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Permit (154) CITY OF TIGARD ELECTRICAL PERMIT 1 COMMUNITY DEVELOPMENT Permit#: ELC2019-00324 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/22/2019 T t C ;E It f7 g Parcel: 2S101AD02400 Jurisdiction: Tigard Site address: 12753 SW 68TH AVE Project: George Fox University Subdivision: WEST PORTLAND HEIGHTS Lot: 9 Project Description: Electrical for TI: Contractor: BEAR ELECTRIC Owner: GEORGE FOX UNIVERSITY PO BOX 389 ATTN: FINANCIAL AFFAIRS DONALD, OR 97020 414 N MERIDIAN NEWBERG, OR 97132 PHONE: 503-678-1355 PHONE: FAX: 503-678-1108 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 05/22/2019 $100.70 Specifics: amps or less 18 crt Branch Circuits w/Purchase 05/22/2019 $133.56 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 05/22/2019 $28.11 Electrical Type of Const: 1 ea Plan Review Electricial 05/22/2019 $58.57 Occupancy Grp: Total $320.94 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 th- rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through X•52-001-4"0. Yo may obtain a c..y of t•= le"direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: /�l� 1"4 Permittee Signature: ykciyoli CCCJJJ OWNER INSTALLATION ONLY � C 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 Application FOR OFFICE USE ONLY City of Tigard I ' A�...1 u ateived s NI Date/By- 3 1 1 .I 'ennrt# L R 13125 SW Hall Blvd.,Tigard,OR 97223 Y �� Plan Review 4 A i lated Permit#: Phone: 503.718.2439 Fax: 503.598.1960 MAY i ey LOIN Date/By 5IZi a , t'1f, .t➢t'1- ,,t j' Inspection Line: 503.639.4175 Ready Da lnr�s. Ed See Page 2 for TIGARD . L.: - r'� DNoti ed/ Supplemental Information Internet: www.tigard-or.gov Ile r i nark s r , TYPE OF WOtli 1NG , .. •. " PLAN REVIEW ❑New construction tY�l Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked). ❑Service or feeder 400 amps or snore ❑Building over three stories. ❑ Demolition 0 Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ I-and 2-family dwelling 'Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agriculhiral amps for all other installations. buildings. ❑ Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency systemlarger separately derived ❑Addition of new motor load of Job#: Job site address: j 17 -3 5.w, (Dtlsystem. ` S.�-C�ek 10OHP or more. ` ❑Six or more residential units. occupancy. City/State/ZIP: r z,,<-,),( Cil,,,,.. ❑Health care facilities. ❑Recreational vehicle parks. i f F Po f i o.h` t,e k ❑Hazardous locations. ❑Supply voltage for more than Suite/bldg./apt.#: Project name: t3 ! A e {c600 volts nominal. 1� 1 0 Service or feeder 600 amps or more Cross street/directions to job site: S W (40,on? oY\ FEE SCHEDULE" 1. Description I Qty. � Each � Total I New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sqft"or less 168.54 4 I Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 (with above sq.ft) I R•IMdQ 0,a( vJve1 OC- ,-6.4' Limited energy,multi-family 75.00 2 / residential(with above sq.ft.) Renewable Energy 0 See Page 2 0 PROPERTY OWNER 0 TENANT," Services or feeders installation,alteration,and/or relocation I Name: 200 amps or less I 100.70 /60:0 2 201 amps to 400 amps 133.56 2 Address: 401 amps to 600 amps 200.34 2 ' City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits-new,alteration,or extension,per panel j 0 APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with Business name: <cl 6e--44-1 above service or feeder fee, le 7.42 IF33�� 12 L_— S each branch circuit Contact name: B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email: Reconnect only 67.84 2 r'u..N t'lr?TIXACToR Pump or irrigation circle 67.84 2� Business name: 5-CG-(' 1v 1<Gf1(G (yi L. Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy 0 See Page 2 2 Address: a0 7 0(J s s L,+T vi t 1` ) panel,alteration,or extension. Each additional inspection over allowable in any of the above l City/State/ZIP: 64,,,,,,,,..„ 1 ej 9 9707e-' Additional inspection(1 hr min) 66.25/hr Phone:(503) 7 -i3e;c" Fax:( ) investigation(1 hr min) 90.00/hr —i Industrial plant(1 hr min) 7818/hr Email: Inspections for which no fee is CCB Lie.: �citl' Electrical Lie.:.dY-/t�C_ Suprv.11-1e.:37-21S5 specifically listed('/z hr min) 90 00/hr ELECTRICAL"PERMIT FEES, Suprv. Electrician signature,required: /. Subtotal: a3'{,.ate Print name: �i p ts' 2l ,,,,,,,, Vg-/e:9?,/,' ❑Plan Review Required(25%of permit fee). se,57 �� 'L7� State surcharge(12%of permit fee): .2t.12. TOTAL PERMIT FEE: 3.2©,15 Authorized signature: This permit application expires if a permit is not obtained within 180 print name: Date. * Number of inspections allowed per permit. 11Building\Permits\ELC_PermitApp_ELR_ERE_doe Rev 06/17/2015 440-46i5T(11/05/COM/WEB