Permit 74 ' - CITY OF TIGARD ELECTRICAL PERMIT
n
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00673
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/28/2012
Parcel: SEG0716
Jurisdiction: TIGARD
Site address: SW NO ADDRESS .
Project: ODOT Subdivision: Lot:
Project Description: Installation of new electrical service for new traffic signal on the ramp from SW Pacific Hwy to northbound Hwy 217.
Contractor: SIGNAL CONSTRUCTION GROUP Owner: ODOT
10780 SW CLUTTER RD TIGARD, OR
SHERWOOD, OR 97140
PHONE: 503 7682 -2252 PHONE:
FAX: 971 - 216 -0079
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 11/28/2012 $100.70
Specifics:, amps or less
1 ea 12% State Surcharge - 11/28/2012 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 cordance wi 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 ENTION: Oregon re s you to follow the rules adopted by the Oregon Utility Notification Center. Th - 'a =. ar7et forth in OAR
952 -001 0010 through OAR 952-0 090. Yo ay obtain a copy of the rules or direct questions to OUNC by ing 503.232. • • • r 1 .00.332.
Issue By: L4�� `N"/k—/ 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:
• , ' - OR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' e...e., - • _ - Date: // c 9.g'/ 2 .--
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.
Electrical Permit Application RECEIVEr roll Ohr•ICI us,: oNl.Y
IL e ii City of Tigard NOV 2 8 2012 Date/By: if Af /p Z13 Permit No.: eL C O 2c/ 00 73
13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
' r 1 Phone: 503.718.2439 Fax: 503.598.19! " I� Date/By: Other Permit:
Inspection Line: 503.639.4175 �� Date Ready/By: tuns: la See Page 2 for
I I C A R D B UILDING DIVISION N otified/Method: Supplemental www.tigard- or.gov PP lemental Information
T1J�E OF WORK PLAN REVIEW
❑ New construction aA Adddition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items 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 Ek mmercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", 'l -3 ",
Job no.: Job site address: q (,l IOOHP or more. occupancy.
6Q- `�� �+ �� �� ❑Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: l k ` �Q �� _ 13 Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: atro . 5 ` 0 g - a 1 t '- ' if r.b _ ❑ Service or feeder 600 amps or more.
V t� s ` 7✓ FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
/� New residential single- or multi - family dwelling unit.
OltIg -/L1/' SEG o 7/ (p Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Tax Ea. add'l 500 sq. ft. or portion 33.92 1
ax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
�,, Limited energy, multi - family 75.00 2
T
L Q� 0 S `C � �, qC residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
(c Lc: Tca tc. Sc�'Ct9.\ 200 amps or less , 100.70 / 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
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
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
h relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I IRGSITACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name eiCN. csc CA1 branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Ci /State /Z[P: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: (7I ) a35- 5o04 Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
w `
E -mail: O �C3: c'c ''CZ -COM —
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: S \I C Qt' r \ ' 4 ? l 1 panel, alteration, or extension. Page 2 2
1 f V Each additional inspection over allowable in any of the above
Address: « �t VV� t, '\ hrt I c k Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: � �,` \ � Cie_ i
Q' Investigation (1 hr min) 66.25/ hr
'j l Industrial plant (1 hr min) 78.18/ hr
Phone: (5:55) ) 90.00/ hr
�"� Z — 2Z Fax: ( 7� /// 4 7 / Inspections for which no fee is
�j specifically listed (V2 hr min)
CB ,Lic.: ic.: I ‘937 Electrical Lic.: G`�� Suprv. Lic.:5C-{( ELECTRICAL PERMIT FEES
3 t/ Subtotal: /o .7C.)
Suprv. Electrician signature, required: —
Plan review (25% of permit fee):
Print name: OVOC1 �` - Date:" a — t_ State surcharge (12% of permit fee): /p,- 0 g
TOTAL PERMIT FEE: // .2 „, 7e
Authorized sig atu ��� T his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ate: • Number of inspections allowed per permit.
1:\ BuildingWermits \ELC- PermitApp.doc 07/01/10 440 -4615T(I1 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permits\ELC- PermitApp.doc 07/01/10
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
SW NO ADDRESS, TIGARD, OR
Commercial - Electrical
199 Electrical final
2013-12-31 (null)
ELC2012-00673
PASS - No C of O
Violation Summary:
Inspector Contractor