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Permit CITY OF TIGARD ELECTRICAL PERMIT • COMMUNITY DEVELOPMENT Permit#: ELC2013-00505 TLGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/22/2013 Parcel: 2S103AA00101 Jurisdiction: Tigard Site address: 10865 SW WALNUT ST Project: Fowler Middle School Subdivision:30 SUPPLEMENTAL PLAT NO.1:ANNE Lot: 7-6 Project Description: Installation of replacement cooking equipment. Contractor: THREE PHASE ELECTRIC Owner: TIGARD-TUALATIN SCHOOL DISTRICT 5618 SE 135TH AVE ATTN: BONITA MAPLETHORPE PORTLAND, OR 97236 6960 SW SANDBURG ST TIGARD,OR 97223 PHONE: 503-263-2558 PHONE: FAX: 503-651-3540 FEES Quantity Description Date Amount 4 crt Branch Circuits wo/Purchase 08/22/2013 $78.44 Specifics: Service or Feeder 1 ea 12%State Surcharge- 08/22/2013 $9.41 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $87.85 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 OAR 952-001-0090. You may obtain a copy of for direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued 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 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. 2013-08-22 10:12 40 h - .h - -l - i P 1 2 Electrical Permit Application u rOR(,l rl('I 11.(1\1.1 - IN City Tigard Ew No.:C ° 13125SW Hall B1vdTigard.OR 97223 AU G 2 2 2013 g���3 fir- ACC '3` 005-65-__ ': Plume: 503.718.2439 Fax: 503.598.19 pattapy: Othrr Pernik: I fU,\li Inspection Line: 503.639.4175 CITY OFTIGARD Date furs: HI See rage 2fur Interne: www.tigard•or.gov : ' ,plNai6ed/Methud; B Supplemental Information • I► I tYr tt'�°I 1't .�;'i•'�'�µ '� 'I'�' 1� t. 'it 1' wg�un:u�ld:p;,ltuinnrn '{�eP��t'flf��y�,,'y iE���r�'1�.1 '� ,'it a; {�,p�{'n,��t,,iG,rga,�r�Ei :an:u.Etgnl•ISlanns(xutaw)ll�ill� r°V l �i i 1kri �it 1� t �t tt t ril 11:J:1: iitiItIJ�'�i StS,l,igEr t 1;1 1 �t t H �l: ) M�.r.'6„ 't .., r 1'a.: t I,t ;'7 3 ItE t i 'Fi, w ti a1 C a ' it'l''t .�uliut,t m C�lbs 1u1 n iJ 1 I r li r..I I1,�. tt.tma is 1 )20 1.••: . + �.. , I t t r r t�rt n � , u. i t �a ❑New construction Addition/ante ationVreplacetnent Please check all that apply('submit j sets of plans wfitems checked below): ❑liery ice ur feeder 41111 amts nr nmi! ❑building over thrCC smrine. ❑Demolition ❑Other: whore the available fault current ❑Marinas and boatyards. It'Iliin rr I i n1 ai r .11 i{It !ip i r p F tw.f2 FwnN t rylN 1 1,11.4,gpa>:s,r,,,T,,.1,•lt ,,,, . ,, {I,p t ff: exceeds 10,000 amps at 150 volts or ❑Healing buildings. illv.nrt3rtl t'ID L l•lattttil�l a Li itj.emituut�;i tualt�lltut.tiati• itniede. eenr .kleutithttgith te'6Is t1< E"i less to pound,or exceeds 14,000 ❑Cummen ial-use agricultural ❑I-and 2-family dwelling fi Commercial/industrial ❑Accessory building ante,fix.411(Aker inOR:duna. buildings. ❑Multi-family ❑Master builder ❑Other. Orin pump. ❑hwtallation of 150 KVA or ,t i; 11,E p"t t i�I I is rlr Ina t oat Ri lrJ: a i['liritiI iri', r t tit at t ulccc,tY , t ,! n t , ,1 ,i ❑Emergency system. larger separately derived system. ci:1al ,J11> s:+ J>lli 1itt !lti,.. tt t t i.�ar ' ,tt1,a !Iact)'ata ! �r,lrl•f,ort i►�� d w arLttl�„uxt,4:Lnvca7iWku1•V,y itul�a:r8ta.r.tittS.thSa..{.r.r,r:r:Yamtlslnia;An{f �1 fir4in�r t 111,_1,1 ❑AI(Irlll{p1UfIICW rfgtnRlQallOf ❑r,A"�'H••'•1.2„•'1.3'� Job no.131Z'i�0 0 Job site address: 01 ("4.) 1 1 1 n'„ 1001W or more. nccuparlcy. O t/J W tom^^Ir ❑Six or more residential units, ❑Recreational vehicle parks. City/Stale/ZIP: � O 1 z. 0 Heahh.carc fai 3i ie,. ❑Supply voltage for more than i ❑Hazardous locations 600 volts nominal Suite/bldg./apt.no.: Project name: O l�` ❑Service nr feeder 600 ampc or more 11.. 1 t 1' rrt,f t ii tt t IE1 sun 1 1-.,ii1 I 1 r ``Ialrl I r�'� .. Tiglflpil�P N.CI L LLU!rllluk�x�'trY ,, T) p,,..?�.,:g n. R'illin �a{YC'd.YdNLC l�YE(Y:>`r1.`Yi(Nt Cross street/directions to job site: tlemnptbn QI! Nee. 7biat New t$ddential single-or multi-family dwelling unit. Includes attached garage. Subdivision: I.ot no.: 1,000 sq.A.or less 168.54 4 Ea.add'l 500 sq.ft.or portion_ 33.92 1 7'ax map/parcel nn.: Limited energy.re idtnttial 75.00 2 1t 1 U L I ni exiw t eav IER Ib yId }E (with above s•.ft. I/. Limited energy.multi-family IIII .� a I� 6 Y i I D I Il-.g • residential(with above .IL) 7 ' _© �1.... ble(.;. ... ei,alr; i!i;.i�g y�`Y ; (�'/ Service a or feeders installation alteration and/or reloattion I r )'i intf latrssot}ant s pnnulmttto{ li It t t i I t It i `i sbszrie rl,rn�it r' , ! I t: 200 am s or less 1(x1.70 Elia/SM';r y do ialilitia liir�allTiltlOaSa;{Il fill 1G1ita at._,l.r 1il !L>a;1tS 1 Mill ,A;t I11 p 11111•1© 201 amps to 400 ampc, 13356 2 Name: 401 ampsto60X)amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 City/State/'ZIP: Over 1.000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Phone:( ) I Fax:( ) relocation 200 amps ur leas 59.36 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 4(5)amps 125.011 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 js�igg�nature; Date: C^ f� Branch circuits-new,alteration,or extension,t r panel t}Ills'/�1!411u?!2[s.i311 tl i :p'1t r 51)E 1 tnVi lti t+l tEI�;t`lfJ f�{�.E,?j.�lt`i I r{ 11 cttr Y i:�tri t y f+q�no-t,r r C t ({.]-••tw A.Fcc for branch circuits wish .E,in. 4d4ia .o il,,,,,...Tsa-t'.nhdseuL$wa'r !:I!<i4,a t It 1 , Is.s�.i.'I�.t I4:uzri�ti�r1,...i l' tit•n! ; r 4ttt above service or fender fee, 7 42 2 Business name: eu:Ei branch c rtuit B.Fee for brand'iinvit,,without Contact name: service or feeder fee•fiat `I branch circuit L 56.18 •.710•I a 2 Address: Each add'l branch circuit 7.42 iz„ 2 Miscellaneous(service or feeder not included) City/State'ZIP' Each manufacnirrd or modular service and/or feeder dg, G7.8a 2 Phone:( ) I Fax: wellin ( ) Reconnect only 67.84 2 B mai I Pump ur irrigation circle 67.84 2 isiitli{d,}r 7[1 FII .ill } I11 11'I 1 'r rl��Inr 'n!� nwC[H"t1 I aft [ tilt 4 t i,l(if( :tl.t.��.,1tI,L:r, ,f�L.!,lg ll. l::1ELLL1.�' t:,ui.1,..2S ;.�.,.:sa;;.l Ll �l!,I,L7,l1.t.1.!!�?`�,9�t���!E I,I& .;!6 f. Sign or outline lighting - 67.114 �© Business name: Ailf AA ■" r' � , S-ne] ateatio)orle tension. ■�_© ,�•- nel.alteration,or extension. Address; J i9`i, 5, .r 4 Z - 4?�. - Each additions)ins ..;on over allowable in an of the above City/State/ZIP: 'fx-4.-t .1 J � q"]may 3 Additional inspecticm(1 hr min) fib L5/hr -■ t�,t/s'° "1 1 investigation(1 hr min) 66,25/hr Mi■ Phone: ♦i►3) _ i► Fax:(SO 3j i S -. 0 industrial plant(1 hr min) am 78,18/hr _. L peciiuns fur which no fee is CCB Lic.: Z tt� G ■ �, s • • s u al! h{,a.qled(!1 hr min) 9l1(l0/hr r ({[j{{ r i3�kf n v !.Ii1(filijlilluu��d �U�;�i..,.4E.ol}-2;:..,j P1. .r.,��!{g.;.T4MME 4t.ntS Supty.Electrician signature,required: 0 ;,1, e Subtotal• •1g, Print name: b„tx,_ 5 (,\ p 1, , pate' ar•L-LI t� Plan review(2530 of permit fee): +-"��`^ �N v I 1 State surcharge(12%of pe'nit fee): 0 , Authorized signature: TOTAL PERMIT FEE: Print name: Date: This permit application expires if a permit is not obtained within :I days after it has been accepted as complete. • Number of inspections allowed per permit. 1:voila,glPenuaslEt.e-remlimpp_zt..bitzdee Rev osr-1/2011 44o-461sRt l/05reoMArm