Permit CITY OF TIGARD ELECTRICAL PERMIT
111111 s� . COMMUNITY DEVELOPMENT Permit #: ELC2012 -00728
Date Issued: 12/20/2012
T E CARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S114AA00100
Jurisdiction: TIGARD
Site address: 9000 SW DURHAM RD
Project: THS - Team Room Rennovation Subdivision: 1993 -078 PARTITION PLAT Lot: 2
Project Description: (1) branch circuit to install 2 lights and (1) low voltage to relocate strobe for fire alarm, reroute power at doors
Contractor: ATLAS ELECTRICAL CONTRACTORS Owner: TIGARD - TUALATIN SCHOOL DISTRICT
4403 SE ROETHE RD 6960 SW SANDBURG ST
MILWAUKIE, OR 96267 TIGARD, OR 97223
PHONE: 503-659-2212 PHONE" 503 -431 -4000
FAX" 503 - 659 -4944
FEES
Quantity Description Date Amount
1 ea Limited Energy 12/20/2012 $75.00
Specifics:
1 crt Branch Circuits wo /Purchase 12/20/2012 $56.18
Service or Feeder
Type of Use: COM 1 ea 12% State Surcharge - 12/20/2012 $15.74
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $146 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 52- 001 -0090 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: Permittee Signature: D lV 4 jPl__i ` #qncki
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.
Dec.20. 2012 11:23AM Atlas Electrical Contractors Inc No. 2814 P. 2
Electrical Permit Application [Mt (lI I ILL I tic u.�[
Ci of Tigard RFCENED Recei`ed 'I Permit No : r
114
u 131 Hall Blvd., Tigard, OR 97223 Date/13 : call e 1 � let -007 �- K
o. 8 il. Plan Review OtlterPe
Phone: 503.7I8.2439 Fax: 503,598.1960 - C 2 0 2012 Date/B : 61,6 — 00.)„.1)
t 1 C; A t� ll Inspection Line: 503.639.4175 Date Ready/By: kris: 21 See Piled for
Intentet: www.tigard•or.gov CITY OFTIGARD Notified/Metbod: -..0 - CO Supplemental leformatlon
i rillYE Of�'i 1M.DIN3;)lV'1S = s`.. REV rT :..,: ,
;; r�- � �� � :PLAN EVY ty�,
❑ New construction ® 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.
s .` CATEGORY OF CONSTRUCTYON' :',''; exceeds 1%000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14,000 ❑ Commeeclal.uso agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑Fire pump. 0 lnslallattonof7SKVAor
c Emergency system, larger separately derived system.
. -` s :
JOB 'SITE. INFORMATION: ANO I:OCATION
., .,' ElMdiuoo of new motor load of Q "A ", "):" "I- 2 ", "! -3
Job no.: 21943 Job site address: 9000 SW DURHAM RD IOOIiP or more' occupancy.
❑ Six or more residential units. 0 Recreational vehicle parks.
City/ State/ZIP: TIGARD, OR 97224 ❑Health -cafe facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: I Project name: 21943 - TIGARD HS GIRLS ❑ Service or feeder 600 amps or more.
t _
, - - F SCREDUf,E _ _ ,
Cross street/directions to job site: based Lien I ow. 1 Pen 1 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
- - Ea, add'! 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy. residential
75,00 2
.DESCRIPTION:, OF' WORK i , - . i . '. " , . (with abovo sq. R.)
Limited energy, multi- family
RELOCATE STROBE, REROUTE POWER AT DOORS, INSTALL 2 LIGHTS. residential (with above sq. R.) 75.00 2
Services or feeders installation, alteration, 'Indio relocation
�1 '' C 200 amps or less 100.70 2
' : ❑ iPRO_ PERTY, OWNER ,' `'❑' TENANT `.. 201 amps to 400 amps 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
Temporary services or feeders Installation, alteration, and/or
City/State /ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 _ 1
-
Owner installation: This installation is being made on property that I own which is not 20l 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
_ �.. , .. above service or feede fee,
` AP 7A2 2
P LICANT I ='' ❑. CONIA6f IzR3oN each branch circuit
Business name: ATLAS ELECTRICAL CONTRACTORS S. Fee for branch circuits wlrhoto
service or feeder Ibe, first I 56.18 56 2
Contact name: TV SHEPERSKY branch circuit
Each add'I branch circuit 7.42 2
Address: 4403 SE ROETHE RD Miscellaneous (service or feeder not included)
City/State/ZIP: MILWAUKIE OR 97267 Each m g, service a or or feeder 67,84 2
tY dwelling, service and/or tender
Phone: (503) 659 -2212 I Fax: : (503) 659 - 4944 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E ty@atlaseleetrical.com atlaseleetrical.com Sign or outline lighting 67.84 2
''::': _," • ' CONTRACTOR Signal circuits) or limited- energy
Business name: ATLAS ELECTRICAL CONTRACTORS pand, alteretio or extension. 1 . Pa :02 75 2
Each additional inspection over allowable in any of the above
Address: 4403 SE ROETHE RD Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: MILWAUKIE, OR 97267 Investigation (1 hr min) 66.251 hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 659 -2212 I Fax: (503) 659 -4944 Inspections for which no fee is 90.00/ hr
s . = ilcal listed K hr min
CCB Lie.: 1532 I Electrical Lie.: 3 -2C I Suprv. Lie.: 5009S . Liectt.CAL' :PE RMIT. FEES' ':':7; ,
Subtotal: 13I.18
Supr•. Electrician signature, required: Plan review (25% of permit fee):
Print name: TY W SHEPERSKY 4; ate: 12/19/12 State surcharge (12% of permit fee): 15.74
TOTAL PERMIT FEE: 146.92
Authorized signature: u1 'ON This permit applice lien expires Ita permit Is not obtained within 150
days after it his been accepted as complete.
Print name: TY W SHEP ol: SKY / Date: 12/19/12 + Number of inspections allowed per permit.
1: 10ulld in5WermivaELC-PeemlJap.doo 07/01/10 410•1615T(I I/OS /COM/WEB
Dec.20. 2012 11:23AM Atlas Electrical Contractors Inc No. 2814 P. 3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
FRESIDBNTIAL WORK ONLY: .`', .
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
0 Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
Q Other:
CGOMMBRCIAI; WORN ONX,Y; . ' .. -.. l
Fee fot each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
0 Intercom and Paging Systems
Q Landscape Irrigation Control*
❑ Medical
[] Nurse Calls
❑ Outdoor Landscape Lighting*
[] Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
r: uuiIdinePermi :AELC- Perm;iApp.doc 07/01/10
Dec.20. 2012 11:22AM Atlas Electrical Contractors Inc No. 2814 P. 1
FAX COVER SHEET
0
ELECTFUICALCONTPACTCIR9, INC.
4403 S.E. ROETHE ROAD
IVIILWAUKIE, OREGON 97267
(503) 659 -2212 • FAx (503) 659 -4944
•
To: f \ • f _ d From:
Fax: �) — 1 Q (a v Pages: ell
Phone: bate: f ra () — igs
Re: CC:
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