Permit irL „ CITY OF TIGARD ELECTRICAL PERMIT
1 11 COMMUNITY DEVELOPMENT Permit #: ELC2013 -00124
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/21/2013
Parcel: SEG331
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 at
southbound off ramp near Greenburg Road.
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 O 952- - 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:
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: El-go r
LICENSE NO. 585 -�--
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 oNialins FOR OFFICE USE ONLY
Cl Of Tigard Received permit No
° 131 Hal Blvd., Tigard,OR 97223 £I j 83 DateBv a .2//3 Eccao,c3 - ao is V
: Plan Review Phone. 503.718 2439 Fax: 503 598 1960 Date Other Permit.
Date/By
T I G A R D inspection Line' 503.639.4175
3 ::i 33 }J Date Ready/By Juns ® Pee Page 2 for
Internet. www tigard-or gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
ew construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stones
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 agncultural
❑ 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ 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 denved system
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
4 �17 �° I00HP or more occupancy
Job no.: Job site address: ( QQ
��� � Z1a� ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: 0C0A (Z.._., ❑ Health -care facilities ❑ Supply voltage for more than
❑Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: akq RA;` "" " ��` "� y °" Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: `te ) \-- y ..�, ��,�1p Description 1 Qty. I Fee. 1 Total 1 '
✓ " — New residential single - or multi- family dwelling unit.
`S �R�IX QA, (69-) includes attached garage.
r /i ( � Subdivision: c4 3 3 f 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 )
Limited energy, multi - family 75 00 2
\ks � y �, t J N c `� --\'k'Cli I g 6 CVu residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
-.0( \.., / ,A �� 3 /na 01�, 200 amps or less ` 100 70 2
Ili PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
Name:
C)00 1 401 amps to 600 amps 200 34 2
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
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 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 ❑ 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 imgation circle 67 84 2
E - mail:
Sign or outline lighting 67 84 2
CONTRACTOR Signal ctrcuit(s) or limited- energy
Business name: . � - t n � l panel, alteration, or extension Page 2 2
/� ` `Q� �n\ 4J���� �`�� ....LC__., Each additional inspection over allowable in any of the above
Address: `�-� C ?A Additional inspection (1 hr min) 66 25/ hr
City/State /ZIP: 5 < C2 9 4 HO '� Investigation (1 hr min) 66 25/ hr
( T Industrial plant (1 hr min) 78 18/ hr
Phone: (�O3) 6ez -ga►jZ Fax: ( ) Inspections for which no fee is 90 00/ hr
specifically liste (h hr min)
CCB Lic.: tlj�z ( ? 3 I Electrical Lic._ Suprv Lic.: 4 . 5 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, require'. r, ,------_ Subtotal:
Plan review (25% of permit fee).
Print name �1 ti `7�("--/ Date: a l 7(gl3 State surcharge (12% of permit fee):
TOTAL PERMIT FEE'
Authorized si •nature:
_ r This permit application expires if a permit is not obtained within 180
Print n.1 ` e:'� Date: Z — a -� days after it has been accepted as complete.
Number of inspections allowed per permit
1 \Building\ Permns\ELC- Permit p dcc 7/01/10 440- 4615T(I I /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
SW NO ADDRESS, TIGARD, OR
Commercial - Electrical
199 Electrical final
2014-02-26 (null)
ELC2013-00124
PASS - No C of O
Violation Summary:
Inspector Contractor