX: 360 - 666 -0135
FEES
Quantity Description Date Amount
1 ea 12% State Surcharge - 08/28/2012 $6.74
Specifics: Electrical
1 crt Branch Circuits wo /Purchase 08/28/2012 $56.18
Type of Use: COM Service or Feeder
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 OA 95 - 001 -00.0. You may obtain a cop of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ` I Ad A A _ 7 ,J / ` Permittee Signature: v I t , � , ' AfPL/ 1
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.