Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00233
i
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/24/2013
T[GA.R.O 9 Parcel: SEG1115
Jurisdiction: Tigard
Site address:
Project: COT Street Light Subdivision: Lot:
Project Description: (1) 200 amps or less for service to street light ROW 12490 SW Main SE corner of Main and Burnham
Contractor: PRAIRIE ELECTRIC INC Owner:
6000 NE 88TH ST
VANCOUVER, WA 98665
PHONE: 800- 573 -2750 PHONE:
FAX: 360- 573 -9866
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/24/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 04/24/2013 $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 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- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,, II
Issued By: Permittee Signature: Al APi
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.
04/23/2013 16:27 FAX 360 573 9866 Prairie Electric Inc. ((( `5/...- 0 001 /002
Electrical Permit Applicati ; . CEIVED FOR OFFICE USE ONL1
Received 11 permit No.: ;� /-6L0 1 0 3 �33
City of Tigard DateB : -/
13125 SW Hall Blvd., Tigard, OR 9722 4 e Plan Review
60 ' . U . J Other Permit:
Phone: 503.718.2439 Fax: 503.597(.19 DateB :
Inspection Line: 503.639.4175 Date Ready/By: JYYq �- /' ® See Page 2 for
TI G A R D p
Internet: vvww.ti g and or. g ov CI OF TIGARD N I l 5� Supplemental Information
_
Please check all that apply (submit? sets of plans w /items checked below) .
® New construction ❑ Addition/alteration/replacement ❑ Service or feeder 400 amps or more 0 Building over three stories
❑ Demolition El Other:
where the available fault current ❑ Mannas and boatyards.
. _ . - ,, . _ , ., 000 amps at 150 volts or ❑ Floating buildings.
_ .. exceeds 10,
' � ex s
'---::;7' .. 5. _ - '• = less to ground, or exceeds 14,000 ❑ Commercial - use agricuhural
❑ 1- and 2 - family dwelling ® Cornmercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
y ❑ Emergency system. larger separately derived system.
• ? ❑ Addition of new motor load of ❑ ••A" "E" '•1_2",.'1 -3 ",
10011P or more. occupancy.
Job no.: Job site address: RIGHT OF WAY (1210 SW MAIN) ❑ Six or more residential units. ❑ Recreational vehicle parks.
� r��� ID Health-care facilities. ❑ Supply voltage for more than
City/State /ZIP: TIGARD, OR I �T�1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: CITY OF TIGARD STREET LIT ❑ Service or feeder 600 amps or more
Cross street/directions to job site: SE CORNER OF MAIN AND BURNHAM Deseriptioa oty. Fee. Total •
New residential single- or multi family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: - 1,000 sq ft. or less 168.54 4
- Ea. add' 1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
(with above sq. ft.)
Limited energy, multi - family 75.00 2
SERVICE FOR STREET LIGHT(S) residential (with above It
Services 0 amps or feeders installation, 1 h 00 110
n alt re ion, and/or relocation
_ „ 2 100.70 I 100
_, 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 59.36 1
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
Owner signature: Date: _ Branch circuits — new, alteration, or extension, r panel
:., '.-=',-.
_ { er f 7
. -_ Fee for branch circuits with
A. +i'
- " above service ar feed ee, 42 2
Business name: PRAIRIE ELECTRIC, INC. each branch circuit
B. Fee for branch circuits without
Contact name: ANITA PASO service or feeder fee, first 56.18 2
• branch circuit
Address: 6000 NE 88 STREET Each add'I branch circuit 7.42 2 _
Miscellaneous (service or feeder not included)
City/State /ZIP: VANCOUVER, WA 98665 Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) 503.286.9209 l Fax: : (360) 573.9866 Reconnect only 67.84 2
E -mail: anitap @prairielectric.com Pump or irrigation circle 67.84 2
. _ • _ . -. _ "° .- .. Sign or outline lighting 67.84
Business name: PRAIRIE ELECTRIC, INC. Signal circuit(s) or limited energy
panel, alteration, or extension. Pa • e 2 2
Address: 6000 NE 88 STREET Each additional inspection over allowable in any of the abov
Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: VANCOUVER, WA 98665 Investigation (I hr min) 66.25/ hr
Phone: ( ) 503.286.9209 Fax: (360) 573.9866 Industrial plant (1 hr mm) 78.18/ hr
Inspections for which no fee is 90.00 / hr
CCB Lic.: 60178 Electrical Lie.: 37 - 49 . \uprv. Lie.' S s tlicall listed (' /, hr min) h
Suprv. Electrician signature, required Subtotal: iOp, Q
Print name: BILL HALBERG Date; . j Plan review (25% of permit fee):
Z 7 = 1 _ State surcharge (12% of permit fee): } Za 01 _
Authorized signature: TOTAL PERMIT FEE: 1/ 71
This permit application expires if a permit is not obtained within
Print name: �` � Date: /7?-041/4 T �/t7 "r^�t days aft it has been accepted as complete. I J
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