Permit 0.
a CITY OF TIGARD ELECTRICAL PERMIT
II a.. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00135
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/24/2009
Parcel: 2S 101 AD02400
Jurisdiction: Tigard
Site address: 12753 SW 68TH.AVE >
Subdivision: V ST HEIGHTS Lot: 32
Project: George Fox University
Project Description: Relocate subpanel, install backup generator, transfer switch, dist. panel. (3) services or feeders
and (3) branch circuits.
Owner: FEES
GEORGE FOX UNIVERSITY Quantity Description Date Amount
ATTN: FINANCIAL AFFAIRS, 414 N MERIDIAN 3 ea Services or Feeders - 200 03/24/2009 $240.90
NEWBERG, OR 97132 amps or less
PHONE: 3 crt Branch Circuits w /Purchase 03/24/2009 $19.95
Service or Feeder
Contractor: 1 ea 12% State Surcharge - 03/24/2009 $31.30
OWNER Electrical
503 - 554 -2080
PHONE: 503 -554 -2080
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $292.15
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. ' • . Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules a set orth in OAR
952- 001 /10 through OA • -II -01 r. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6. • • • ' 3 . 4. /
Issue. : r � . _ . 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 INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N — Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
no.
r
Electrical Permit Application /� FOR OFFICE: USE oN1.Y
City of Tigard Date/B a ®f Permit No.: 4 ��,4f_ 6
IN n 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
. Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T 1 G A IZ D Inspection Line: 503.639.4175 Date Ready/By: lug ^- ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: I ia Supplemental Information
YPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
O Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 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 75 KVA or
O Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of
10OHP or more. occupancy.
Job no.: Job site address: /2753 St v 687 Ai/E P
// ❑ Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: Po eTzg,v,o 97 X73 ❑ Health -care o c a iion s. 0 Supply voltage for more than
/ G L ❑Hazardous locations. 600 volts nominal.
Suit _Id . pt. no.: Project name: 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
n ) 4A.. k(�� Limited energy, multi - family
RRL OI/3Tx- sf8PAN�r - 2 / 7 j residential (with above sq. ft.) 75.00 2
� /�T RAVEL- Services or feeders installation, alteration, and/or relocation
6: jT , , T/e4A -5F9 t
- ) /rell 200 amps or less 3 80.30 25/0,9102
A�/
�\
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 0 160.60 2
Name: 6E�DR.GE �a X l/n/ / 1, 000 amps ^ 601 amps to 1,000 240.60 2
Address: /'_7S3 SGT. ‘P7 c - Over 1,000 amps or volts 454.65 2
City/State /ZIP: Pot -, 97Z23 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 503 ) J555'f/ Zee CI Fax: (y43) 56-5/ —Z00f 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with l
3PLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 3 6.65 / 9. Q
S 2
each branch circuit
Business name: 6 / UN/Aves,ry B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: / pAL v c i 3E� l/
, e - first branch circuit
Address: & P Ave- , Each add'l branch circuit 6.65 2
2-753 �� Miscellaneous (service or feeder not included)
City/State /ZIP: , 7719/-1i) , 972Z-5 Each manufactured or modular 90.90 2
�^ �U r' � C � _ dwelling, service and/or feeder
.5.-� 2 l/
Phone: (93) Fax: ( 5 5
03 3 r " ZOO, Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
_ Signal circuit(s) or limited -
Business name:
GE),GE A �/ /V6 ieS /" energy panel, alteration or
Address: !/ e , (/ / � fr n /` 7D extension. Describe: Page 2 2
n
City/State /ZIP: 0 &4 oa- j 7/ 9 21V Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ft3 ) 55 - • 6 10 g0 Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: 3 s' Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �� Subtotal: aZ ti �.�Jr
Plan review (25% of permit fee):
Print name: coie86 A-vi� L Date:
State surcharge (12% of permit fee): 3 3
Q
Authorized signature: TOTAL PERMIT FEE: 042 , /s
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05 /COM/WEB