Permit •t CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00301
T f G A R o 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/30/2013
Parcel: 2S101AD02400
Jurisdiction: TIGARD
Site address: 12753 SW 68TH AVE
Project: George Fox University Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Installation of (2) branch circuits for bathroom remodel. Bathroom located on second floor, south wing.
Contractor: GEORGE FOX UNIVERSITY Owner: GEORGE FOX UNIVERSITY
1101 VILLA ROAD ATTN: FINANCIAL AFFAIRS
NEWBERG, OR 97132 -1218 414 N MERIDIAN
NEWBERG, OR 97132
PHONE: 503 - 554 -2014 PHONE: 503 - 554 -2080
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 05/30/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/30/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 - >..r.ance • • 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. AT' NTION: Oregon •w -quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 X010 th •ugh OAR 952- may obtain a copy of the rules or direct questions to OUNC by calling 503.232. r 1.800. 2. 344.
Issue • By: / Permittee Signature:
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 INSTAL ION ONLY
SIGNATURE OF SUPR. ELEC' 'JO,/ � 1� 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 Application ° VF i FOR 01.1-It I. I SE t)Nl.l
^"
City of Tigard Date/By: 5 gip/ 3
13125 SW Hall Blvd., Tigard, OR 97228( Received
Er
3 Q 2013 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 /
Date/By: No.: �! i3_ pp j
y: Other Permit:
TIGARD Inspection Line: 503.639.4175 { TlGARD Date Ready/By: orris: See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
31II! pi r:l jR !f
TYPE O WORK PLAN REVIEW
❑ New construction ® Addition /alteration/replacement 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 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 ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A "E ", ' I - ", "I - ",
Job no.: Job site address: 12753 SW 68 to Ave 100HP or more. occupancy.
❑ Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: Tigard Or. 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Bathroom Remodel ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW Hampton St. 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
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
replace ceiling lighting , move GFCI, and add 2 wall sconces. residential (with above sq. ft.)
' i Renewable Energy ❑ See Page 2
p2 < LODI'2 ,u1'W Gv r Ara Services or feeders installation, alteration, and /or relocation
PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: George Fox University 401 amps to 600 amps 200.34 2
Address: 414 N .Meridian 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State /ZIP: 9 7132 Temporary services or feeders installation, alteration, and /or
Phone: (503)554 -2010 Fax: (503)554 -2009 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, per panel
❑ APPLICANT X CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: George Fox University each branch circuit
B. Fee for branch circuits without
Contact name: Paul Corbett - Furgal service or feeder fee, first I 56.18 56.18 2
branch circuit
Address: 1101 Villa Rd. Each add'I branch circuit 1 7.42 7.42 2
City/State /ZIP: Newberg Oregon 97132 Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: (503) 554 - 2080 Fax: : (554) 554 - 2009 dwelling, service and/or feeder
Reconnect only 67.84 2
E - mail: pcorbett @georgfox.edu Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: George Fox University 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
Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Newberg Oregon 97132 Investigation (1 hr min) 66.25/ hr
Phone: ( ) 7f /� Fax: ( ) Industrial plant (l hr min) 78.18/ hr
I ( Inspections for which no fee is 90.00/ hr
CCB Lic.: 36 -75C% Electrical Lic.: Suprv. Lic.: 3973S specifically listed (/2 hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 63.60
Print name: Paul Corbett- Furgal / of P ate: 5 -30 -13 Plan review (25 % of p ermit fee): G3
State surcharge (12% of permit fee):
7
Authorized signature: ,,,e" / TOTAL PERMIT FEE: 71 . ; 4'M
This permit
i
application expires if a permit is not obtained within 180
Print name:PjgUL 2tf��
c r ��/2 -� ! Date: �r 3p _/3 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1 : \ Building\ Permits \ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440.4615T(11/05/COM/WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12753 SW 68TH AVE, TIGARD, OR, 97223
Commercial - Electrical
125 Wall cover
06/06/2013 00:00
ELC2013-00301
PASS
Violation Summary:
Inspector Contractor