Permit (90) CITY OF TIGARD ELECTRICAL PERMIT
1,1 COMMUNITY DEVELOPMENT Permit#: ELC2019-00070
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2019
T f tlf. Parcel: 2S 103AA00101
Jurisdiction: Tigard
Site address: 10865 SW WALNUT ST
Project: Fowler Middle School Subdivision: None Lot: None
Project Description: Extending(2)branch circuits in classroom#40.
Contractor: OWNER Owner: TIGARD-TUALATIN SCHOOL DISTRICT
TIGARD-TUALATIN SCHOOL DISTRICT BY MAPLETHORPE, BONITA
6960 SW SANDBURG ST 6960 SW SANDBURG ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 02/11/2019 $63.60
Specifics:. Service or Feeder
1 ea 12%State Surcharge- 02/11/2019 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total - $71.23
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the r adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through O 952-001-0090. Yoa c y of the rule-or direct questions to OUNC by calling 50. 2.1•s7 or 1 00.332.2344.
Issued By: • ,��.r� ��_ Permittee Signature:.49 A
.�.�
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Electrical Permit Application FOR OFFICE USE ONLY
CityTigardReceived
of Date/B : r�/iEWi w�ltJj'Qm r((
I - e 13125 SW Hall Blvd.,Tigard,OR 972 ("t \/ Plan Review
Phone: 503.718.2439 Fax: 503.598.11\„!t I V E D DateB : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: ® See Page 2 for
TIGARD 1 1 Notified/Method: Supplemental Information
� Internet: www.tigard-or.gov FEBD 12019
Please check all that apply(submit 2 sets of plans w/items checked).
❑New construction Ed Addition/alter io/milmil!isioN
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
,, d )CATEGORY OFeds:$TRUCTION --,2,1,1,,,, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ' Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB'SITE ('RMA-TION ANAL, OtCATION ,;„;:;!,',::!•-'' ❑Emergency system. larger separately derived
0 4305-w 1365- S� j S ❑Addition of ore motor load of system.
Job#: Job site address: flkirk 1 ooHP or more. ❑system
City/State/ZIP: �` ❑Six or more residential units. occupancy
} 1 Or c.: — a ❑Recreational vehicle parks.
`(�/A � 0Health-care facilities.
Suite/bldg./apt.#: - I` Project name: ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to'ob site: \er �`t L :t' �„
� ,: ' FELE$CIIEI?ULE
( � Descnption I Qty. I Each I Total I •
i�p� Qw 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#
Ea.add'l 500 sq.ft.or portion 33.92 1
„ i'' V I°I), ;DESCRIPTION O? ORI ,... '.."4..:.', Limited energy,residential
(with above sq.ft.) 75.00 2
C— ��tVrf (�� Ct,1 ti L S Ct eek 5 i Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
4 �- (..V, -1... <45,,S iii'' 1 f _� Renewable Energy 0 See Page 2
:, PROPERTY1-OWNER - . . 'r.0 TENANT-;, Services or feeders installation,alteration,and/or relocation
Name: 1(kala PriJA�H'k1vk 'jcLoOk �/t 2 200 amps or less 100.70 2
tn \ 201 amps to 400 amps 133.56 2
Address: ( 61(420 n� NO��f 401 amps to 600 amps 200.34 2
City/State/ZIP:Ilgt/- Or -7 �pc 3 601 amps to 1,000 amps 301.04 2
Phone: (93 ) ((n k, t4o00 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: (/ [9. 0 (�
L ^ -r- 1) ,v_I,,Oe_•05 Temporary services or feeders installation,alteration,and/or
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
APT'LICANT tI ',CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: "rtGQ f) 'a SL ' \,`6 �A above service or feeder fee,
\ 7.42
V 3?
each branch circuit
Contact name: B.Fee for branch circuits without
Address: Ct(QO • service or feeder fee,first / 56 18 5 1 2
�(-1 l �1�7(IA. V� branch circuit C9
City/State/ZIP: 1
Each add'I branch circuit 7.42 '7,1),, 2
-1'1/41 �it O ��� Miscellaneous(service or feeder not included)
/
Phone:( t)3 ) 7161 V(ocil, Fax: :( ) Each manufactured or modular 67.84 2
Email: 50 �TTss) .Y4. oL J S dwelling,service and/or feeder
Y 1Reconnect only 67.84 2
r 11 ii("i M a:�'i�i „r a t,x.CONTRACTOR '1h . !:',”= , , Pump or irrigation circle 67.84 2
Business name: cn.�_ ,,,,.,.. 63-e-40/ iia J G/--) Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: panel,alteration,or extension.
Ci /State/ZIP: Each additional inspection over allowable in any of the above
ty Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
..CCI. ;:,- --. Electri Suprv. Lic.:l00`0�1 5 specifically listed('/hr min)
n ELECTRICAL PERMIT FEES / 7
Suprv.Electrician signature,required: Subtotal: (r? >,(s'CJ
Print name: Gamma Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): . ")-. G 3
Authorized signature: TOTAL PERMIT FEE: 77. 33
This permit application expires if a permit is nut o twined within 180
Print name: Date: I days after it has been accepted as complete.
* Number of inspections allowed per permit.
t.\Building\'ermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/20[5 440-461 ST(11/05/COM/WEB
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 ELC2019-00070
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor