Permit y CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2014-00428
T!GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/04/2014
Parcel: SEG0716
Jurisdiction: TIGARD
Site address: NO ADDRESS
Project: ODOT Subdivision: Lot:
Project Description: Replace meter for signal on Northeast corner of intersection of Hwy 217 and 99W.
Contractor: ODOT Owner:
9200 SE LAWNFIELD RD
CLACKAMAS, OR 97015-8585
PHONE: 971-673-6201 PHONE:
FAX: 971-673-6202
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/04/2014 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 08/04/2014 $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 acc 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: Orego law requires you to follow the rules adopted by the Oregon Utility Notifica' Center. Those rules are set forth in OAR
952-00 010 through OAR 952 0 4ray obtain a copy of th rules or direct questions to OUNC by calling 503. 32.1 1.800.33 2344.
Iss ed 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' I i ' 4 .r i�C`A`T <� Date: f 7 /
LICENSE NO. �v�
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 Applicati FOR OFFICE USE ONLY
Recei ved �j �^LC ��ry City of Tigard / DateB : Z5 Permit No.: L j a;I - 13125 SW Hall Blvd.,Tigard OR RECEIVE1 fff Plan Review
Phone: 503.718.2439 Fax: 503.598.1'.1 r Other Permit:•U Date/B
Inspection Line: 503.639.4175 4 Z 14 Date Ready/By: Juris Ei See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CINVIKivib
TYPE PLAN REVIEW
y�/��+�/� Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction Addition/altera ion/c'�I�f'e`Me�INt'
0 Service or feeder 400 amps or more 0 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 ❑CommerciaUindustrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","1-3",
Job no.: Job site addressi9/ j7�ff//��/ ��� I00HP or more. occupancy.
/ /!�/f/ ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than
e ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name: ei7� ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: W Description I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4
�N/6 Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: G 4( W Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
75.00 2
e p 1a rne� er 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 / 100.70 ,iii)x70 2
_ 201 amps to 400 amps 133.56 2
Name:
O('�rp to �i- 0� (1 kn Spa, ( j.e.,{14vti 401 amps to 600 amps 200.34 2
Address: ��v S-$_ iii -wr% Kt.( 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: C c_kh-en.4 S O K Temporary services or feeders installation,alteration,and/or
Phone:( ( )(403 G2.40 relocation 1 Fax:( ) 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,per panel
❑ APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name: O oT ..`c L,1-r I`.41 each branch circuit
B.
Fee for branch circuits without
Contact name: V c. Ph Art service or feeder fee,first 56.18 2
branch circuit
Address: GD.0o .5c. M....0 h l A Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: 6).4c.,k,g,ye,q S 0 R Each manufactured or modular 67.84 2
Phone:(Q'7 ) 0 Fax: :( ) dwelling,service and/or feeder
rf • lD Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Cy. D. d.j Signal circuit(s)or limited-energy See
/ panel,alteration,or extension. Page 2 2
Address / Each additional inspection over allowable in any of the above
���, ......00„,, i'a.��L �� Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:G' i i 5;;;v7i/j/ Investigation(1 hr min) 66.25/hr
Phone:(97/ 473 6 C9/ Fax:9Weer73,� Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic /��/ d Electrical Lic.: 24-)?�C. ,'j uprv.Lic.: 5 go(S specifically listed(Y hr min)
'� Ile ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: e7� n ,l (pll Subtotal: 100.70
Print name: D h 5 1" Date: g/( /( �• Plan review(25%of permit fee):
State surcharge(12%of permit fee): f �'`d
Authorized signature: ( TOTAL PERMIT FEE: //),.. 7 Si.
This permit application expires if a permit is not obtained within 180
Print name: do k g s ye Date: s 11 /t I G� days after it has been accepted as complete.
* Number of inspections allowed per permit.
1.Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(11/05/COM/WEB
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
NO ADDRESS
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00428
Herb Stabenow
Violation Summary:
Inspector Contractor