Permit 4 CITY OF TIGARD ELECTRICAL PERMIT
1 1 '- COMMUNITY DEVELOPMENT Permit #: ELC2009 00277
T 1 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/09/2009
Parcel: 2S 101 AD02400
Jurisdiction: Tigard
Site address: 12753 SW 68TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: 32
Project: George Fox University
Project Description: TI - (1) service & (20) branch circuits.
Owner: FEES
GEORGE FOX UNIVERSITY Quantity Description Date Amount
ATTN: FINANCIAL AFFAIRS, 414 N MERIDIAN
NEWBERG, OR 97132 1 ea Services or Feeders - 200 06/09/2009 $80.30
amps or less
PHONE: 20 crt Branch Circuits w /Purchase 06/09/2009 $133.00
Service or Feeder
1 ea 12% State Surcharge - 06/09/2009 $25.60
Contractor: Electrical
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $238.90
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 re set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 46.6 9 or 1.82.234¢.
Issued By: P ermittee Signature: 1�
OWNER INSTALLATION ONLY D
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 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.
.. - — 06/05/2009 FRI 8:34 FAX 503 554 2009 GFU Plant Services ?002/002
Electrical Permit Application Rry FOR OFFICE USE ONLY
City of Tigard L ; !,, ., r R cd Permit No.: LC. f 1 009 • DOA/
v 13125 SW Hall Blvd., Tigard,OR 97223 Diltsh3y, Q�
g J UN 0 5 20 - Plan . t Review
Phone: 503.639.4171 Fox: 503.598.1960 � u Other Permit:
Inspection Lute: 503.639.4175 Date Ready/13y: ru El See Page 2 for
TIGARD interact: www.tigard•or.gov 1 / •. - t, , Notified/Method; 1 Supplemental Information •
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❑ Ncw construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /itcros checked below):
0 Service or feeder 400 amp or more ❑ Building over three stories.
❑ 1) em011tlon ❑ Other: where the available fault current 0 Mannar :uhd boatyards.
t E "� d �' :-- exceeds 10,000 amps at 150 volts or ❑ Floating buildin
.1 p>.
A'
9 • n � �� """`' 1 " ^' � " "` " " . » : " less to ground, or exceeds 1,000 ❑ Commercial -ti apiouhrml
❑ I - and 2-family dwelling ommercial /industrial El Accessory building amps for all other insinuations. Iwildiltgs.
0 Multi-family ❑ Master builder ❑Other: ❑ Fire pump. 0 Inn:dlatinn
ay _ A» • "4a. '� c.-4Q � r a e .,,,, ❑ limerscnry system. larger separately derived system • o'er : .. � - A' o - `" ' ,,. ' " O Addition of new motor lead o f ❑ "A" °E "1.2 "1.3°
Job no.: Job Site address: is 7S Ave_ 1 'e• 100HP or more. occupancy.
� j ❑ Six or more residential units. Recreational vehicle parks.
City /State /ZIP: 4 r y cv- D !/ ^` /� � 7 .2.2 3 ❑ i lealth - pre facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt, no.: [ Project name: 0 Service or feeder 600 amps or more.
'
� / °"ue. i+ . T" `. "., 01 1377 i w+'"75 ; ; . -
Cross strect/dircctions to job site: C�f`r1 � g ' >� if CJ n/ V4/714;`f104 frDnrnPtivn .., I iTFe ,.,j Total V 1 •
I New residential single- or multi- family dwelling unit.
• Includes attached garage.
_
Subdivision Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no.: Ea. add'I 500 sq. tt. or portion 33.40 1
1.imiled energy, residential 75.00 2
K.ly ' "w 1' T 110A01RIP]T9 V(;p "° o "' ::
with above sq. ft.)
' Limited energy. multi - family
75.00 2
residential (with :lows sq. It.)
Services or feeders installation and/or relocatio
.a. s•'. k. ..W ,.. emu,..+: cry. a�u. 1.. .R.I.....,......�..�.�.._..,...
200 amps or less / 80.30 X 0 ,3 0 1 2
, "'^ ""' ems .' E6 ° PROT t O• : r C7 .l u . y , ! , h ; w. 201 amps to 400 amps 106.85 2
Name: 401 am to 600 amps 160.60 2
' 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services Or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or Icss 66.85 1
Owner installation: This installation is bcing made on property that I own which is not 201 "raps 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, r panel
Owner signature: Date: A. Fcc for branch circuits with
r •.'. �." . „ w :�;:_� � , ..,A( l� r , h . ' le24- .� a" `c 1� ��rr ppQ(�(� i ., above service or feeder fee. .� ^ 5 .9 ` 2
.tT .,3^�;.. ... .' ° "ia . : �a•!1:ro :•.•ma . �Iw.n•.ata.�w.a°°i"P'wY'r1`Fw`, i�G,r,.`YY.,..`r',°°'°'�,. r•"� 6.6,
each branch circuit
Business name: B. Fcc for branch circuits
Contact name: first service or feeder fee, 46 85 2
fast branch circuit
Address: Each add'I branch circuit 6.65 2 -
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or nodular 90.90 2
dwelling. service and/or feeder
Phone: ( ) I Fax:: ( ) Reconnect only 66.85 2
E -mail: • Pump or irrigation circle 53.40 2
j!.F.n" . :. : n ' , 4,1 t0IiI 'Et?1Z''.X'q 1 • e, , " t't mac5" Signor outline lighting 53.40 2
Business name: Geote �9IC U�(/ / //�� Signal �ircuil(s) Or limited
energy panel, alteration or
Address: ./ y ' ,
extension. Descrlbe: Page 2 2
lait /State/ZIP: N ve&7ec O/C Each additional inspection over allowable in any of the above
Pcr ( S 3) �.9 s 1 (.� �) 5 y- goe f Investigation 62.50
Phone: V l p Fax: S lnvestigution per hour (1 hr min) 62.50
CCl3 Lie.: 36 . -75 I Electrical Lie.: I Suprv. Lic.: 97 Industrial plant per hour 73.75
_AO' ,i' ' . ;ALETRIC'y1r..P.)E`R;I 11�%'',PF,FS .;'".:i :', ::: :: ..
Suprv, Electrician signature, required: ��� ��Z, - G Subtotal:
Print name: ,o/x,12.... Co28e1 , -C - Date: 6..5: 6'' Plan review (25 permit fee):
scam surcharge (12/4 of permit fee): 57
\ Authorized signature: +r �' �� TOTAL PERMIT FEE: ,z3h�
!fi This permit a pplip tna expire. if a permit is not obtained witbi
� . s lat Warne: (7 In r v Date: 6,57 O- da after It bas been accepted as complete.
• Number of inspections allowed per permit.
P\ HUildina \PenniulnLC•PermihApp.doe 05123/06 440we15T(I tNS/COM/%VHI!