Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00719
A ,i I DEVELOPMENT SERVICES DATE ISSUED: 12/02/1999
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102CC -00500
SITE ADDRESS: 13490 SW PACIFIC HWY TRAFFIC SIGNAL
SUBDIVISION: BOX ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of a 200AMP Service /Feeder for traffic signal. -
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 HMI 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:
ODOT ODOT
11565 SW ATLANTA 9200 LAWNFIELD RD.
TIGARD, OR 97223 CLACKAMAS, OR 97015
Phone: Phone: 503 - 653 -3124
Reg #: ELE 24 -186C
LIC 49292
SUP 3667S
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRM• GEO 12/02/199. $64.25 99- 320128 Elect'l Final
5PCT GEO 12/02/199E $5.14 99- 320128
Total $69.39
OPIGINAL
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 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATUR / ISSUED BY: /
OWNER INSTALLATION ONL
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: /2 I
LICENSE NO: & O . V 5
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Permit Application Plan cl'ea`
13125 SW HALL BLVD. Recd By
Date Recd I L - L - g
TIGARD OR 97223 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # EGC ) fPf 06 9
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1. Job Address: i ?� Q SiA1 � �;C +4(0( - _ 4. Complete Fee Schedule Below:
Name of Development I'rC.tc.ct.L C
. Number of Inspections per permit allowed
Name (or name of business) 0 07 Service included: Items Cost Sum I
Address C �I L a a
. JI�fY�C� 4a. Residential - per unit 7 7 4
1000 sq. ft less $ 11 5 City /State /Zip Tl3 t 0 Each additional 500 sq. R or
portion thereof $ 26.75 1
Commercial csi Residential ❑ United Energy $ 60.00 _
Each Maned Home or Modular
2a. Contractor instal only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation /r
Electrical Contractor ( 200 amps or less � $ 64.25 (0 2
Address ZOO Lain L D 201 amps to 400 amps $ 85.50 2
CI State Zip .77 0/5- 401 amps to 600 amps $ 128.50 2
City P 601 amps to 1000 amps $ 192.50 2
Phone No.(S0.3) ,S3 - 2, t Over 1000 amps or volts $ 363.75 2
Job No. I Reconnect only _ $ 53.50 . 2
Elec. Cont. Lice. No. Ali I 'bc- Exp.Date lb- Cl -GO 4c. Temporary Services or Feeders
OR State CCB Reg. No.Lf9 2-9 Z Exp.Date 125r-03 Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
401 amps to 600 amps $ 100.00 2
Signature of Supr. Elec'n Over 600 amps to 1000 volts,
2 f see "b" above.
License No. 3J 6 S Exp.Date LOIM. I 61
Phone No.463 3(2.11 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or .
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit - $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous •
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle . $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
(if required):* panL alteration or extension $ 60.00
3. Plan Review section
+� Minor Labels (10) $ 100.00
Please check appropriate Item and enter fee in section 5B. 4f. Each additional Inspection over
4 or more residential units In one structure the allowable In any of the above
Per Inspection $ 50.00
Service and feeder 225 amps or more
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as nc
described in N.E.C. Chapter 5 5. Fees: ,
5a. Enter total of above fees $ ( i ,
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ S'
Not required for temporary construction services. Subtotal $ Go ? . �
6b. Enter 25% of fine 6a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ �---..-
IS NOT COMMENCED WITHIN 180 DAYS; OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # II_
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 6 c l '
i:\dsts\forms\electric.doc
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3/6/00 Activities for Case #: ELC1999 -00719
9:35:28 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 APPlication received 12/2/99 BON RECD No Hold GEO 12/2/99
ELCC003 Permit created 12/2/99 GEO DONE No Hold GEO 12/2/99
ELCC730 Elect'I Service 2/1/00 BRP PASS No Hold AKJ 2/1/00
. ELCC500 (F)Issue permit 12/2/99 GEO DONE No Hold GEO 12/2/99
ELCA800 Case finaled 2/15/00 JMT DONE No Hold JMT 2/15/00
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Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /1/00 AM PM BLD
Location 0 - 4 q 0 Pec.6 Suite MEC
Contact Person ryvice Ph 53-312 PLM
Contractor Ph SWR
BUILDING Tenant/Owner i i^��R. ? ELC f 99 g -OO7/
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post &Beam (,1.(2 pis
Ext Sheath /Shear �� Q
Int Sheath /Shear
Framing
Insulation 1
Drywall Nailing L ' a /-4 Y i / 0 v / L) S- .. Y UI C Q
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof ?
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS ART FAIL
E TRIC _
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Fi
ASS\ ART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date Z 0 J
` e Ins Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.