Permit E �? CITY OF TIGARD
ELECTRICAL PERMIT
1 t 7 s ,�t COMMUNITY DEVELOPMENT Permit #: ELC2010 00308
/2010
{, Date Issued: 06/23
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: SE 3/2010
Jurisdiction: Tigard
Site address: SW NO ADDRESS
Subdivision: Lot:
Project: Hall /Pacific Hwy Traffic Signals
Project Description: (1) 200 amp service and (3) branch circuits for street luminaires at the NW corner of Hall and
Pacific Hwy (near Interior Motives).
Owner: FEES
IMAD LLC Quantity Description Date Amount
11875 SW PACIFIC HWY 1 ea Services or Feeders - 200 06/23/2010 $100.70
TIGARD, OR 97223 amps or less
PHONE: 3 crt Branch Circuits w /Purchase 06/23/2010 $22.26
Service or Feeder
1 ea 12% State Surcharge - 06/23/2010 $14.76
Contractor: Electrical
PRAIRIE ELECTRIC INC
6000 NE 88TH ST
VANCOUVER, WA 98665
PHONE: 800 - 573 -2750
FAX: 360- 573 -9866
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $137.72
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
Issued By: Permittee Signature: /9� /970,096,7 ..-7
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 an inspection that business day.
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.
06/22/2010 11:34 FAX 360 573 9866 Prairie Electric Inc. [j001 /003
Electrical Permit Application FOR OFFICE lISE ONLY �1
City of Tigard � DEEew f �0 pe O� -- eeSOP
Iii .. STig, OR 97223 �Nb P
Phone: 503.639.4171 Fax: 503.598.19 Date/By: Other Permit:
TIGARD Inspection Line: 503 1� Datc Ready /By. t ® See Page 2 for
Internet: www.tigard-or gov , � 9 ' s L Nonfie r) Supplemental Information ,�. -,c,t 1' t4 3 , 1 :.+'�' '.i'�' ,-;, -- -f. ' ' a 5 , i / ...i 7 r. t . , �I u iP r: r.. r
ease chec a t sets o plans w /items checke ow).
� _ .- a I'�' � '�lv� r<l�th 1 �� _r�F M��.
r��j (t, � r � -sr
❑ New construction ®AdditlOn /a1[era[IOn /���3Qe %S %U Plk ll hat apply (submit 2 f d bel
tt ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: �J1 . where the available fault current ❑ Marinas and boatyards.
z
exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
e My` t ti ''' 14** 1 1 G Yf i r 6
i �3> n c rv. a m, ,i!" - �? ° less to ground, or exceeds 14,000 ❑ 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 75 KVA or
❑ Emergency system. larger separately derived system.
2 ' fifth ,r .9.it4 5 . 1 4 1► A :ly . ' r,ga ❑ Addition of new motor load of ❑ "A" "E" "1.2" "I -3"
, �r n' ' / �j Six or or more. occupancy.
Job no.: , (�f"1 Job site address :r r r a `� ! `L
II. Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: T /State /ZIP: t d 0 a 7-2-z-3 / �CP� rI Health - care facilities ❑ Supply voltage for more than
/ / ❑ Hazardous locations 600 volts nominal.
, '' r r ❑ Service o r feeder 600 amps or more.
Suite bldg. /apt. no.: Project name: 5140M-Z 0 y pe
Cross street/directions to job site: //7.ff�j C 5/6—AigfiLS Description J Qty J Fee. 1 Total J •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168 4
.En add'' 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
.4g' `,iy 5 r_r ,ax `,W .. , �^ /'AT`"UIL, ICII =:. _.._...': mssii " (withabQsesq. ft.) 67.84 2
..z>_ "'' rT1` . if? — A ! Limited energy, multi- family 67.84 2
Service and Circuits for Street Luminaires C ejCi l ' residential (with above sq. ft.)
A/ Lt) C^- t j �� Services or feeders installation, alteration 1 and /or relocation
/�•+ v 1 200 amps or less I 100.70 100.70 2
7 , 7a r e yi ` 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent. or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
,., above service or feeder fee, 3 7 42 22.26 2
. -t ? :.�,�,��:� ...� .'!t�13��°�'lr ' ear , ,, _... _..,- .._ , -� _.. ,.-a, .;a. each branch circus
Business name: Prairie Electric, Inc. B Fee for branch circuits without
. service or feeder fee, first 56.18 2
Contact name: Anita Paso branch circuit
Each add'I branch circuit 7.42 2
Address: 6000 NE 88 Street Miscellaneous (service or feeder not included)
Each manufactured
City /State /ZIP: Vancouver, dwelling, A 98665 a or modular 67 84 2
service and/or feeder
Phone: (360) 573 - 2750 Fax: : (360) 573 - 9866 Reconnect only 67.84 2
Pump or irrigation circle I 67.84 2
E - mail anitap@prairielectric.com
ra µ t i v f , - P 3 ,•,, v ,- , . �, Sign or outline lighting 67.84
%_-f' i , ",r', I _-, 1, . ,h 4 Sr 7 CO � V ," __:-,` 4'sn _� = f?_`'`'d,,,!•„ ..__._ . ,_ Signal circuit(s) or limited- energy
Business name: Prairie Electric, Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the a bov e
Address: 6000 NE 88 Street Additional inspection (l hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Vancouver, WA 98665 Industrial plant (1 hr min) 78.18/ hr
P one: (360) 573 -2750 Fax: (360) 573 -9866 Inspections for which no fee is 90.00 / hr
specifically listed CA min)
CCB Lic.: 60178 V Electrical Lic.: 3 -491C / Suprv, Lic.: 35625 / 1 ' . °` G'` RIL k1[ e a "'°n? r r
Subtotal: 122.96
Suprv. Electrician signature, required / Plan review (25% of permit fee): _
Print name: Bill Halberg , 1 1 Date: 6-21-10 State surcharge (12% of permit fee): 14.76 /
TOTAL PERMIT FEE: 137.72
Authorized signature: This permit application e pires do ' is no btained within 180
O of days after it "been pled aslete. / ` Print name: Date: ins n w t!�' ( (,J���fff 1^ Q L
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