Permit (70) CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit#: ELC2017-00460
T1 GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2017
Parcel: 2S 103AA00101
Jurisdiction: Tigard
Site address: 10865 SW WALNUT ST
Project: Fowler Middle School Subdivision: None Lot: None
Project Description: Electrical for renovation of main entry,science wing,and woodshop.
Contractor: MARK ADAMS ELECTRIC INC Owner: TIGARD-TUALATIN SCHOOL DISTRICT
PO BOX 2748 BY MAPLETHORPE, BONITA
CLACKAMAS, OR 97015 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-557-8543 PHONE:
FAX: 503-557-8508
FEES
Quantity Description Date Amount
14 crt Branch Circuits wo/Purchase 10/05/2017 $152.64
Specifics: Service or Feeder
1 ea Plan Review Electricial 10/05/2017 $113.16
Type of Use: COM 1 ea 12%State Surcharge- 10/05/2017 $54.32
Class of Work: ALT Electrical
4 ea Limited Energy 10/05/2017 $300.00
Type of Const:
Occupancy Grp:
Total $620.12
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 0 R 952-001-0090. btai of the rules or direct questions to OUNC by calling 503.2 1 7 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.
Electrical Permit Application FOR OFFI( F ESL ONE)
Received
City of Tigard DateBy: ((j /R l( / Permit#: e� /7-„00 it `„�
II 't 13125 SW Hall Blvd.,Tigard,OR 9722 i� Plan Review ti
_' Phone: 503.718.2439 Fax: 503.5914 ���F Date/By: 7/S//7 Related Permit#: i f�e/�o2lvl'?-06,)/67 #/ate,
t 1 G A K I1 Inspection Line: 503.639.4175 / Ready Date/By: Juris: El /See- Page 2 for �.•�/
Internet: www.tigard-or.gov �V� L�. ���` Notified/Method:7/f, 7 �a+ �4 I Supplemental Information
TYPE OF WORKAt 6 ocelot` PLAN REVIEW
❑New construction ®Addition/alteratigr lWO\
, �Q i� Please check all that apply(submit 2 sets of plans w/items checked):
,tl ❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: 501-1)1where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
o Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: I Job site address: 10865 SW Walnut St 100HP or more.
occupancy.
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. 0 Recreational vehicle arks.
0 Health-care facilities. P
Suite/bldg./apt.#: ( Project name:Fowler Middle School Reno 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW Walnut St and SW Tiedeman Ave FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:2S103AA00101 Ea.add'1500 sq.ft.or portion 33.92 l
DESCRIPTION OF WORK Limited energy,residential
Renovation of Main Entry,Science Wing and Woodshop as well as other minor
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
renovations,and a siesmic upgrade of the building residential(with above sq.ft.)
Renewable Energy 0 See Page 2
PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:Tigard-Tualatin School District 200 amps or less 100.70 2
Address:6960 SW Sandburg S 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2
Phone:(t10 s ) 1{.31 . 4.0 r3 u Fax:(509, ) 4.3 r • 40.4-'3 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 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT r 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: S AF2,A•-L1 1:Q,-1-S B.Fee for branch circuits without
service or feeder fee,first 1 56.18 SI,
Address:
(„y 4,0 S,,,; S b v rZ.,6 J i branch circuit
City/State/ZIP: 7I to h 012 C 7 7.'i Each add'i branch circuit 13 7.42 2
1 Miscellaneous(service or feeder not included) q •it 4i
Phone:(t,o5 ) t)1 5. 41,.; Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: S r.H (2s 1?q-y Li,64. 1..J` Reconnect only 67.84 2
.�,,_, , }I CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 04•- 1.5 ,FI� ) _Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy a See Page 2 300 2
Address: C �� {' panel,alteration,or extension.
City/State/ZIP: '/ q 70 ( e Each additional inspection over allowable in any of the above
GAG K-cL:w«5 / - 1. 1 $ Additional inspection(1 hr min) 66.25/hr
Phone:(j 23)5-57-a5-11 3 Fax:( ) Investigation(I lir min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: -, d c e_e.I-1c.ex,,fV' Inspections for which no fee is
CCB Lic.: )71 lc) -i 1 Electrical Lie.: lif I Suprv.Lie.:60��p specifically listed CA hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: t Y� �,� Subtotal: "kracits-,2 IA
Print name: -c G Date: a Plan Review Required(25%ofpermit fee): 3 t• r1if
5� � P��ut 5� 1 Q � 1 .7 ,���
State surcharge(12%of permit fee): _S3..3.
Authorized si l - TOTAL PERMIT FEE: 1a )j,
\ ^ This permit application expires if a permit is not obtained within 1 �'
Print name: 4 V ^ Date: ,y t 1 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\BuildingWermits\ELC_' eApp_ELR_ERE.doc Rev 06/17/2015 440.4615 (11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description ► Qty. I Each I Total I *
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
C Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener*
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
C Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(V2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
Clock Systems
// Data Telecommunication Installation
11 Fire Alarm Installation
(� HVAC
C Instrumentation
® Intercom and Paging Systems
C Landscape Irrigation Control*
n Medical
C Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: 4
*No licenses are required. Licenses are required for all
other installations
I:\Building\PermitslELC_PermitApp_ELR_ERE.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10865 SW WALNUT ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2017-00460
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor