Permit • ® CITY OF TIGARD ELECTRICAL PERMIT
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Ii
a COMMUNITY DEVELOPMENT Permit #: ELC2013 00102
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/13/2013
Parcel: 2S110BC10200
Jurisdiction: TIGARD
Site address:
Project: Troy Park Subdivision: 2004 -071 PARTITION PLAT Lot: A
Project Description: (1) 200 amps or less and (1) branch circuit installation of an electrical service to fee one (1) streetlight
Contractor: LIGHTWORKS ELECTRIC CO Owner: CITY OF TIGARD
20915 SW 105TH AVE STE A 13125 SW HALL BLVD
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 691 -2959 PHONE:
FAX: 503 - 691 -2918
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/13/2013 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 02/13/2013 $7.42 '
Type of Use: COM Service or Feeder ,
Class of Work: OTR 1 ea 12% State Surcharge - 02/13/2013 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 R 52 -001 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / J'L KJ Permittee Signature: D 4 P °'- / clan O/J
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 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.
02/12/2013 14:50 5036912918 LIGHTWORKS ELECTRIC PAGE 02/02
Electrical Permit Application, RECEIVE FOR OFFI(11 11Sh. ()NI.)
City of Tigard it . ()/ 3 00/D a--
16M- =HA Perm • No
14 . 13125 SW Hall Blvd., Tigard, OR 97223 FFB 1 2 2013 53111111 Plan Review
'
I; Phone: 503.639.4171 Pax: 503.598.060 - DatcfB : Other Permit:
TIGA Inspection Line: 503.639.4375 Data Ready/By: la See Page 2 for
RD
Internet: www.tigard CITYOFTIGARD NalinediMilthnd: hirie72,c=7
$oppleonontri lafermation
•1,....'..., . 7 : ...7 j..; . ,I , ; . ., ..,! ::.•,•,;:,..,:;...:' 4 '•:':,;'':.:!:!. ';;: i l,A ,...' ':!•t'L,' A ....,1':'‘q .. `,. ...* ''■
kErNew construction 0 Addition/alteration/replacement pl ease check nil that apply (submit a acts of plans writcrns checked below);
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition CI Other: where the available (huh current 0 Marinas and boatyards. • :.:: 1. 'idttraitc t /i -:: :„, tttioitti exceeds 10,000 amps at 150 volts or 0 Floating buildings.
lass In ground, or exceeds 14,000 0 Commercial-tote agricultural
0 I- and 2-family dwelling 1:ICommercial/industrial 0 Accessng building amps for all ether intrnillatimo, buildings,
0 Multi-family 0 Master builder r8 Other 4u4v 0 il m Pu 0 Insiallatkm of 75 KVA or
., . ,...,. . .., ,. _ 0 Emergency system. larger separately derived system.
: ". „.. : ..,; : P 7 ,;, ■ 1 4 4: . At . ;00 1 0:4 4 10,:;:0,0iti0 7 44tq :; ;'::';!: : :: . :.:',.:‘ ,1 1kF.r'', 0 Addition of new moor lord of 0 "A", "V", "i-r,
OCCupOny.
Jab 110.! I Job site address:/2je0r
a Six or more residential units. 0 R c omit; o n il I WhisriO POTICr.
City/Stale/ZIP: -r,,n-,,i 0 iS q 777 5 CI Hcaldt-carc facilities. 0 Stipply voltage for more dtan
0 Wriardous locations. 600 voInt nominal.
Suite/bldg./apt no.: Project name: rge) .0 . CIServiec to fonder 6on ...ps nr more,
';,:f KILWIVIVIO :::.:::■:'..•.;";:::,:::::,,';
Cross street/directions to job site: ,// /if &WA. ,.. ./.z, /.„24 Ali ' , .. • ' , . . . ..
10211111M1b1711•1111521
New residential single- or multi-family dwelling unit.
70 4.4ti 9 Includes attached garage.
Subdivision: 7 A g9_v /0/A -7, k.,_ Lot no.: 1,000 sq. It or less 145.15 4
13a. add'i 500 sq. tt. or portion 33.40 1
Tax rnaplparcel no.: Limited energy, residential
75.00 2
-....; ;SPO'frt1 (wall above sq. it.)
Limited energy, muhi-thmily
75.00 2
. A)/ e/ecci-v-t ,57c)sev.ce > , !. 0 r,ickntini (with nhiwo 5g, 11,)
. V ct ai ,, &V-- Beryl= or feeders Installation, alteration, and/or relocation
002 amps or icss 1 80.30 _./ 2
.:!.....1';.•:::'141;F:""111:1,tRir*OVVtigil]:::...ii!:'',"::!..ilirliti?:'12f:.;PS'P'IVO*Ntiii.''::':.;.qfi 201 amps to 400 mnps 106.85 2
Name: 401 amps to 600 amps I 60.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary service" or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or 1ms 66.85 T
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 10 599 amps 133.75 2 • Branch circuit; - new, alteration, or extension, ocr panel
Owner signattre: Dale:
A. Pee for branch circuits with
above service of feeder fee / 6.65 / 2
, each branch circuit
Business name: /....yAl-kvoce-k.. E,:le ci-v-t c B. Fee for branch circuits
.•-•-. _..— 5_/_. WilhOla scrvicc or fcaler fcc,
46.85 2
Contact narnp; . 7, t c.i.f r 77 - 1 . 1 .... :::—/ fe first branch circuit
. .
Address:20f/ 5 .St) /0 5 4-ve et 0.4. 4,..tt 4 14 Bach add'I branch circuit 6.65 2
—
Miscellaneous (service or feeder not included)
City/Slide/ZIP: 7 iliA /706• Z. Each manufactured or modular
1 dwelling. service and/or feeder 90.90 2
Phone: 15P3 )0y-- ze.) Fax: : (03)61i-2_17 & ' Reconnect only 66.85 2
_ .. .
li-mail: Pump or irrigation circle 53.40 2
1: ..:..!: .:: ,. 4: t 019114cyl - 441';A;,::ii..?,:l.: , ;;;;: ....:; .,.,' . :' ::.;,: .',- ..-.::',..'; Sign or outline lighting . 53A0 2
Signal circuit(s) or limited-
Business name: 5 or1-1-,..,
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State/Zna: Each additional inspection llowa Me in any of the above
Per inspection 62.50
Phone: ( ) Fox: ( ) , Investigation per hour (1 hr min) 62,50
.. Industrial , plant per hour 73.75
CC8 Lic.: 1.5 9 Lie.:31-6 75 C Su prv. Lie.: 2 (5-
..,..:-1 i:.:.
Suprv. Electrician .....n si gnahl ....... Z . f-e_ Subtotal:
Plan review (25% of permit fee):
Print name: (Z 6 v1.0 id L P I Date: / -1 7_ -46( 5
State surcharge (12% of pennit fee):
Authorized signature: Lroir pp.F..i; ja ,
' MR% permit application expires If a permit is not obtained within 1
Print name: Date: days after It has heed accepted as complete.
* Number of inspections allowed per permit,
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