Permit CITY Y ®� TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 00441
COMMUNITY DEVELOPMENT
DATE ISSUED: 7/31/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136AD-06300
SITE ADDRESS: 10955 SW 65TH AVE ZONING: C -
SUBDIVISION: PGE LOT : JURISDICTION: TIG
PROJECT: PGE ANTENNAS
Project Description: Installing (1) service and (1) branch circuit.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PORTLAND GENERAL ELECTRIC MONTI ELECTRIC INC
COMPANY PO BOX 30478
121 SW SALMON ST PORTLAND, OR 97294
PORTLAND, OR 97204
Phone: Contact #: PRI 503 - 491 -4909
FAX 503 - 665 -7200
FEES
Description Date Amount Reg #: ELE 26 -1018C
[ELPRMT] ELC Permit 7/31/2008 $86.95 LIC 135326
[TAX] 12% State Surchar 7/31/2008 $10.43 SUP 4591S
Total $97.38 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: � _ Permittee Signature: �� y /
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'N: 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.
, -, � r w � � ;, :viii
Electrical Permit Applicatio Ci� £ z , ,' , ..., . . 01 - 1. 1(.: t S L x 0 1 . , , ,
x4 ������""" Received d � Pennit No.: /
Ci ty of Tigard 1 �- Date/B : ® W __ arms C4 9- ) y !
• I� a 1312 SW Hall Blvd. Tigard, OR 9722 ( \� , Cam'- Other Permit: '� ` 4 6 -, —.., 00,1. )
t k Phone: 503.639.4171 Fax 503.598.1960 CT1G I� . ° Oh , s ee P
olc In ect Line: 503.639 Q ` 1 S a ate Ready: By Page 2. for
w - T PO., A' RCA ���� V11 Notified/Method: 717..e. Supplemental Information
�ay� Internet: www.tigazd- or.gov C,
TYPE OF WOR�vI PLAN REVIEW
—
Zi.. Pleas e check all that apply (submit 2 sets of plans w /items checked below):
ew construction ❑Addition !alteration /replacernent _ ❑s ee or feeder 400 amps or more ❑ Building over three stores.
Demolition 0 where the available fault current ❑ Marinas and boatyards.
CAT G RY OF CONSTRUCTION exceeds 10,000 amps 01150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I and 2 family dwelling Commercialiindustrial ❑ Accessory building amps for all other installations. buildings.
0 ❑ Fire pump. ❑ Instal ation of 75 KVA or
Multi ❑blaster builder ❑ Other: ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 2 ", "I - 3",
t l ^ p �p 100HP or mart. occupancy.
Job no.: 1 ' V ` Job site address: ` _ `55 S _t, ( " t '� .�• C.. .
❑ Six or more residential units. ❑ Recreational vehicle parks.
� / 0 facilities. ❑ Supply voltage for more than
City /Stat & /LIL': 1 l { Z i O �t a ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ,L - f ( , 1 q ci ❑ Service or feeder 600 amps or more.
U FEE SCHEDULE
Cross street/directions to job site: �� __ � ..se.„,;.„ 1 Qty. 1 Fee. ( Total I • _
w New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 ' 4
Subdivision: Lot no.:
Ea. add'1 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
A.X., L) iQ , residential (with above sq. ft.) i
Services or feeders installation, alteration. and/or relocation
200 amps or less l 80.30 4,'0 ,3d 2
0 PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 106-85 2 . 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps I ` 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and /or
City/State /Z.1 P: relocation .
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
201 amps to 400 amps 1 00.30 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 133.75 2
intended for sale, icase, 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 1
❑ APPLICANT ` 0 CONTACT PERSON above service or feeder fee, l 6.65 l (eG< 2
e ach branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
46.85 2
Contact name: first branch circuit _ .
Each add'l branch circuit 6.65 _ 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E-mail:
Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
p Signal circuit(s) or limited - •
Business name: ` t t o ec i C i CYY l s. energy panel, alteration, or
3 t� extension. Describe: Page 2 2
Address: �O l
City/State /ZIP: P001 &v1d 0 1 q'� 0 120 Each additional inspection over allowable in any of the above
f Per inspection 62.50 -
Phone: (q) L H - -1 Q 09 Fax: ( 503 06_13 investi per hour (t hr min) 62.50 ,
CCB Lic.: 1 35 (p Electrical Lic.: in - iNs 6 Suprv. Lic.: 1-i Industrial plant per hour 73.75
�� ($ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: , e . I Subtotal: E'(o , Q5
Plan review (25% of permit fee)'.
Print name: S in t`�b%t ti Date: 1 \oc.6 State surcharge (12% of permit fee): 10 .(-13
Authorized signature: r, % , , '~`__- TOTAL PERMIT FEE: 'a . 3 S
A I This permit application expires if a permit is not obtained within 150
Print name:5 ���� Date3 1 () days after it has been accepted as complete.
6' 00ZZ - 009 dppeo quo e'':LO 90 1.s In