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Permit s CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENTIN Permit#: ELC2017-00387 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/26/2017 Parcel: 2S1070001302 Jurisdiction: Tigard Site address: 16650 SW BULL MOUNTAIN RD Project: Polygon at South River Terrace Subdivision: None Lot: None Project Description: Temporary service and(1)branch circuit for job trailer. Contractor: LIGHTWORKS ELECTRIC CO Owner: 20915 SW 105TH AVE STE A TUALATIN, OR 97062 PHONE: 503-691-2959 PHONE: FAX: 503-691-2918 FEES Quantity Description Date Amount 1 ea Temp Services or Feeders- 05/26/2017 $59.36 Specifics: 200 amps or less 1 crt Branch Circuits w/Purchase 05/26/2017 $7.42 Type of Use: COM Service or Feeder Class of Work: OTR 1 ea 12%State Surcharge- 05/26/2017 $8.01 Electrical Type of Const: Occupancy Grp: Total $74.79 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 Issued By.through 0 952-001-0090. You may obtain a copy of the rules or direct PQ�itteeons oOUNC by Signature:�lling 503.232.1987 1.800.332.2344.�77 0 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 603.639.4175 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. 05/23/2017 03:06 5036912918 LIGHT4JORKS ELECTRIC PAGE 02/02 Electrical Permit ApplicatiECEIVED FOR 0rl'ICE USE:,ONLY Rees; City ofTli Tigard ate/13 ; S iS /2 el _,�(' - w 13125 SW Hall Blvd„Tigard,oR 972MAY 2 b 2 017 Plan Review I Phone; 503.639.4171 rax.; 503.598.1960 Date/By: Other Permit: T t c n k ra Inspection Linc: 503.639,4175 CITY OF TIGARD7 N to>Read/AY: heels: et See rag,:2 for Internet: www.ti dor. ov JBU�� PING TIGARD on t ;_ ,...H L .!, WOIk'1?C `•� DIVISION Supplemenml tnformnti ,.•., , ..' ®Ncw construction 0 Addition/alteration/replacement Please creek all that apply(submit 2.^.oto of plans w/item.[checked below): 0 Service or feeder 0100 amps or more 0 Building over three stories. 0 Demolition ❑Other: where the available fault ourrent 0 Marinas and boatyards, exceeds 10,000 amps at 150 volts orFloating buildintg : „ .. . :•:CA'CRCx1FT;�Y;::� ONS':TItlJCT1,ON: .:;. ,,... 0F1 :, • less to ground,or exceeds 14,000 CI Commorcint-ase agricultural ❑1"and 2-.family dwelling [ll Commercial/industrial 0 Accessory budding amps for all other installationt, bnildinpa, ❑Multi-famtly Muster Ot0 her; Ll Fire pump. 0 lnsnllation of75 KVA or - ' ❑Emergency sytem. larger separately derived s ystem,:tOb SIT tif RNTA ]�O ANb OCATION '' ❑Addition anew motor load of 0,A,.,$„<1_2, ,y3' . �.. l/_r &O �ll Al0 h 1001.ir or more, Rcvpation Job no.: Job site address: 1 SOCA-J '_I� /� f [l Recreational vehicle parks. ln�w �.A (]Six or more residential emits, City/State/ZIP: --17‘544.. 1 B p /,1 Z(/ ElHealt7t,�lfn rtcilitics. ❑Supply voltage more than (t l`" 7 ! 13 Hazardous locations. 600 volts nominal, Suite/hIdg,/Apt,no.; Project name: 0 Servicc or feeder 600 amps or more. -• if+'CC 5C1ri.EDU1LE Cross street/directions to job site: + fr' - T- L fi t,G�_ C'� .�.��(.off ,e,-1,( 7.4 Zh Rtriptton Qty. Fcc. T/Int " New residential single or multi-family dwelling unit. •c1y AZ.VSS tc-C CA il' fi1z.. /?f: ";1 -7r77 c: zS >r. t Includes attached garage. Subdivision; Lot no.; 1,0(10 sq.ft.or loss 145.15 4 Ea.addl 500 sq,it,or portion 33.40 1. Tax map/parcel no,; Limited energy, residential 75,00 2ECLPfIOV°l ..W (with abovo�s_( ._ _4f 4 ( - ' Limited energy,multi-family W 4-0t11- 7,.,., ', .. . _ yi c-t 1 _&z i ., reside»tial(will,above sq.fl,) 75.00 2 Services or feeders installation alteration and/or relocation CI arty;4- ,r ik r i 200 amps or less 80,30 2 [3 PROP.E:RTY O%I?N:R)<t • • • • • 0;T.'t"i kft.IVT201 amps to 400 amps 1.06.85 2 Name; 401 amps to 600 amps 160,60 2 601 amps to 1,000 amps 240.60 2 Address: Over.1,000 amps orvol 454,65 I 2 City/State/ZIP: Temporary services or feeders installation,alteration,and/or relocation Phone:( . ) Fax:( ) 200 amps or less -J „6f1'fRF" f 9 0 i Owner installation:This installation is being made on properly that I own which is not 201 amps to 400 amps 1.00.30 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 133.75 2 Branch circuits-new,alterations or extension,per panel Owner signature: - Date: A• .Pee for branch circuits with t3�i C CACT::Pl ttSON. each rani c orc lit fee, , p� ""�-` each branch circuit: „..e.„6,-.,( ' ' �r � ' Business name: Li d e G (.B. J” 5,Fee for branch circuits Contact name: 14141 ��___6,14 ,,e., withouts service or feeder fee, l �"� first branch circuit 46,85 2 Address; a 9/5 Lk of sv 1 Each add'1 branch circuit 6.65 2 .t Miscellaneous(service or feeder not included) City/Stale/7lP:7 �f 4. 9-70(1;„2„ Each manufactured or modular 90,90 2 dwelling,service and/or feeder Phone.60 2 )!p gi... 6,1 Fax::61)3 ) Q Reconnect only 66.85 2 E-mail: X gh le_v_kt'.%_a. +?,.(e�'��rt`t�.Cavi ,, Pump or irrigation circle 53,40 2 C0 ''RACI'OYt- Sign or outline lighting 53.40 2 T�usincss name; Signal circuit(s)or limited- e9 orLS ,Cl�tiriG s fr),.. i -r energy panel,alteration,or extension,Describe: Page 2 2 Address: 94.5 -:� A- City/State/ZIP:- "� !'' � 9 '/� Each additionalinspection over allowableany in of the above ' � Pcr inspection 62.50 Phone:5 3, )/0 9/- 29 Fa=t:64 )Ca 2 R it __ 9 /l Investigation per hour(1 hr min) 62.50 �Li jJ(" per hour 73.75 CCS Li(.:/58$9J� Electrical Iic„ �/_(�7cI Suprv.Lie.:, ?.i*,+ I»dus. . plant ELECTRICAL,II'Ii+l(t iT FEES Suprv.Electrician signature,required: t7 �" Subtotal; Print name: // / Date: _ Plan review(25%ofper•mit fee): 6,y4,$ I,tQ/ wry @ „. State surcharge(12%of permit fl=ee): ,0 / Authorized signature: / "" .. 7`f r .. - TO'TAI.PtRM1T FES: 7, Print name: Date: 4_ j mix permitapplicationexpirernpermit isnotobtained within 150ti��y � sdays after It has been accepted as complete. * Number ot'inspections allowed lar permit. I;\Ouilding\Po rnit ict,C-POntlitApp.tloc 05/23/06 440-4615T(I1/05/COIN/Wei 05/23/2017 03:06 5036912918 LIGHTWORKS ELECTRIC PAGE 01/02 20975 SWhAVLATIN,OSUITE 2 LIGHTWORKS PHONE:543.6972959 ki. ELECTRIC COMPANY F•AX:503.691.2978 CCB#156595 Fa)/ Prone k ' -Li L oe 5 C:'a�- Fay 50 .. (.I() Pages: • L-las Date; srpk_si_ii7__ Re: CC: ©Urgent 0 For Review El Please Comment 21P lease Reply ❑Please Recyc cic O SkIe, rAt(A''c,. (o utn