Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2013-00596
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2013
Parcel: 2S102BA01201
Jurisdiction: TIGARD
Site address: NO ADDRESS
Project: Fanno Creek Trail-Main to Grant Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 53
Project Description: Lighting for Fanno Creek Trail under the Pacific Highway overpass and along Pacific Highway:(1)service and(7)
branch circuits for lighted bollards,junction boxes,and street lights.
Contractor: INLAND ELECTRIC INC Owner: TIGARD, CITY OF
360 SE BASELINE 13125 SW HALL
HILLSBORO,OR 97123 TIGARD, OR 97223
PHONE: 503-681-4700 PHONE: 503-639-4171
FAX: 503-681-4738
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/10/2013 $100.70
Specifics: amps or less
7 crt Branch Circuits w/Purchase 10/10/2013 $51.94
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 10/10/2013 $18.32
Electrical
Type of Const:
Occupancy Grp:
Total $170.96
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 9 -r.1-0090. You may obtain a copy of the r _ ect questions to OUNC by calling 503.2-2.1987 or 1.800.332.2344.
e"-\
Issued By: – ----- — Permittee Signature: milli;•mm
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 503.839.4175 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 _.`
i c,lt riGd lC " l'',.h (t)N1'.1 y
r City of Tigard Re«ived
� Date/B : ,O i+lll Perna[No.. ��-�0 l - a
ti .° 13125 SW Hall Blvd.,Tigard,OR 97223. Plan Review
Phone: 503.7182439 Fax: 503.59:1VAS r per pmt_ ZT
Inspection Line: 503.639.4175 `+` Q �t y y 0 See Paget for
I,1 L,-- il, p D 1° 17itcKcad!B i ��
Internet ww1►.tigtlyd-or.gov O� Notified/Method:,On Supplemental Information
TYPE.OF.-WORT{ 4010 V'TlGl� ' PLAN REVIEW
®New construction ❑Addition/afterationl�� Please check all that apply(snbmit2 sets of plans wfitems checked below):
❑Demolition ❑Other: 81 ❑Service or feeder 400 amps or more ❑Building over three stories
where the avalable fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
l/induslrial less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ I-and 2-family dwelling ❑Commeicia
❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder
®Other:Trail Light ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE LYFORMATION•AND LOCATION 13 Emergency system. larger separately derived system.
❑Addition of new motor load of ❑°A ","l.2^°1.3
Job no.:CIP 92024 lob site address:City owned property(n/a) 100HPormore. o ancy.
❑Six or more residential units.
City/State/ZIP:Tigard,OR.97223 ❑H•rl faliti-. Supply voltage for more that
'9 .1 .r / 1 600 volts nominal.
Suite/bldg./apt.no.: Project name:Fanno Crk Tri: Main-Grant ❑! !'ce`r :-,cr•rt amps or more.
FEE SCHEDULE -
Cross syreet/directions to job site:On Fanno Crk Trail adj.Tigard Bicycle& Description I Qty.] Fee. I Total 1 •_
Ski(12549 SW Main St).Along HWY 99W adj.to Fanno Crk Apartments New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.IL or less 168.54 4
Tax map/parcel no.:2S102AC00800,99W r/w Ea.add']500 sq.R.or portion 33.92 1
Limited energy,residential 75.00 2
DESCRJP ION OF WORK- (with above sq.R)
Limited energy,multi-family 7500 2 Installation of 99W Undercrossing Lighting,lighted bolloards,j unction boxe s,
residential(with above sq.R.)
street lights,circuits,aloe Fanno Crk Trail at 99W undercrossin and along 99W Renewable Energy ❑See Page 2
g g Services or feeders installation,alteration,and/or relocation 1
® PROPERTY OWNER ' - -I -• • ❑ TENANT 200 amps or less i 100.70 r 2
1�J .?J
Name:City of Tigard 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: 13125 SW Hall Blvd 601 amps to 1,000 amps 301.04 2
City/State/ZIP:Tigard,OR.97223
Over 1,000 amps or volts 552.26 • 2
Temporary services or feeders installation.alteration,and/or
Phone:(503)718-2466 Fax:( ) relocation
Owner installation:This installation is being made on property that I own which is not 200
amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125,08 2
401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,Per panel
❑ APPLICANT . . • I . ►l-CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7
7.42 f,j'/ 2
'Business name:City of Tigard each branch circuit
B.Fee for branch circuits without
Contact name:Jeff Peck service or feeder fee,first
branch circuit 56.18 2
Address:13125 SW Hall Blvd Each add'Ibranch circuit 7.42 2
City/State/ZIP:Tigard,OR 97223 Miscellaneous(service or feeder not included)
Each manufactured or modular
67.84 2
Phone:(503)718-2466 Fax::( ) dwelling service and/or feeder
Reconnect only 67.84 2
E-mail:jeffp@tigard-or.gov Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: ItAeo.4 E)J ef� '�i�� b )3,( Signal circuit(s)orlimited-energy See
- -
`x� "1 panel,alteration,or extension. Page 2 2_
Address: ,c. 6 5E %'-tC Sc_l 1 0,,,t_ SF Each additional inspection over allowable in any,of the above
Additional inspection(I hr rain) 6625/hr
City/State/ZIP: N It1sbb1 °Jk„ 91 14S Investigation(1 hr min) 66.25/hr
Phone:(,S,..6) (A i ,y W Fax:(,j, ) (,t i 1.' )3c Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: tS1 (4,-S"�l]il/qt Electrical Lic.: 3d � C Suprv.Lic.: 55405 specifically listed(%,hr min) 90-00/hr
Supt'.F.lectriciail' gtlatGr�,required: r r��e / Jbl lift ELECTRICAL PERMIT FEES
�- '+ IS.1, C4 ,
1'`,31 C.J Subtotal:
Print name: gs�.A 0 tS Date:tic,/s3 Plan review(25%of permit fec):
' State surcharge(127o of permtt fce): i :).74.
Authorized signature: _v .... TOTAL PERMIT FEE: j)() ,ti TOTAL
This permit application expires it's permit is not obtained within 180
Print name: Sitvtr kij1 0 Date: S/<//3 days after it has been accepted as complete.
• Number-of inspections allowed per permit.
l:\BuiidingaPcrmits%ELC PennitApp ELR ERF doc Rev052112013 400-a6I5T(1 1t05/COWWEB
General Ledger
• Journal Entry Proof List
11111 •
User: AmyL
Printed: 10/10/2013- 4:53 PM
Batch: 10013.10.2013 T I G A R D
Account Number Account Description Debit Amount Credit Amount Line Description Project Management
Journal Entry: 176-04-2014 Journal Entry Date: 10/10/2013
100-0000-24001 State Building Permit Surcharg 0.00 18.32 Electrical Permit-ELC2013-00596-Fanno Creek Trail
100-0000-10100 Cash 18.32 0.00 Electrical Permit-ELC2013-00596-Fanno Creek Trail
220-0000-43103 Electrical Permit Fees 0.00 100.70 Electrical Permit-ELC20I3-00596-Fanno Creek Trail
220-0000-43103 Electrical Permit Fees 0.00 51.94 Electrical Permit-ELC2013-00596-Fanno Creek Trail
220-0000-10100 Cash 152.64 0.00 Electrical Permit-ELC2013-00596-Fanno Creek Trail
420-8000-56005 Capital Improvement Projects 170.96 0.00 Electrical Permit-ELC20I3-00596-Fanno Creek Trail
420-0000-10100 Cash 0.00 170.96 Electrical Permit-ELC2013-00596-Fanno Creek Trail
Journal Entry Totals 341.92 341.92
Journal Entry Balance 0.00
Report Totals: 341.92 341.92
•
0.00
•
GL-Journal Entry Proof List(10/10/2013- 4:53 PM) Page 1
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
NO ADDRESS, TIGARD, OR
Commercial - Electrical
199 Electrical final
2014-01-23 00:00:00
ELC2013-00596
PASS - No C of O
Violation Summary:
Inspector Contractor