Permit CITY OF TIGARD ELECTRICAL PERMIT
•' 2 COMMUNITY DEVELOPMENT Permit#: ELC2020-00361
Date Issued: 9/8/2020
TicAAD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16310 SW 85TH AVE
Project: Clean Water Services Subdivision: None Lot: None
Project Description: (7)underground conduits in primary pump room. No wire or cable in conduits.
Contractor: OWNER Owner: CLEAN WATER SERVICES
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 hr Industrial Plant(1 hr min) 07/16/2020 $78.18
Specifics:
1 ea 12%State Surcharge- 07/16/2020 $9.38
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.56
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA 52-001-0090.0. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: e; /1-1° 6`1 C l/r
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
t.
Electrical Permit Application FOR OFFICE USE ONLY
JUL 7 202"
City o Tigard Received �r y�y�`J f g f"��T Or r DalelBy: 74,fre "/ 'emit°: 4 2_).'�..,.t-02361
III u 13125 SW Hall Blvd„Tigard,OR 2 ) r I,, /". Plan Review �C(/V
U Phone: 503.718.2439 Fax: 503. 1 kt, p')i 1t f Related Permit 8:
YLLI I�Y(-' -t l)f 7':; Q�csady D
1 1 G A R f) Inspection Line: 503.639.4175 - Ready Date/By: juP; . , ® See Page 2 for
Internet: www.tigard-or.gov NotifedlMethod: Supplemental Information
TYPE OF.WORK PLAN;REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit$sets of plans w/items checked);
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition ❑Other;
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION ..,";- - exceeds 10,000 amps at 150 volts or ❑Floating buildings.
El 1-and 2-family dwelling [ElCommercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps far all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMAT 'LOCATION 0 Emergency system. larger separately derived
/ L3-T/!7�(/E 0 Addition of new motor load of system.
Job#: Job site address: ✓
IOOHP or more. ❑"A" "E""1-2""1-3"
City/State/ZIP: �J ❑Six or more residential units. occupancy.
ty 774/{2,0 02 q 12 2¢ ❑Health-ca a facilities. ❑Recreational vehicle parks.
Suite/bldg./apt#: Project name:pe/,N/yt,y , IM/2/Li Ctvtew i 73' ❑Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: , //L/M/ir-j /ZO FEE SLIIEAIJLE
DeseAption I Qty. 1 Each, I Total 1 •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORT( Limited energy,residential
/N. T/J 14 (with above sq.ft.) 7s.00 2
7 - Ll1/Nc/4 coma/ s`JNOtYL c4fLawi✓l) �1N$-y/ Limitedenergy,multi-family 7500 2
J9/D 14-)//2. . D . G' L. . residential(with above sq.ft.)
PROPERTY OWNER Renewable Energy 0 See Page 2
❑ TENANT - Services or feeders installation,alteration,and/or relocation
Name: 'LEA/ 441/17 .„.,574l//e S" 200 amps or less 100.70 2
Address: //�e) s'' J es-A, ,�17� 4 6 01 amps to 00 amps 133. 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 77c'i/le,f) p2 9 r,Z Z 1- 601 amps to 1,000 amps 301.04 2
Phone:(6-23).. 47 _6'j�e_c' Fax:( ) Over 1,000 amps or volts 552.26 2
L� /26" Temporary services or feeders installation,alteration,and/or
Email: zk'oy/N e C,Gsr�/I„,,,,e J Jx/Ls</L///�c,, ,D relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
)3] APPLICANT .CONTACT PERSON. Branch circuits—new,alteration,or extension,per panel
dL,E�/s-/ l�.4 X. S�4,//C�.f A.abo for branch dees with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: ,/1/1-2./e .Z 46 ft,/ B.Fee for branch circuits without
Address: //v 50� jW {� /r service or feeder fee,first 56.18 2
v6- A/� branch circuit
City/State/ZIP:- 64 .Q .0 a- 9 7224- Each add'I branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
a3) ,�lf. -g/ Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: 7/60y'1..4 L'/-F /✓.q-j _. j�_,l/C.<5..,p !,—
Reconnect only 67.84 2
CONTRACTOR - . Pump or irrigation circle 67.84 2
Business name: a -/0 61/4—Mi s pie.�f' Sign or outline lighting 67,84 2
Address: r� o G� y(ti d Signal circuit(s)or limited-energy ❑ See Page 2 2
�44- ,s � /ice�€ panel,alteration,or extension.
City/State/ZIP: -77G � gl/Z G�. , ¢ Each additional inspection over allowable in any of the above
I,If Additional inspection(lhrmin) 66,25/hr
Phone:,'3)�.7 _g/B'' Fax:( ) Investigation(1 hr min) 90,00/hr
Email' Industrial plant(1 hr min) / 78.18/hr 1 ,j,
Inspections for which no fee is
CCB Lie.: Electrical Lie.: Suprv.Lic.:47975 specifically listed('/,hr min) 90.00/hr
7iyl,,l- ELECTRICAL PERMlbt FEES
Suprv,Electrician signature,required: — r�
�-✓ Subtotal: ��!°i, /Li
Print name: , f4 ./o ,z/4 7y Date: 7/740lp 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): la,3 8
Authorized signature:?jjP /' TOTAL PERMIT FEE: g'?,r Sb
' This permit application expires if a permit Is not obtained within 180
Print name: rr�n•/7"G/T) ,/6-t y Date:'77/i/gypZU days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:1BuitdingtPermits1ELC PermitApp ELR ERE,doc Rev 06/17/2015 440-4615T11 IPo5/COM/WEB