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Permit r 9 CITY OF TIGARD ELECTRICAL PERMIT a: COMMUNITY DEVELOPMENT Permit #: ELC2009 -00472 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/10/2009 Parcel: 1S136DB00500 Jurisdiction: Tigard Site address: 11619 SW PACIFIC HWY Subdivision: Lot: 0 Project: ODOT Project Description: Replace service and (1) branch circuit to existing traffic signal. Traffic signal is located in median strip in front of the Mazatlan restaurant. Owner: FEES GGE TIGAR LLC Quantity Description Date Amount 11619 SW PACIFIC HWY 1 ea Services or Feeders - 200 09/10/2009 $80.30 TIGARD, OR 97223 amps or less PHONE: 1 crt Branch Circuits w /Purchase 09/10/2009 $6.65 Service or Feeder 1 ea 12% State Surcharge - 09/10/2009 $10.43 Contractor: Electrical ODOT 9200 SE LAWNFIELD RD CLACKAMAS, OR 97015 -8585 PHONE: 503 - 969 -1027 FAX: 971 - 673 -6202 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $97.38 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. A •': • -.on law r-euires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -01 -0010 through OAR , 52 -' -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5 246.6699 or 1.800.332.2344. ' L Iss d 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 an inspection that business day. 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. • '')9/09/2009 WED 15:16 FAX 971673620 ®001 /002 E lectrical Permit Application OFFICE USE ONLY III City of Tigard RECEIVED Received Q /0- b f A pp lk , Permit No.: 2/„.d n � f n o el? 2 '. q 13125 SW Hall Blvd., Tigard, OR 97223 2009 p Plan Review a Phone: 503.639.4171 Fax: 503.598.1960S E P 0 9 2009 DateBy: Other Pennic • TI GAR D Inspection Line: 503.639 Date Ready /By mfi/ ri Ei See Page 2 for Internet: www.ligard-or.gov CITY OFTIGARD Notified/Method: //1 ,. Supplemental Information TYPE OF littliFDING DIVISION' PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wlitems checked below): . ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. • CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. • less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. . El Multi-family ❑ Master builder ...1R ;C Sit ,;, ❑Fire primp. D lnstallation of 75 KVA or JOB SITE INFORMATION AND LOCATIO J ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1.3 ", Job no.: Job site address: 1' 1. . �i.,� 100HP or more. occupancy. � • ■� ii_ / ❑ Six or more residential units. ❑ Recreational vehicle parks. City / State/ZIP: 'f fi q W ❑ Health -care facilities. ❑ Supply voltage for more than t G1 Jl Yr.� sr l� v ta\ is. . �� 1 CI Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: J Proje name: in Ta ❑ Service or feeder 600 amps or more. 4 - - • 1 FEE SCHEDULE Cross street/directions to job site: Deteription I Qty. I Fee. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: I Lot no.: / /i Ea. add'I 500 sq. ft. or portion 33.40 I Tax ma p P / areel no.: (• l:) Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 0 e..‘v 3"L fLe +0 rip e--;<; ,,, p residential (with above sq. lt.) _ Services or feeders installation,alteration, and /or relocation pp J rr -f� St( Imo` 3 200 amps or less i 80.30 j O ' 2 ❑ PROPERTY GONER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: O 401 amps to 600 amps 160.60 2 _ 601 amps to 1,000 amps 240.60 2 • Address: ZOO 3 C L ���p4� - Over 1,000 amps or voles 454.65 2 City/State/ZIP: Cta e� , 0 6 / 70i Temporary services or feeders installation, alteration, and /or relocation Phone: (C fl) ( '1.2 4 k 12;'ax: en, (�7 34, .2... 200 amps or less 66.85 I — Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2 J • intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel • A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 1 6.65 � 2 each branch circuit Business name: B. Fee for branch circuits • Contact name: without service or feeder fee, 46.85 2 • first branch circuit Address: Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City /State/ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) I Fax: : ( ) Reconnea only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: ©�^ Signal circuits) or limited - energy panel, alteration, or Address: Q - a_oO G , A e Z O extension. Describe: Page 2 2 City/State/ZIP: C1.-ct ct CT-S CA- 'e D 7 o Is- Each additional Inspection over allowable in any of the above l Per inspection 62.50 Phone: r Fax: ( JtrJr 4i�q �n 2-� I� (9.70 7 � ( 9. 2 .Q 2_ Investigation per hour (I nrmin) 62.50 CCB Lic.: k) p I Electricallic.: a,-‘t t 8/ �- Suprv. Lic.: z G6 '7 S industrial plant per hour 73.75 , ELECTRICAL PERMIT FEES r, Suprv. ElectriciA signature, required: / . I • ua. ' i p` ,, -'. 4/ (to Subtotal: 6c Plan review (25% of permit fee): I Print name: 517 Nub Date: Q rQ State surcharge (12% of permit fee): i 0 ({ 3 Authorized signature: I i I 0AL l TOTAL PERMIT FEE: T 7.05q 141114141.^. � This permit application expires if a permit is not obtained within 180 Print name: Sow Pmt car\ Date: 5 I days after it has been accepted as complete. 0 Number of inspections allowed per permit. I:1 Bui ldingWermirs\ELC- PermltApp.dae os/23106 440.4615T(t I /05 /COM/WEB