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Permit y f n CITY OF TIGARD ELECTRICAL PERMIT 14. �. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00447 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/02/2009 Parcel: 1 S 135DD00600 Jurisdiction: Tigard Site address: 11831 SW PACIFIC HWY Subdivision: Lot: 0 Project: HWY 217 S/B Ramp Signal Project Description: New (1) 200 amp service and (1) branch circuit for existing traffic signal from Hwy 217, southbound, next to Young's Funeral Home. • Owner: FEES ALDERWOODS (OREGON) INC Quantity Description Date Amount BY SERVICE CORP & SUBSIDIARIES, ATTN: PROPERTY TAX -9TH FLOOR, PO BOX 130548 1 ea Services or Feeders 200 09/02/2009 $80.30 amps or less PHONE: 1 crt Branch Circuits w /Purchase 09/02/2009 $6.65 Service or Feeder 1 ea 12% State Surcharge - 09/02/2009 $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. 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 throug AR 9 01- 00. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By - -- Permittee Signature: 94 ,e1/ / /C /9-77 0 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 603.639.4176 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. 'Q 'a / 20092 1:57PMx 97CANNERY PIER HOTEL No.9998 P. 10002/0" RECEIVED Electrical Permit Application Fr)It urn l(r: I m.. ta.l.l City of Tigard S E P 01 2009 Received UrtaB : 9 - 0 > Air PemtitNo.:67..6a0/ AT/ 3125 sW hell Blvtl, Tigard, OR 97223 Plan Review Phone 5 03.639.4171 F 5 03. 0 TIGARD 17atd8 : Other pe n i T � ; 1 , I nterne G DIV io nLino: 503.639. a BUILDING DateRradyB': Ed SePsge2 Internet; www.ligard-or -gov l4otifled/Mothod: IleM Supplementallnformeyon TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/ eplacement Please cheek all tier apply (submit j Sots of plane w /mane checked below): ❑ Demolition El Othei: ❑ Service or feeder 400 amps or more ❑ Building over three stories, whore the eveilable fault current O Matinee end barnyards. CATEGORY or CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. llhidusaial loss to ground, or exceeds 14.000 ❑ Omameroiat -use agricultural © 1 - and 2 - family dwelling ❑ Commercla ❑ Accessory building amps for ail other installations. buildings. ❑ Multi ❑ Master builder Other: Tta.grc.. S, t ,,,' ❑ Fro Purim ❑ Installation of 75 KVA or JOB SITE INFORMA•I'ION AND LOCATION ❑ �ereB°� system larger separately derived system. ❑ Addition of now motor laid of ❑ "A ••B ". "1.2 ", "t -T. Job no.: Job site address: f J Qy��i1 -' CI ct � loop Or more. occupancy. j� ❑ Six Or mews Taidential unip. ❑ Rearealimal vehicle parks. City /State/ZIP: ( ; , . elk ii es 60-7a y • ' ❑ lfeelth•uare facilities. Cl Supply voltage for more than =L' • Hazardous locations. 600 wills namioel. Suite/bldg. /apt. no.: Project name: a r) 51(3 rc , „ ,, S , 1 ' 'r Servieeor feeder doe amps or more. - '�' FEE SCHEDULE Cross skeet/directions to job site: bnatotarr 1 enr. f m . I 7 1 • I'iew residential single or multi - family dwelling wilt. Includes attached garage. Subdivision: Lot no 1,000 sq. fl. or leas 145.15 4 J f357 ' w Limited iced energy, aq. a e portion 33.40 1 Tax map/parcel no.: !�-� Limited energy, residential »HI�TION OF. WORK (with above sq. ft.) 75.00 2 � Limited energy, multifamily i� S 2- v tJrc.4— Ii, Y Q- �Gr� • ___ residential (with above sq. a.) 75.00 2 11 'i •� Sr Services or feeders InetaWtlon and/or relocation S� 8� 200 amps or less ` 80.30 to ° 2 .11iO4100OWNER • I' • ...O .x'LN*Prr• 20/ amps to 400 amps 106.85 2 Name: 0 O 0 L 401 amps to 600 amps 160.60 2 Z.di SE 601 amps to 1,000 amps 240.60 2 Address: �w v ( Over 1,000 amps or volts 454.65 2 City /State/ZIP: e a � o k Gi . ( s' -- 7bmporary services or feeders Installation, alteration, and/or relocation P h o n e ( ( ) ( 073 . ‘,2e3 Fax: oit )17( 7 3- ,2.o . 200 amps orless 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100,30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch dirtnits — newelteratlon, or extension, ter panel Owner signature: Date: A. Fee for bralnch circuits with . ' El APF'L.ICANT; .. . " .CONtAIGT; LAIRS OR. above service or feeder fee, 1 6.65 6. 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee 46.85 2 first branch c Address: &ooh odd'I branch circuit 6.65 2 MiscelianeousSservice or feeder not included) _ City/State/ZIP: Each c0anufactuced or modular dwelling, service and/or feeder Phone: 90.90 2 ( ) I Fax:: ( ) Rcomtneot only 66.85 2 E-mail: a..• . a .4 _ • , '1 r I • r -i • •.. pump or irrigation oirolo 53.40 2 CONTRACT ,'. :: ;' • : ' • • - „' • Sign or outline lighting 53.40 2 • Business name: C900 Signal cirouit(s) or limited- Address: p 11 e � 0 3 extensi Describe! or 4 �t.t� N Page 2 2 City/State/ZIP: Gl[r4,11A ■ C Q 7 0 i is- Each additional inspeclien over allowable In an of the above Per inspection 62.50 Phone: ( 563 ) • d Fax: (' J ) !•;. , 7 Z G a oz.- Inveati r hour (1 br min) 62.50 CCB Lic.: N�� Electrical Lic.: t1_ r , $ • • . Li Industrial plant per how 73.75 Suprv. Electitci signature, required: • ' et a / ■ M 7�t QM ELECTRICAL PERMIT — FEES;' r • p� ia�>t 'ti , , I Print name: V • e ,' i . Date: Plan review (239S of permit fee): I d • State surcharge (12% of permit fee): P tit I d a Authorized signature: , tl' If ` TOTAL PIT T FEE: , • • ti Print name; 'Sp R..0 Da . • N M I This p e r m i t application m h o , If a permit b net oh • .. .... 1 T •, days after it hoe born accepted as complete. LtHalldins�ramhaLC.PamltApp.tec 0523/06 • NumberefimpeotionseIlowadpauermit. Q C.10 -t6 I Ipr/COMlW89 J Received Time Aug.31, 12:49PM i r . ' vi