Permit •
CITY OF TIGARD ELECTRICAL PERMIT
il
' ' -.- COMMUNITY DEVELOPMENT Permit #: ELC2012-00674
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/28/2012
- -. •-,-, . Parcel: SEG2063
Jurisdiction: TIGARD '
Site address: SW NO ADDRESS
Project: ODOT Subdivision: Lot:
L.
Project Description: Installation of new service for new traffic signal and installation of temporary service for temporary traffic signal.
Located at intersection of SW Pacific Hwy and SW Beef Bend
Contractor: SIGNAL CONSTRUCTION GROUP Owner: ODOT
10780 SW CLUTTER RD TIGARD, OR
SHERWOOD, OR 97140
• PHONE: 503 - 682 -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 Temp Services or Feeders - 11/28/2012 $59.36
Type of Use: COM 200 amps'or. less
Class of Work: ALT 1 ea 12% State Surcharge - 11/28/2012 $19.21
Electrical
Type of Const:
Occupancy Grp:
Total $179.27
Required Items and Reports (Conditions)
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 t •ugh OA' ' • - 001 -0091 You may obtain a copy of the rules or direct questions to OUNC by calling 503. 987 or 1.800. .
Issued By: `'—./ — - i Permittee Signature: �■
OWNER INSTALLATION ONLY r
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date: . •
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' C ■ Date: /, „l$ y
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 ApplicatioRECE E Rec eived D FOIZ OhFICI: USE. ONLY
City of Tigard
II 111! // 8 �R Permit No.: L P / 2-!XJ 7
Date/By:
• 13125 SW HaII Blvd., Tigard, OR 9722 • 2 8 2012 Plan Review
C . Phone: 503.718.2439 Fax: 503.598.196 Date/Ely: Other Permit:
I' I G A RD D Inspection Line: 503.639.4175 CITY T'^ a D n Date Ready/By: Suns: ® See Page 2 for
Internet: www.tigard- or.gov V f �1 /'+ TIGARD Notified/Method: Supplemental Information
T PE OF t.), •
kQING DIVISION PLAN REVIEW
❑ New construction Addition/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.
, L — VJ , C` less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ommercial/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 ", "I -2 ", "l -3 ",
Job no.: 1 Job site address:�,,(� Q IOOHP or more. occupancy.
11CX r'[ `� ❑Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: -- "Ci c6 cxtd i { � j7aa ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name /s- \` ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 5E 3.2 6,3 Description I Qtr. I Fee. I Total I
-�ert,e6tcx i C 910 � r New residential single- or multi-family dwelling unit.
•� Includes attached garage. _
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'I 500 sq. R. or portion 33.92 I
Tax map /parcel no.: . - '77 7 .=-I. - - -- : - - .. - - Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
71 ('. Oa 0� EGA U ktn It CN't`C4 .C.,T: .c"Ca residential (with above sq. ft.)
Services or feeders installation, alteration, and/or•.relocation
Ct4414 - Ceirn? S2Kl cQj SOS- ' V bkO. 200 amps or less ( 100.70 (00 • PC 2
PROPERTY OWNER ❑ 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
relocation a
Phone: ( ) Fax: ( ) 200 amps or less 4 59.36 6'/ .d I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
/' each branch circuit
Business name: S l /i ��(Z� R l B. Fee for branch circuits without
service or feeder er r feeee, first 56.18 2
Contact name: ".- ci branch circuit
Each add'I branch circuit 7.42 2
Address:1).0. �t: 5‘` C�w'k]o OQ 1(-40 Miscellaneous (service or feeder not included)
1 ' ) ) l O � Q ? ; Each manufactured modular
Ci ty ( ` /State /ZIP: ` l g o
dwelling, , service and/or or r feededer 67.84 2
Phone: (503) 6$ Z _ zz Fax: : ( ) Reconnect only 67.84 2
E -mail: �� t 1 PJC.CSCLkO c c� cX 1(S tZ . Can Pump or irrigation neigt 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR
Signal circuit(s) or limited- energy
Business name: S , panel, alteration, or extension. Page 2 2
q
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (V2 hr min) 90.00/ hr
CCB Lic.: ` ept 373 Electrical Lic.: G`C1 Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: a Subtotal: /60 • 06' Plan review (25% of permit fee): .—'
Print name d 71_,1/44) -, , _. Date: (l Z8_ zo (Z State surcharge (12% of permit fee): / q . R /
c____'..—...—...`) TOTAL PERMIT FEE: l 7 9. 2
Authorized sighatu —. ` - ■ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Dat+ * Number of inspections allowed per permit.
1:\Building\Permits\ELC- PermitApp.doc 07/01/10 440 -4615T(11 /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*
El Vacuum Systems*
❑ Other: •
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
E l Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ 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)
ELC2012-00674
PASS - No C of O
Violation Summary:
Inspector Contractor