Permit (100) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00855
Date Issued: 11/20/2017
T[G ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106AD05900
Jurisdiction: Tigard
Site address: 12994 SW RIVER TERRACE BLVD
Project: River Terrace East, Lot 166 Subdivision: RIVER TERRACE EAST Lot: 166
Project Description: Electrical Service for Comcast underground power supply.
Contractor: MCCOY ELECTRIC CO INC Owner: ADLV LAND HOLDINGS LLC
29191 NW WEST UNION RD BY FORSUM, MICHAEL
NORTH PLAINS, OR 97133 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 503-234-7521 PHONE.
FAX: 503-234-9473
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 11/20/2017 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 11/20/2017 $12.08
Type of Use: SF 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 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 y u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 9.!001-0090. Yo ay obtain a py of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / �+ i!� /��//`� Permittee Signature: L/`r
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 503.639.4176 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 ' " . ,-..
FOR OFFICE USE ONLY
City of Tigard N 0 V 9 2017 Received ��,
Date/By: !! ( /? / Permit 4: i.G 2o0- Fs 3"
13]25 SW Hall Bivd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598 19 ! 'f Related Pemit it:
Inspection Line: 503.639.4175 ��,( )- 1 t�`�'1 t L' DataRy'
I./G A R I] Internet: www.ti and-or. ov ;;---1.-/1 N '"% ! t!�J i Q,i l l Otcady Date/By: Jugs ei See Page 2 for
g gNotified/Method: Supplemental information
.TYPE OF;Avol C N . .
a: r .... P)tr3, ;IiEY1EW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other:
where the available fault current ❑Marinas and boatyards.
:; ' :OA'TJGORY OP GONSTRUt17ON ' ` exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El 1and 2-family dwelling 0 Commercialhndush ial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
El Multi-family ❑Master builder ❑Other ampsother installations. buildings.
Firpump. of 1 0 KVA
11
❑ nt ❑ S or
....:.JOB SITE l FQ 1►LAT10Nr.AiD,;LOCATIQN a Emergency system. larger separately derived
Job#:760 I Job site address S1URiver Terr Rtvd&sT Ad ❑Addition of new motor load of system.
�r 100HPormore. 0"A","E","1-2""I-3"
City/State/ZIP:Tigard / +s?9"9y s� ��i �: 7�C:� L /,l�Six or moreresidential units. occupancy.
Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:River Terrace East 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:See attached map
•PEE:S BgIIJI.E .
Dmeriptioa l Otv. I Each I Total 1...`..
New residential single-or multi-family dwelling unit.
Subdivision:River Terrace East - Lot#: 166 ' Includes attached garage.
Tax map/parcel#: (.1----
___.. -__ __ __ �' 1,000 sq.ft.or less 168.54 4
AESCRL1'TION;UI WO 00 sq.ft.or portion 33.92 1
Ea add'15
.R1i �....,:.: . Limited energy,residential 75.00 2
Install electrical service to new Comcast Underground Power Supply (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
( ,PItO1PEIiTX'"O RenewE ❑ e2
�:.T)L1I�i111 Services
able or feedersnergy installation,alteration,
Page and/or relocation
Name: 200 amps or less 1 100.70 100.70 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to I,000 amps 301.04 2
Phone:( ) t I Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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
: x p:AP.FLICANT ..<::; .t ,::; . CI,CONTi1'.W.t.E[t50PJ,..; B''aneh cilruits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone: 1VIlseellaneous(service or feeder not included)
( ) Fax::( ) Each manufactured or modular 67.84 2
Email' dwelling,service and/or feeder
Reconnect only 67.84 2
.:�:,:= ::... ... CONTItr).C"I'ta.R Pump or irrigation circle 67.84 2
Business name:McCoy Electric Co.,Inc. Sign or outline lighting 67.8¢ 2
Address;29191 NW West Union Rd Signal circuit(s)or limited-energy
panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP:North Plains OR 97133 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)234-7521 Fax:(503)234-9473 Investigation(I hr min) 90.00/hr
Email:janah@mccoyelectric.com Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 8277 Electrical Lic.: 26-82C Suprv.Lic.: 52085 ,specifically listed(.4 hr min) 90.00/hr
Suprv.Electrician signature,required:
E4,01 lc-AL:P,WIFT FEE$,_. ..,:..:
Subtotal: 100.70
Print name: Zack Armstrong Date: 11-9-17 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 12.08
Authorized signature: TOTAL PERMIT FEE: 112.78
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.
1U3uildingwermits\ELC_permitApp_Ei.R_ERE,dec Rev 06117/acts 440-4615T(11/05K'OMRYEa
Tennessee Cable Service,Inc.
17035 SE Evergreen Hwy.
Vancouver,WA 98683
Project Name: River Terrace East 1&2
Street Location: SW River Terrace Blvd&Street M
County: Washington
City: Tigard
#Of Supplies In Project: 1 of 1
(one P/S Per Form)
New P/S Info Old P/S Info
Power Supply Value: 15A/90V Power Supply Value:
Power Supply Number: 01 Power Supply Number:
Comcast Map#: ORB VB V 115 AT&T Map:
PGE Map#: PGE Map:
Underground to
PGE Pole#or Vault#: transformer PGE Pole#or Vault#
Pole Permit#: Pole Permit#:
Permit Req.Date: On Penn.Date:
Monthly Bill#: Monthly Bill#
AT&T Completion Date: PGE Notification Date:
County Notification Date: PGE Disco Date:
County Inspection Date: AT&T Wreckout Date:
POE Notification Date:
PGE Activation Date:
Notes:
TCS Job#B17019
New underground power supply.
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12994 SW RIVER TERRACE BLVD,
BEAVERTON, OR, 97007
Record Type: Record ID:
Residential - Electrical ELC2017-00855
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor