Permit CITY OF TIGARD ELECTRICAL PERMIT
31 .4 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00444
Date Issued: 07/25/2012
. TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1 S 25/201 0700
Jurisdiction: Tigard
Site address: 12655 SW NORTH DAKOTA ST
Project: AT & T Subdivision: Lot: 0
Project Description: (10) branch circuits for the replacement of (6) antennas and adding (1) cabinet to existing equipment platform.
Contractor: GREEN POWER ELECTRICAL CONTRACTORS INC Owner: HA& R, LLC
PO BOX 836 ATTN: TAMMY HOUSE
AMITY, OR 97101 12655 SW NORTH DAKOTA ST
TIGARD, OR 97223
PHONE: 971 - 259 -1051 PHONE:
FAX: 503 - 835 -2702
FEES
Quantity Description Date Amount
10 crt Branch Circuits wo /Purchase 07/25/2012 $122.96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/25/2012 $14.76
Type of Use: COM Electrical
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 0 952 -0 - P 0. You may obtain a copy of the rules or direct questions
e rrnittee Signature: calling 3. �2.19�r1.800.332.2344. g , / 0 �
Issued By: � !�� / � `
_
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 603.639.4176 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.
07/24/2012 08:54 5038352702 BRC GUTTERS &POLE BLD PAGE 02/02
V Electrical Permit ApplxCBt;! E '�" IV ED 1 Orrl(,1; ust: ONLY
Received /o1•
City of Tigard 2 4 2 012 Date/By: 9 e ,2 5. - J v Permit No.: ELC 0 10/ . 2 12,, y99
13125 SW HaII Blvd., Tigard, OR 97223�U Plan Resiew s
Phone 503.718.2439 Fa 503.59 Dare/By: czak_ ev0 6
T 1 is A i t D Inspection Line: 503.639,4175 C of T�6pgD Date ReedyBy " r� s: Other fermi 63 see Page 2 for
Internet: www.tigard - or.gov 1 r 0e Ol Notified'M thud: o' &. Supplemental Information
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❑ New construction CO Addition/alteration/replacement Please check all that apply (submit Z sets of plans w /items chocked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards,
... .... rit .. " r.,. r n: flF. w ee U 'i�';i;:;q:1;i •r „ n, ,
° ... , . 1" ' 7 fl�l � l � al'• is "'I I . ,� • exceeds 10,000 amps at 150 volts or Floating buildings.
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.....' ,�," •�.," .; _■• less to ground, or exceeds 14,000 ❑ Cortun0ereial - use agricultural
❑ 1• and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ �
Master builder 0 Other: Fire pump. Installation of 75 KVA or
: , .:. • .... , , � ., . ; .. ; i : " "' ' .. .;., , . Ills ,., n ., .r, J! i ❑ Emergency system. larger separately derived .
.. , , .. ':: :: ��.! ! , ',, ,, ,,'I ie `117 'i ,'I P'' 1• lil, i ntnr load of 1
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Joh no.: Job site address: 12655 SW North Dakota St 1ooHPortnore. occu pancy.
❑ 5ix OT more residential units ❑ Recreational vehicle parks
City /State /ZiP: Tigard, OR ❑ Health -care facilities, ❑ Supply voltage for more than
❑ Hazardous locations, 600 volts nominal.
Suite/bldg. /apt. no.: A Project name: IO Service or feeder 600 amps or more.
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job site: SW i> '; 1 ��� ,6'_- .,u;w�m.• � I �tiry.4s. 'h I �
Cross street/directions to : S 125 Ave mocriptioe 017. Poe. 7oyp
. New residential single- or multi-family dwelling unit.
. Includes attached garage. _
Subdivision: l Lot no.: 1,000 sq. ft. or less 168.54 4
Ea add'l 500 sq. ft or portion 33.92 . •S,
•
Tax map/parcel no.: Limited energy, residential tial 75.00 2
::I . ,:r•: ; i j �;.i,, ' ; ., . %! 's (...: -: r' �;, r! ;; .'i P m : , l i n i � li;A� (with above sq. R)
;:.! i. ! limited energy, multi- thmtly 75.00 2
upgrade to cell site residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
• 200 amps or less I 100.70 2
� ; �:! E _. l i �, i iei i 20] am t0 400
133.56 2
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Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: • Temporary services or feeders installation, alteration, and/o
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
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
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
. . I:: il;r:r; i'I 1 N!i� ,i,i,:: ';!a i ' ,'•:'''':''' 'r . ° , a'I. above Service or feeder fee, • � ,� ,'x d'" �'
!pllilii �' L ! 14 � . � „ • � , ... � �� . 1 1'' 11 n I I .42 2
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�,,, ,,,<i �. 1 ��Iil Yl .dr � •. . ab ... iY r� I(itilii . I11.,6d, � M1 each branch circuit 7
Business name: Green Power Electrical Contractors Inc B. Fee for branch cirarits withorn
service or feeder fie, first • 1 56.18 56.18 2
Contact name: Shirlene Seigal branch circuit T
Each add'1 branch circuit 9 7.42 •I 66.78 2
Address: PO Box 836 Miscellaneous (service or feeder not included) T
Ciry /State /ZiP: Amity, OR 97101 dwelling, service aandVor feeder 67.84 2 i
Phone: (971) 259 -1051 Fax: : (503) 835 - 2702 Reconnect onls' 67.84 ' 2
E-mail: shirlencl,gpecelectric.com Sign or irrigation circle _ 67.84 2
,, . 67,84 2
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Rosiness name: Green Power Electrical Contractors Inc panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: PO Box 836 . • Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Amity, OR 97101 Investigation (1 hr min) 665/ hr
industrial plant (1 hr min) 78.18/ hr
Phone: (971) 259 - 1051 � Fax: (503) 835 -2702 lnepections for which no fee is
J. 4 s • ifical listed %a hr min 90.00/ hr
/
��/ CCB Lic.: 190713 6II , Electtical Lie.: C737 7/ J r� Suprv. Lic.: 5531S I I) ) • j j fily...i 11 ie " ;y ".1 ;, s i . , 1140. :: ::. , .a
Suprv. Electrician signature, required: _ • a Subtotal: 122.96
Plan review (25% of permit fee):
Print name: Karter Roberts Date: State surcharge (12% of permit fee): 14.76 /
Authorized signature: ' TOTAL PERMIT FEE: 137.72
This permit application expires if a permit is not obizi ned within 180
D days after It bas been accepted as complete.
Print name: Karter Roberts
I 1� a • N um b er o inspections allowed per permit
i:\ BWiding \Parmius \ELC- Permicapp.doc 07 /01/10 440- 4e15T(11 /05/COM/tWEe