Permit CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00269
x DEVELOPMENT SERVICES DATE ISSUED: 5/23/01
+L ,.) I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103BB -07100
SITE ADDRESS: 12475 SW 121ST AVE
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: UNDERGROUND CABLE POWER SUPPLY
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
HARBOUR, KELLY POWER TECHNOLOGY
12475 SW 121ST AVE PO BOX 1766
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: Phone: 503 - 657 -0315
Reg #: LIC 129287
ELE 3 -511C
SUP 3575S
FEES Required Inspections
Type By Date Amount Receipt Underground Cover
5PCT JMT 5/23/01 $6.42 0000000214E Elea! Final
PRMT JMT 5/23/01 $80.30 0000000214E
Total $86.72
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 throu• h OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -23 • .
Permit Signature: re5 Issued By:
III OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
OS/23/2001 08:37 FAX 5036847287 taxy or 11$ara va
.
•
• I Elect ricalPearmitApplication
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City of Tigard Project/app. ao. rapitod
CbYa17tln.t 13125 SW Hall Blvd. Tigard, OR 97223 pmeissned: By: I Receiptno.:
Phone: (303) 639 -4171 Cue tile no.: Payment type: Fu: (503) 398-1960 / .
Land use approval: O al: 0 ' / /
Tl' 01 P1:R' 1IT
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0 New oxistrection O AtbStiontaBeratlenhepiacaocat 0 Other: O Partial
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TCI OF TQALATIN VALLEY, INC.
POWER SUPPLY LOG- INSTALLATION
�1 SITE INSPECTION
Project is �!eC 1475 Date: 5 �f�l
Project Name: A OSA (#14i MaP #: Co 6 3
Projected Completion Date of Project: Originator:
In order to obtain the permit for any new power supply installation, the
following information must be provided. CC_
Exact (or closest) Address to Installation: I Lp+ ECt, ± df 12165 5) i( t
A ity: T
Aerial
-"County: W0.011 V`
In Underground
Pole is
Transformer #:
-• • of Service Feed From Transformer to Breaker:
- • ) y Representative:
* Service Breaker Size Rating: All Service Breakers to be High Magnetic.
0 - 10 HVA
10 - 20 KVA
* In order to determine the required breaker rating to be installed, the
following information will apply in all cases.
The PGE representative needs this information to determine the required
ground fault interruption (GFI or AIC) rating of the breaker to be
installed at the particular transformer serving the new power supply.
All Underground Installations: # 8 wire for service and ground
All Aerial Installations: # 10 wire for service and ground
- - -,
NOTES:
i FOR OFFICE USE ONLY
Electrician Install BREAKER CHANGE ONLY
Power Notification Power Notification
Power Activation ► Power Disconnect
TCI Notification TCI Wreckout
TCI Cutover Old Account I
New Account i I Billing Complete