Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2021-00111
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/8/2021
Parcel: 2S106AC04200
Jurisdiction: Tigard
Site address: 13004 SW LARKWOOD PL
Project: Comcast Subdivision: RIVER TERRACE EAST 3 Lot: 14
Project Description: Underground power supply located on the SW corner of the Roy Rogers and Scholls Ferry Road intersection.
Contractor: BOB'S ELECTRIC
Owner: POLYGON WLH LLC
2700 NE BURTON ROAD STE A 703 BROADWAY ST STE 510
VANCOUVER, WA 98662 VANCOUVER,WA 98660
PHONE:
PHONE: 360-254-7200
FAX: 360-254-8219
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/05/2021 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 03/05/2021 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344..2
Issued By: Permittee Signature: a : t P2 -
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.
arS ' _
o
�. �'
Electrical Permit Applicatio> �� �� FOR 0I l l( I. I SI:(ICI 1
City of Tigard FEB 2 5 2021 Received ') / i.... Permit M, �. // l`l
Date/By: 2 i J!�7 EL C._.t9&I a i
t r^• 13125 SW Hall Blvd,Tigard,OR 97223 Plan Review
s' Phone: 503.718 2439 Fax: 503,598.IL+Ty OFTIGARD Date/By: Related Permit II:
Inspection Line: 503 639.4175 Ready Date/By: tuns: 0 See Page 2 for
+It'ARD BUILDING DIVISION Notified/Method: 3 ��1, !'17F ,.?' . Supplemental Information
Internet: www.tigard-or.govl
TYPE OF WORK ;w ,t•.,1- PLAN REVIEW
0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ I-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.
0 Multi-family ❑Master builder 0 Other: 0 Fire pump.. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system
Job#:21 199 Job site address:.
10011P or more.. ❑"A""E" "1-2""I-3"
� � '`"��� ❑Six or more residential units occupancy.
City/State//.1P:Sherwood, OR /� }� ✓6C �C+e t try �. ❑Health-care facilities ❑Recreational vehicle parks
Suite/bldg./apt.#: Project name: L 0 Hazardous locations ❑Supply voltage for more than
•- -w ,"`t� --• 0 Service or feeder 600 amps or more. 600 volts nominal
Cross streeUdirections to job site: SW Corner of Roy Rogers and Scholls FEE SCHEDULE
Fer in the new construction area Description i Qty. 1 welch 1 Total I. `
ry 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 energ
y,residential 75 00 2
New underground power supply for Comcast Cable (with above so ft)
Limited energy,multi-family 75.00 2
_residential Cwith above sq.ft.)
El PROPERTY OWNER ❑ TENANT Renewable Energy O See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1 100.70 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:( ) I 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
0 APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A Fee for branch circuits with
Business name:Bobs Electric above service or feeder fee,
each branch circuit 7.42 2
Contact name:Kevin Broselle B.Fee for branch circuits without
service or feeder fee,first Address:2700 NE Burton Rd., Ste. A branch circuit 56.18 2
City/State/ZIP:Vancouver, WA 98662 Each add'I branch circuit 7,42 2
— Miscellaneous(service or feeder not included)
Phone:(360)254-7200 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67 84 2
Email:kevin.bobselectric@gmail.com Reconnect only 67.84 z
CONTRACTOR Pump or irrigation circle 67 84 2
Business name:Bobs Electric Sign or outline lighting 67 84 2
Signal cireuit(s)or limited.cneryry
Address:2700 NE Burton Rd., Ste. A panel,alteration,or extension 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:Vancouver, WA 98662 Additional inspection(1 hr min) 66.25/hr
Phone:( 360) 254-7200 —I Fax:(360 ) 254-8219 Investigation(I hr min) 90 00/hr
Industrial plant(1 hr min) 78 18/hr
Email: kevin.bobselectric cegmail.com
Inspections for which no fee is
CCB Lie.:53136 Electrical Lie.:.353 . Su 'l.ie.:4322S specifically listed(Vs hr mini 90 00/hr
� ,,--m L,..,� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,require : ."":,. -,.;r
_.. Subtotal 100.70
Print name:Kevin Broselle sr Date:02/24/2021 0 Plan Review Required(25%of permit fee)
State surcharge(12%of permit fee) 12.08
Authorized signature: TOTAL PERMIT FEE 112.78
This permit application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
. ..'-. a Number of inspections allowed per permit.
t:1Building't'ermits\ELC_PermitApp ELR_ERE.doc Rev 06/17/2015 440-4615T(1 I/05/COM/WEB