Permit p CITY OF TIGARD ELECTRICAL PERMIT
• * COMMUNITY DEVELOPMENT Permit#: ELC2014-00382
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/14/2014
Parcel: SEG2377
Jurisdiction: TIGARD
Site address: NO ADDRESS
Project: ODOT Subdivision: Lot:
Project Description: NW corner of 99w&Durham Rd: (1)service and(3)branch circuits for modification of existing traffic signal.
Contractor: SUNDOWN ELECTRIC CO Owner:
PO BOX 129
FOREST GROVE, OR 97116
PHONE: 503-359-0604 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/14/2014 $100.70
Specifics: amps or less
3 crt Branch Circuits w/Purchase 07/14/2014 $22.26
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 07/14/2014 $14.76
Electrical
Type of Const:
Occupancy Grp:
Total $137.72
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 acco 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. AT ION: Oregon :w -• ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 010 through OAR 952-0 1-0090. Y•u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 8 or 1.800.332.2344.
Issu d 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' ° G Date: 7//41/7y
LICENSE NO. 3L/17 5
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 I FOR OFFICE ESF.t,\I 1 p
City of Tigard Date/B 7 /`l fil O Permit No.:(/LJ..(j/ /A9 5 L
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
s Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
I I t, \H I Inspection Line: 503.639.4175 Date Ready/By:
Avis. Si See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Informadon
TYPE OF WORK PLAN REVIEW
❑New construction 0 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.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ i-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: ❑Fire pump, ❑Installation of 150 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E","1-2","I-3",
Job no.: 14-084 Job site address: Durham Rd @a 99W (, ' 3 7 7.) 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:OR99W:Durham Rd-Fischer ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 4T124 ft- '3 7 7 Description I Qty. I Fee. I Total I •• New residential single-or multi-family dwelling unit.
O kr-# 6.9-.5 T eGI A.)e'/L Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 l
Tax map/parcel no.: -
Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
Traffic Signal Modification residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,,alteration,and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less I 100.70 100.70 2
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:( ) Fax:( ) relocation - - -
200 amps or less 59.36 I
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,per panel
❑ APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 3 7 42 22.26 2
Business name: each branch circuit _
B.Fee for branch circuits without
Contact name: service or feeder fee,first
branch circuit 56.18 2
•
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Sundown Electric Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 _ 2
Address: PO Box 129 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP: Forest Grove,Oregon 97116 Investigation(1 hr min) 66.25/hr
Phone:(503)359-0604 Fax:(503)359-0206 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 67442 Electrical Lic.: 37-445-C Suprv. Lic.: 3427-S specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 122.96
Print name: Gene Nelson Date: 7-14-14 Plan review(25%of permit fee):
State surcharge(12%of permit fee): 14.76
Authorized signature: TOTAL PERMIT FEE: 137.72
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Building,.Perini ts\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(I1/05/COM/WEB