Permit CITY OF TIGARD ELECTRICAL PERMIT
2 7 , COMMUNITY DEVELOPMENT Permit#: ELC2020-00470
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/13/2020
TfGARTi Parcel: NO PARCEL
Jurisdiction:
Site address: SW NO ADDRESS
Project: ODOT Subdivision: Lot:
Project Description: ODOT roadway light pole upgrades and maintenance retrofit project on Hwy 217 and I-5. 155 street light fixtures.
Contractor: INDUSTRIAL LIGHT& ENERGY INC Owner:
11807 NORTH CREEK PARKWAY SO SUITE
B103
BOTHELL,WA 98011
PHONE:
PHONE: 425-806-9200
FAX:
FEES
Quantity Description Date Amount
36 Building Misc Fund 10/12/2020 $36.00
Specifics: (copies/prints)
2 hr Hourly Electrical Rate 10/12/2020 $180.00
Type of Use: COM 1 ea Hourly Electrical 12% 10/12/2020 $21.60
Class of Work: ALT Surcharge
45 Plan Review-Electrical 10/12/2020 $45.00
Type of Const:
Occupancy Grp:
Total $282.60
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 the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: \Vi. , t.Y) Qt1T Permittee Signature: on ‘Co+1 l -y\
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.
RECEIVE P - zd
Electrical Permit Application 1 ry/� FOR OFFICE USE ONLY
City of Tigard 0 / /
/fir/
S C[P 1 0 2020 Received
Date/By:, ' Pennit /i� a 1J (/9 N f/w ' �
;� ' • 13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TIGARD Plan Review !a /�/�� I�I Related Permit#:
Phone: 503.718.2439 Fax: 503.598.1 DateBy: l!d
Inspection Line: 503.639.4175 ` .11��ING DIVISION Ready •
DateBy: / , luris'. RI See Page 2far
I I UARI) Internet: www.tigard-or.gov Notified/Method: f,, a a Supplemental Information
TYPE OF WORK - PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wiitems checked):
❑ Demolition ❑Other: ❑Service or feeder 400 amps or more 0 Building over three stories.
where 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 ❑Accessory building less to gonad,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family 0 Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOR SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address: �: -/rre ❑Addition
00H oo mf ore.motor load of system.
e�U e�ff/lC�r � 100HP or more. ❑.'A„ •E„ .`l-2„ "I.3,.
City/State/ZIP: Tigard,OR ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:ODOT Roadway Light Pole Upgrades(Maint.Warls Hazardous locations. 0 Supply voltage for more than
CJ Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I "
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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
ODOT Roadways/Highways-Cobrahead and High-Mast Lighting Maintenance retrofit project. (with above sq.ft.)
Limited energy,multi-family
15 5 p residential(with above sq.if) 75.00 2
Is-G (,,.� E�(-�'1 G/ }L"jLi Renewable Energy 0 See Page 2
121 PROPERTY OWNER 1 ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: Oregon Dept of Transportation 200 amps or less 100.70 2
•
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) 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
® APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Industrial Light&Energy Inc.dba Northwest Edison above service or feeder fee, 7.42 2
each branch circuit
Contact name: Gabi Mullins B.Fee for branch circuits without
Address: 11807 North Creek Parkway South,Suite B-103 ervice t feetfee,first branch circui 56.18 2
branch
City/State/ZIP: Bothell,WA 98011 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(425 )985-7757 I Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: gabriellem@nwedison.com
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Industrial Light&Energy,Inc. Sign or outline lighting 67.84 2
Address: 11807 North Creek ParkwaySouth,Suite B-103 Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Bothell,WA 98011 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 425 )985-7757 I Fax:( ) Investigation(I hr min) 90.00/hr
Email: gabriellem@nwedison.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 2 90.00/hr
CCB Lie.: 187903 I Electrical Lie.: LMS396 I Suprv.Lic.: 5920S specifically listed(V,hr min)
����p ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 2' /"" ' Subtotal: 180.00
Leonard Saint John Anterola 09/�/2020 D Plan Review Required(25%of permit fee): 45.00
Print name: Date:
State surcharge(12%of permit fee): 21.60
Authorized signature: TOTAL PERMIT FEE: $246.60
/� /J// This permit application expires if a permit is not obtained within 180
Print name: ( ae4.40...46, 7�yy Date:09/08/2020 days after it has been accepted as complete.
L/C!�/ $ Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description
Fee for all residential systems combined: $75.00 Q,. Each Total
5' Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70 2
5.01 to 15 kva 133.56 2
El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
El Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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:
❑ Other: Each additional inspection is 66.'s hr
charged at an hourly(1 hr min)
inspections for which no fee is 90.00./hr
specifically listed(hi hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Paget),
*
(SEE OAR 918-309-0000) Nam6e a�r; Peenaas allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
U Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting* •
El Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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