Permit (36) °s.
CITY OF TIGARD ELECTRICAL PERMIT
'- COMMUNITY DEVELOPMENT Permit#: ELC2017-00519
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/12/2017
TE '. 9 Parcel: 1S136CC00000
Jurisdiction:
Site address: PACIFIC HWY/HWY 217
Project: ODOT Subdivision: Lot:
Project Description: Replace service meter on the south side of the northbound on ramp to Hwy 217 from Pacific Hwy.
Contractor: ODOT Owner: ODOT
9200 SE LAWNFIELD RD 9200 SE LAWNFIELD RD
CLACKAMAS, OR 97015-8585 CLACKAMAS, OR 97015
PHONE: 971-673-6201 PHONE:
FAX: 971-673-6202
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 07/12/2017 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 07/12/2017 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports(Conditions)
AI
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all • er -•plicable 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 w'.rk is °uspended for more the 180
days. ATTEN ON Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. ' ose ules are set forth in OAR
952-001- 10 through 95 - 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19:7 or 1.:0• '.2344.
. LSStel 4 1Pf i'
Issu By: Permittee Signature: �' f/G
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' _T Date:
LICENSE NO. g 7 z(6 S
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.
E1ec_*rical Permit ApplicaFOR OFFICE USE ON
�` i4ECEIVED Received / , Permit#: EL.L.�/7"� 57/
City of Tigard DateB : 7 /.2-(17 Will
II r 13125 SW Hall Blvd.,Tigard,OR 972*1 1 2 2017 Plan Review
Phone: 503.718.2439 Fax: 503.598. Date/B : Related Permit#:
I Inspection Line: 503.639.4175 v ,--Nr: (� Ready Date/By: Juris: ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov CIT i v i 1 i"'ARv Notified/Method: Supplemental Information
p G pIVISIQ�N
III l : . , TYPE t 5 1' II1 11 , PLAN REVIEW
Please check all that apply(submit 2 sets of plans w/items checked)
❑New construction ®Addlt101l/alteratlOtl/replaCement ❑Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
!h „la, - :� 'ql 1p!I Ids'
CATEGORY QF CONSTRUCTION... 4,,' I1111
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultutral
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATIO 4tANDr LOCATION a 0❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:HWY 217&HWY 99W NE CORNER 100HP or more. ❑"A","E">`°t-2",°`t-3",
❑Six or more residential units. occupancy.
Rec
reaho
nal vehicle arks.
City/State/ZIP:TIGARD/OREGON/97223 ❑Health-care facilities.
P
❑Hazazdous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name:RAMP METER SERVICE ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:217&99W BEHIND GUARD RAIL .0 ° !II 11111 , X11 FEE SCHEDi1LE 11 111,1 11'1' 10!'
e.0-1",2.5Description I Qty. I. Each I. Total
/j g..
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: / /3/E♦"at,D/QCT Ea.add'I 500 sq.ft.or portion 33.92 1
l ` " 44' `, Il ..'DESCRIPTION'OF WORK .$` 1 Limited energy,residential 75.00 2
REPLACE SERVICE THAT WAS HIT BY A CAR (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy
0 See Page 2
®..PROPERTY,OWNER ' ;, ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:ODOT 200 amps or less 1 100.70 1 2
amps to 400 amps 133.56 2
Address:9200 SE LAWNFIED RD 401 amps to 600 amps 200.34 2
City/State/ZIP:CLACKAMAS/OREGON/97015-8685 601 amps to 1,000 amps 301.04 2
Phone:(503)849-3313 Fax:(971)673-6202 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 own 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 125.08 2
Owner signature:
Date: 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,eer panel
. ,.;. I' �"APPLICANT 1 Q:CQNTIACT PERSON I A.Fee for branch circuits with
t Business name: above service or feeder fee, 7 42 2
each branch circuit
Contact name:
B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
Each add'l branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
{UNTRACTOR.= Pump or irrigation circle 67.84 2
' Business name:ODOT Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
vi.ddress:9200 SE LAWNFIED RD panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:CLACKAMAS/OREGON/97015-8685 Additional inspection(1 hr min) 66.25/hr
Phone:(503)849-3313 Fax:(971)673-6202 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:Steven.M.Hoecker@odot.state.or.us Inspections for which no fee is
1`i a specifically listed(%:hr min) 90.00/hr
4 CCB Lic.:expo 4fif Electrical Lic.:pi494G Suprv.Lic.: 5746S Itliliq P1 =ELECTRICg1L PERMIT1EES
e. Suprv.Electrician signature,required: Subtotal: 100.70
Print name: ,,i m. kAcme_tc_e-ct_
Date: 7/12/2017 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 12.78
TOTAL PERMIT FEE: 112.78
Authorized signature:
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.
I:\Building\Permits\ELC_PermitApp ELR_ERE.doc Rev 06/17/2015 440-4615TQ 1/OS/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE S HEuu E 1111111i
Description I Qty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(V2 hr min)
COMMERCIAL WORK ONLY: EI.ECTRICAL(PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 = Number of inspections allowedper permit.
3r p
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Buildingwermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
PACIFIC HWY/HWY 217
Record Type: Record ID:
Commercial - Electrical ELC2017-00519
Inspection Type: Inspector:
115 Electrical service Jeff Grove
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor