Permit a CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00966
73125 SW Hall Blvd.,Tigard OR 97223 503 718 2439
Date Issued: 12/09/2015
Parcel: SEG3625
Jurisdiction:
Site address: SW NO ADDRESS
Project: Pacific Highway Improvements Subdivision: Lot:
Project Description: (1)service and(2)branch circuits for irrigation. This work is located at the NE corner of the intersection at Pacific
Highway Frontage Rd 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 12/09/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 12/09/2015 $13.86
Type of Use: COM Electrical
Class of Work: ALT 2 crt Branch Circuits w/Purchase 12/09/2015 $14.84
Service or Feeder
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 fonh is OAR
952-001-0010 through OAR 952-001-0090
� ( oPY o rules or direct questions to OUNC by calling 503 232 1987 or 1 800.332 2344
Issued By: s Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made an property I awn 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 tho job site until completion of the project.
Approved plans are required on thejob site at the time of each inspection.
Electrical Permit Application[ E1VEmg]Mglmmlmm�, EMISSION!
City of Tigard n,wed, t P.mit a: I S—
• 13125 SW Hall Blvd.,Tigard,OR 97223 1 Plan Re:
■ phone: 503.718.2439 Fax: 503.598.1960 pEC ate/B : Related Pemdt#:
Inspection Line: 503.639.4175 a TIGAA y By: I.M. O See Pae 2 for
Intemet: www,tigard-or.gov ,'t♦�Q` IS` ethod: SuppkmenW lnfornisoon
New COMMIction ❑Addition/alteration/replacement Please check all that apply(sabmit Ssm.(pian w/nemschmked):
0 Service or feeder 400 amps or awn Q Building ova Wrte aeries.
❑Demolition ❑Other. ,hare the available(atilt current 0 Mariam and bo rw&.
exo ods 10,000 amps d 150 volts or Q Floating baildings.
❑1-and 2-family dwelling ®Commercial/industrial ❑Accessory building lees to ground,or excen&14,000 ❑c.mmeteial-use agricukuml
❑Multi- Master builder Other. .apes for all other hunnatiom. buildings.
family ❑ ❑ ❑Fire pump. ❑Installation of ISO KVA or
Q Emergency system. larger separately derived
❑Addition of new motor load of syaem
Job#:
400162 Job site address: 14098 SW Pacific Hwy. 100HPormom. ❑"A","e',"l-2-,-I-3
City/Stat tdZIP: TI ard.OR.97224 QSixormore>eaidentwluoin. occopin0 Reue.wy.
onel vehicle Phs.
Q NeaIW<am facilities.
Suite/bldglapL#: Project name: OR99W:Gaalde/MeDonald 0 Hezardoes lucatioae. ❑supply voltage for store than
❑Service or feeder 600 amps or mart. 600 volts ruminal.
Cross street/directions to job site: SW Pacific &SW Canterbury Lane
r Dau naei try. I Goa I T.w
New residential single-or multi-fandly dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or leas 168.54 4
Fa.aM'l 500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
The service will feed an irrigation controller.The service is 120/240 volt,single phase 200A with some sq.ft.
Limited energy,multi-family 75.00 2
residential with above sq.ft.
Renewable En Q Q-9...2
Services or feeders installation aIteration,and/or relocation
Name: 200 s qtr or less 1 1 100.70 100.70 2
Address: 201 amps to 400 amps 13336 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders Installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I owe which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.os 2
Owner signature: Date: 401 amps m 599 atop, 168.54 2
Branch circuits-new alteration or extension,perpamel
A.Fee for branch circuits wish
Business name: Prairie Electric,Inc, above service or feeder fee, 2 742 14.84 2
each branch circuit
Contact name: Wally Halberg B.Fee for branch circuits wilhout
service or feeder fee,Ont 56.18 2
Address: 6000 NE 88th Street,Building'13",Suite 101 branch circuit
City/State/ZIP: Vancouver,WA.98665 Fath add')branch ci rcun 7.42 2
Miasellaneouaservice or feeder not include
Phone:( 360 ) 573.2750 Fax::(360 ) 397.0501 Each manufactured or modals
dwelling,service and/or feeder 67.64 2
Email: wlndyh@prairieleetric.com Reconnect only 67.84 2
Pump or irrigation Circle 67.84 2
Business name: Prairie Electric,Inc. Sign or outline lighting 67.Ea 2
Signal chcuit(s)or limitedt orgy 0 See Page t 2
Address: 6000 NE 8M Street panel,alteration or extetab
City/State/ZIP: Vancouver,WA.98865 Each additional Inspection over allowable in an of the above
Additional inspection(I hrmin) 66.25/hr
Phone:( 360 ) 573.2750 Fax:( 360 ) 397.0501 Investigation(1 hr min) 90.00/hr
Email: windytt@pfaldelecitic.com mal L Industrial plan(]hr min) 79AS/hr
Inspections for which no fee u 90.00/In
CCB Lic.: 60178 Electrical Lic.-96666— Suprv.Lie.: j j 1AA5 cifical fisted K b<min
Suprv.Electrician signature,requi Subtotal: 1 115.54
Print name: gill HalbBrg Date: 12.7.2075 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 13.86
Authorized signature: 'TOTAL PERMIT FEE: 129.40
This permit apPlieanoa eapirs,if a permit b not obtained within 180
Print name: Bill Halberg Dat ' .1.2015 days after It has been accepted as complete.
• Number ofimpeenom allowed per pemtil.
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