Permit IICITY OF TIGARD ELECTRICAL PERMIT
■ COMMUNITY DEVELOPMENT Permit#: ELC2015-00110
T EC; 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/25/2015
C;
Parcel: SEG1627
Jurisdiction: TIGARD
Site address: SW No Address
Project: ODOT Subdivision: Lot:
Project Description: Traffic signal electrical service cabinet on the NW corner of Gaarde and Pacific Hwy.
Contractor: PRAIRIE ELECTRIC INC Owner:
6000 NE 88TH ST
VANCOUVER,WA 98665
PHONE: 360-573-2750 PHONE:
FAX: 503-576-7422
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 02/25/2015 $100.70
Specifics:, amps or less
2 crt Branch Circuits w/Purchase 02/25/2015 $14.84
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 02/25/2015 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
GGG 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.
Electrical Permit ApplicatisECE1E1) j OI (Hi1 1( I. I ‘,I O\I 1
Received ?- , Permit No.: 0,c
City of Tigard �,� . j� �00 C(d
:,t • 13125 SW Hall Blvd.,Tigard,OR 97 B 2 3 2015 Plan Review I Phone: 503.7182439 Fax: 503.598.1960 Date/B : Other Permit:
Inspection Line: 503.639.4175 UE TIGAR l Date Ready/By: 0 See Page 2 for
7:i"�:1i:1) ,ITY
Internet: www Ugard-or goy s Notified/Method: EM Supplemental Information
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❑
New construction ®Addition/alteration/replacement Please check all that apply(submit j sets of plans w/items checked below):
❑Service or feeder 400 amps or snore ❑Building over three stones.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
.'4:77., `+`t t , i'r t l' h',,' � +r " +r-..1..( r i- "1r1r it G°n:Trzl,rip:. :'- exceeds 10,000 amps at 150 volts or ❑Floating buildings.
' less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-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
4 .�.:*,,w ; � ❑Emergency system.
' r �4,a + y d s s 1 0, ll +t r , �,. a ❑larger separately der iv
ed system.
...,Ei6-.. .d ,�•. +;�.<,_f.�?�r- .ti, 1 �,. ,tY �.s.�ia. e ,„: , d.. i ❑Addition of new motor load of
100HP or more. occupancy.
Job no.:400162 Job site address:—13999 SW Pacific Hwy. ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR.97223 /6,17 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name (3. r' ❑Service or feeder 600 amps or more. `
Cross street/directions to job site:NW corner of the intersection of Dacriptioa Qtr. Pc. Total •
New residential single-or multi-family dwelling unit.
SW Pacific Hwy and SW Gaarde Street Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq.ft or less _ 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: -Limited
energy,residential
ntial
3a�" r � '�'��,c u .• w'r" , & 1,-;.9Mx"7��"*,,,.7.213,,F.,,,,,,,
°', �y g ,+ 4_�•�t� (with above sq.ft.)
75.00 2
,",,.� _ .d t.? Yil, ±,,.,-.....,.., .,n _.L..,;,„-,4, ,i . -,,,...�..:__ s. . ,Ij •
Limited energy,multi-family
75'00 2
Traffic Signal Electrical Service Cabinet residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
..,. *c r „ r a , ,.h r-^ 4 . °i r7+'. ,~ry I :� ,.T ,,, fs!i 200 amps or less 1 100.70• 100.70 2
K r
< r7 i 201 amps to 400 amps 133.56 2
'L fi.ti'f.�t �cn�-x r.a.�:.�.1JC�.�i:¢._F-. L,.�.��C+��k,.u..:i':.i+x.�.si-Yxi:,. ..._.xsr�Et �._.�...s,4 �.u.:sti_.
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 a 68.x4 2
Owner signature: Date: Branch circuits—new,alteration,or extension, r panel
t '40 'r,` ”" d . ' ' -.-,t r a-"r t' :'"., j A.Fee for branch circuits with
.,,1, /j _ L -, ::, ..1_.,: .;...4.may...-. ,..,:....,t.:':-.;,--::,..,.,., ,.,. ._ _ _.�_.:, ,i above service or feeder fee. 2 7.42 14.84 2
Business name:Prairie Electric Inc. each branch circuit
B.Fee for branch circuits without
Contact name:Wally Halberg service or feeder fee,first 56.18 2
branch circuit
Address:6000 NE 88 Street Each add'I branch circuit 7.42 2
City/State/ZIP:Vancouver,WA.98665 Miscellaneous(service or feeder not included)
tY Each manufactured or modular
Phone:(360)607-0359 I Fax: :(360)397-0501
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail:windyh @prairielectric.com Pump or Irrigation circle 67.84 2
11-: ,,:f'*}-1:'..cry. t >. ." 4^ fr 'ti} T.' ,',Y_.-k. .a .' •• Sign or outline lighting 67.84 2
Business name:Prairie Electric Inc. Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:6000 NE 88 Street Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Vancouver,WA.98665 Investigation(1 hr min) 66.25/hr
Phone:(360)573-2750 j Fax:(360)397-0501 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90,00/hr
CCB Lic.: 60178 Electrical Lic.: 37-491 Suprv.Lic.: )�),5 s ifical listed %:lir min
"i •( 'J �f :i, ;l nra
Suprv.Electrician signature,required: Subtotal: 115.54
Print name: Bill Halberg • Date: 2/10/15 Plan review(25%of permit fee):
I State surcharge(12%of permit fee): ..FiY O(ark
Authorized signature: TOTAL PERMIT FEE: 'r/,tR.ti 0
This permit application expires if a permit is not obtained within 186
Print name: Bill Hallo ° Date: 2/10/15 days after it has been accepted as compkte.
• Number of inspections allowed per permit. e I
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