Permit „ CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00129
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/21/2013
Parcel: SEG877
Jurisdiction:
Site address:
Project: 217 Active Traffic Management Subdivision: Lot:
Project Description: (1) 200 amp service and (1) branch circuit for message signs for Hwy 217 corridor. This sign is located 500' eash
of SW Main St and Pacific Hwy (99 W), nearest cross street is SW Scoffins St.
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 02/21 /2013 $100 70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 02/21/2013 $7 42
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 02/21/2013 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 through OAR 952 -0 -0090 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: T:--
AV
s 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:
CONTRACTOR INSTALLATION ONLY 7�y�
SIGNATURE OF SUPR. ELEC' -- --z-.....„ .,.. - Date: 7— zl _zoo
LICENSE NO.
5Bffo3
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 ApplicatiaECE VED FOR OFFICE USE ONLY
Date/B / /3 67-1_ C. %3 -Dora 9
City of Tigard i y o2 02, Permit No
13125 SW Hall Blvd., Tigard, OR 9722F�B 2 1 2013 Plan Review
Phone: 503.718 2439 Fax 503 598.196 Date/By Other Permit
T I G A R D Inspection Line' 503.639 crry OF 1 ' I GARp Date Ready/By Juns. El See Page 2 for
Internet: www tigard -or gov ,� �� [� �1 Notified/Method- f (� Supplemental Information
TYPE OF WURK t�G DIVISION
PLAN REVIEW
ew construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans whlems checked below).
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Mannas 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 ❑ CommerciaUindustrial ❑ Accessory building amps for all other installanons buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately denved system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3
Ob no.: Job site address: C c ` (� \ ^ IOOHP or more occupancy
5� IwXJ x ` va\ 1 l 0 or more residential units ❑ Recreational vehicle parks
;Ci ty/State /ZIP: i a TILL) ❑ Health -care facilities ❑ Supply voltage for more than
t ❑ Hazardous locations 600 volts nominal
Suite/bldg./apt. no.: Project name: ' T �" `c`.. Service or feeder 600 amps or more
J j. ;� � 11� `�
`^\ G C FEE SCHEDULE
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Cross street/directions to job site: .\R� Description I Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
i���r s7 Includes attached garage.
7 Subdivision: S of ,� � / 2 Lot no.: 1,000 sq. ft. or less 168 54 4
Ea add'I 500 sq. ft or portion 33 92 1
Tax map /parcel no.: Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
11— Limited energy, multi- family 75 00 2
\IC!_6 % � s `c \ G 1.- 1\ \C.Q.) /g (6tA CV-433C\ k residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
. c0(� / �6 0J1 'C3p5 200 amps or less % 100 70 2
IM PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
C)00 401 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: ( ) Fax: ( ) 200 amps or less 59 36 1
201 amps to 400 amps 125 08 2
Owner installation: This installation is being made on property that 1 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 ivith
❑ APPLICANT I ❑ CONTACT 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: branch circuit
Each add'I branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67 84 2
Pump or Irrigation circle 67 84 2
E - mail:
Sign or outline lighting 67 84 2
CONTRACTOR
n Signal circuit(s) or limited - energy Business ��� '��� ir't q v Each additional inspection over allowable in any of the above
V Gcn. \. ) ���
panel, alteration, or extension. Page 2 2
l - �J
Address: C n�` �1 ( ' j ?8 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: 5 - 0� �4 lO Investigation (1 hr min) 66 25/ hr
t Industnal plant (1 hr min) 78 18/ hr
Phone: (5)3) 6e Z — f5Z Fax: ( ) Inspections for which no fee is 90 00/ hr
ip specifically listed (V: hr min)
CCB Lic.: 6 .77- Electrical Lic.: Suprv. Lic.: � 5 ELECTRICAL PERMIT FEES
VI
a� Subtotal'
Suprv. Electrician signature, require.. .
Plan review (25% of permit fee)
Print name"( _ SCD� Date: i3 State surcharge (12% of permit fee)'
` TOTAL PERMIT FEE.
Authorized si! nature: This permit application expires if a permit is not obtained within 180
� days after it has been accepted as complete.
Print n.t ` 1 Date: Z Zk - «-1 7 • Number of inspections allowed per permit
I\BwldmglPermits\ELC -Perms pp .oc 17 /01 /10 \ 440 -4615T(II /05 /COM/WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
, TIGARD, OR
Commercial - Electrical
199 Electrical final
2014-02-26 (null)
ELC2013-00129
PASS - No C of O
Violation Summary:
Inspector Contractor