Permit CITY OF TIGARD ELECTRICAL PERMIT
71 2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00178
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
Parcel: 25101 BCO2202
Jurisdiction: Tigard
Site address: 8430 SW HUNZIKER RD
Project: City of Tigard Subdivision: Lot: 0
Project Description: (1) branch circuit for modification of traffic signal located on SE corner of Hall Blvd and Hunziker St.
Contractor: CHERRY CITY ELECTRIC Owner: CITY OF TIGARD
1596 22ND ST SE 13125 SW HALL BLVD
SALEM, OR 97302 TIGARD, OR 97223
PHONE: 503 - 639 -4171
HONE: 503 - 566 -5600
FAX: 503 - 540 -8147
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 04/06/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/06/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is ' . • . •'-ct 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 rccordance with - • •rove• 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. AT NTION: Oregon law equi es ou to follow the rules adopted by the Oregon Utility Notifi • ': Center. Those rules are set forth in OAR
952 -001 -• • 10 t rough OAR 952-8 0090. ou may obtain a copy of the rules or direct questions to OUNC by c- ' • 503.232.1987 or 1.800.332.23' .
Issued = �K7�!/v l, Permittee Sign. � .�i / _i : _ I
■
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' . '' 1 / Date:
LICENSE NO. l gog(
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.
. Electrical Permit Application FOR OFFIC F 1 SF ONLY
City of Tigard Received ,� ��
Permit No e)e`` r 00 `
13125 SW Hall Blvd., Tigard, OR 97223 e
Phone: 503.718.2439 Fax: 503.598.1960 ,.: _ Other Permit:
l IG \i:.t7
Inspection Line: 503.639.4175 Date Ready/By: Avis: H See Page 2 for
Internet www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction "J Addition /alteration/replacement Please chec.k all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
1 - and 2-family well'® Commercialfmdustrial ❑ Accessory amps s o ground, all other exceeds ons, ❑ Commercial -use agricultural
El 1- d � �' 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.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", `1 -2 ", "1-3 ",
Job no.391 1 Cksz Job site address: g4 jO 50.) 't,.,1 ,i„y 100HP or more. occupancy.
Or ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project ll 1 nam e: K ti , 1 —{ % 11 1 m -, , J CI ❑ Service or feeder 600 amps or more.
Cross street/directions to _job site: 6 , W, " - 0 \ 1 B 1 Y ti S , w rr,eer+w. FEE SCHEDULE
Qty. I Fee. I Total
T S' S New residential single- or multi-family dwelling unit.
c ( \ a , - , s -E_ ed „ e x( E ' c n.,l S P4 V +i� Includes attached garage.
J 1,000 R or less 168.54 4
Subdivision: Lot no.: sq.
Ea. add'l 500 sq. ft or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
r r DESCRIPTION OF WORK (with above s9. fl.) 75.00 2
1\ a L > r 1 o a . ■ V f� s� Limited energy, (with above sq. 2
T A c y residential with above ft..) 75.00
C r 1- Services or feeders installation, alteration, and/or relocation
C V 4a s „�/ v +��; Ve { SI, ---S }". -5 c O r �s V . 200 amps or leas 100.70 2
. PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
C ,� 401 amps to 600 amps 20034 2
Name: t' (4 601 amps to 1,000 amps 301.04 2
Address: 1 3 it s u 1 1 $ l r Over 1,000 amps or wits 55226 2
/StatdZlP: T \ c ] Temporary services or feeders Installation, alteration, and/or
Ci
ty 1 i 93 C , 1 Q t� `"/ Z v relocation
Phone: (6 V,3) 7 1 V�z 1 3 1 Fax (c.59_3) 3 p ) l c% l 1 6 v 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Brach circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ( ❑ CONTACT PERSON abOYe service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first '
Contact name: branch circuit / 56.18 �( 2
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each rude" or mom 67.84 2
dwelling service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect Only 67.84 2
- Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: C k t? r C yi q Z.-2- Z.-2- s C') ' 1 ' 1 Q } C C , panel, alteration, or extension. Page 2 2
C , 1 1 r C Each additional inspection over allowable in any of the above
Address: 1 5 1 6 a f`2 C 6 l i (1 le min) 66.25/ hr
City/State/ZIP: ,S -. \ .t ) Q � ° t 13 O Z Investigation (1 hr min) 66.25, hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (5‘13 ) 614_6 L V Fax (S u3) 6 % 1- Z c°l.S Inspections for which no fee is 90.00 / hr
specifically listed CA hr min)
CCB Lic.: % ( 4, 6 V Electrical Lic.: 3 7- G Z•C Suprv. Lic.: 13 `c"Y3 :S ELECTRICAL PERMIT FEES 1
Suprv. Electrician signature, required: l W e+. d (25% Subtotal: L ,
Plan review (25 /e of permit fee): _
Print name: k <e r r�� +-., t...3 - ,It, . Date: 3 — 9 —ZL 1 I Slate surcharge ( 12% of permit fee): 6 a 4
Authorized signature: TOTAL PERMIT FEE: C Z
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: s
Number of inspections allowed per permit.
1:\ Building \P'emuta(ELC- PemetApp.doc 07 /01/10 440-4615T(l1/05/COM/WEB