Permit •
CITY OF TIGARD ELECTRICAL PERMIT
• 2 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00573
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/02/2012
Parcel: 2S 114AA00300
Jurisdiction: Tigard
Site address: 16295 SW 85TH AVE
Project: Durham Cell Site /Day Wireless Subdivision: 1993 -078 PARTITION PLAT Lot: 2
Project Description: (1) 200 amps or less for feader for wiring of cell site equipment
Contractor: WEST SIDE ELECTRIC CO INC Owner: WH SHIPMAN LIMITED
1834 SE 8TH AVE BY NORRIS & STEVENS INC
PORTLAND, OR 97214 621 SW MORRISON STE 800
PORTLAND, OR 97205
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/02/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 10/02/2012 $12.08
Type of Use: COM Electrical
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
•
t . 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
'1 '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 OA 95 - 001 -00 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � Permittee Signature: ,21( f 4/ / �e!.4 Ad
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.
2012-10-02 04:16 WEST SIDE ELECTRIC 15037360677 » 5035981960 P 2/2
Electrical 12elMilAppllicat ...,,,,iotif,. i " I,. It IR ()I.' u Ill .7;1 ( )" I 1
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City of Tigard 1 ...,,,,../ ,,.. , ''...7' . Received t o . I t x
,
Date/B : Permit No.: ....a.e1;491;kr 491551.3
lig --:' 13125 SW Ilan Blvd., Tigard. OR 97223 p CT 0 2 2012 ' Other Pamit: &P * 1
AO', * OD
' s ' Phone: 503.7182439 Fax: 503.598.1960 Date/B :
II , ,, ,., n Inspection Line: 503.639.4175 117f4111 El See Page 2 for
Supplemental infonnadoo
Internet: www.tigarcl-or.gev Cri-' ,IG;iti'ii.J.-* N :
• '
. , . .., ti.vIti.,..fi: . ' 0 ` :).Li •'- • ,
',.... ' - 5,";7.4;.: '''.'..=> 2%4:i:±7 ,. 4:4 ..., 1 .......ke ., 1 :n..,' , ti : i .•:41..... 20 A .:4,1 ,A ‘..ii 3 ..I. ■ ,, 7 • .i.. .} 114,,i . ...,..,, 0 %..e.,. . . O. P. ..,ITC...1 , ..., 1- -• • -
..T.,. ....;, `,..:,.... ' 1... - i . r .:: . ....'•-‘ 71r .. . . ,VAIIslilret:..710'71 .:‘ o. (0 r. ...'. . . • .. ■ ■• .i... .' ..... ' .... .6 ..- • .. i leace check ell that apply (submit seta of plans che cked below).
0 New construction 'El Addition/alteration/replacement ID Service or theder 400 amps or more 1:113uilding over three stories.
0 Demolition El Other: where the available fault current 0 Marinas and boatymds.
,
P' osur q-1,} JAY: Y Z:A exceeds 10,000 amps at 150 volts or a Floating buildings.
:, . - . - r■., - • '''' ' re w m t .,'S ' 1 ' ''. 011; '',.. , 'r ', ! r• ' % RCM ,, ,N50:: .;.. 1 al
,..._,,..___. ;. ::,,,..;... •407„...4,14:i:.". . --' A ' . 4 q:`,. ,L .• ,
.."''''..'■AtA.-;‘,....N.1.11-::,•,:?Arail: ' ..-'., ... '''''' • 44. len te ground, or exceeds 4,000 0 c ommerc i a l. = ag ricultur
1:1 I- and 2-iamily ' g Commcrcial/indu stria] 0 Accessory building amps for all other installations. buildings.
CI Multi-family 0 Master builder 0 Other: 0 FiTC Pur4P. 0 i of 75 KVA or
larger sepsnaely derived system.
. . rp,....-.., z.A 0 Emery:my SYstem-
4- .~., 1 1 i t. , • 1 : : . 5r f .. ., 1 '.. , 7,7 7 i,.....'., : l',i:77,...,,.... i , 7 . ,f4,75 - ...o7i, 7 1 4 , i . ,..,1...l iz ,, ,,,,, , ,, ...L.t...... , 62 : 1 ,. .. , 1f......,. , ,, , ..:1 - 5. 't,,,',"/,,i 0 Addition of new motor load of D"A" , "E "I -2", "14".
,.__. 100HP or more. occupancy.
Job no.: '7f /1 : Job si /6: ?
te , . , --,..: S /,
.. • 0 Sta or more residardial (Mb. 0 Reacational vehicle Wks-
/ 404 0140kb-care facilities. CI Supply voltage for more than
City/State/ZIP: ' ,e qr °Haze:dons looshons. 600 volts nominal.
— ' - A , . 0 Service or feeder 600 amps armors
Suite/bldg./apt. no.: Project name: i) ")
Ly , (c; i / .
-
Cross street/directions to job site: Kin NIM1201==.11111 ,
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1 so. ft. or less
, — 168.54 4
EL add'I 500 sq. ft, Or POrtiOrk 33.92 I
Tax map/parcel no.: Limited energy, residential 75.00 2
(with above Sq. ft.)
Limited energy, multi-family
i 75.00 2
fr 14// r J/2 7 al C e /1/ / e9L.4i,fir .0.4"- residential (with above sq. ft) _
Services or feeders installation, alteration, and/or relocation
,.,, 7 V -
200 amps or less / 100,70 pu L 2
201 ant to 400 a
Ps 133.56 2
— - 4 - ' ' - 401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301,04 2
—.__-
Address: Over 1,000 amps or volts 552.26 2 •
Temporary services or feeders Installation, alteration, and/or
City/State/ZIP: relocation
—..-------
Phone: ( ) j Fax: ( ) • 200 amps or less 59,36 I
- --
201 amps te 400 arnPs 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168,54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits- new, alteration, or extension, pr panel
Date: A. Fee for branch circuits with
O wner signature:.------ ....,..,.,,,
4 . - , Tia z.':^;:ti2.1:•T'AE: ' :477%7, :A S .i; ),. S' - !';',. ,,, WO.
l iVq s ..... - P , ^A' = ■%Z ., 2 i i • ■ $ f c 1,',:, ,..TYV ,...... ' .' '"O'iL....' , '1... , 'L ',-.: ' '‘;..r ' ''' each branch circuit 742 2
B. Fee fbr branch circuits without
Business name: SerViCe or feeder fee. lirat 56.18 2
branch circuit
Contact narne: Each add'I branch circuit 742 2
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Address: Miscellaneous service or fecde not included
• • E manu f a ctured or modular 67.84 2
City/Stare/ZIP: dwelling, service and/or feeder
Reconnect only 67,84 • 2
Phone: ( ) Fax: : ( ) Pump inigation circle 67.84 2
E-mail: Sign or outline lighting
67.84 2
7
4 ' 'ilt -' ' .e,ar .,..:a.-- ,t...- .,. .....16. .. :1-. •
..,`Pc. --,•• ' 2-10= •,' • ' k■:- ' di- 45-,,, - ,,,,,, - --••"'-'•• 1-4 '' a - e altera_m_l____L_i er____---NF--- extension. 2 2
Business name: West Side Electric Each additional inspection over allowable In an of the above
Address: 1834 SE 8 Ave. Additional linnet ( hr min) 6625/ hr
- Investigation (1 hr min) 6625/ In —
City/State/ZIP: Portland/OR/9721 industrial plant (I hr min) 7s.181 hr
Phone: (503) 23l-1548 Fax: (503) 736-0677 I nspec ti ons f which no .00/ hr
fee is
a. - ifical listed 14 hr min 90
.;:..y.7......7V: r! , • .'; - ,--- - '. ,'''' L 4 '" 4 '
Su -rv. *c 5698-S .. re., -----------,-.. - --- _.
CCH Lie.: 13306 El... , i l, Lic.: '. 13 , Subtotal: /00 -'--
/E.VTIli r WI" . A'
Suprv. Electrician signature, requi --.. . -
Plan review (25% of permit the):
u y
State surcharge (12% of permit fee): /2 -
Print name: Brent G Wall Date: /C2 2 / L _
- TOTAL PERMIT FEE: //1 It
Authorized signature: Thb permit opplIcalion expires if a permit is not obtained within ISO
— days after It has been accepted ea oomph:a.
Print name: i_Datc: • Number of inspections allowed per permit.
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440.4615T( I trostc0,kwEB
IMuilding\PorminNELC-PcnnitApp.doc 07/03/10