Permit Support Document INn CITY OF TIGARD ELECTRICAL PERMIT
S" COMMUNITY DEVELOPMENT Permit#: ELC2021-00019
•` Date Issued: 1/14/2021
T j G y R a 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 it Parcel: 2S1136000600
t Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Project: Tertiary Backwash Pumps Subdivision: None Lot: None
Project Description: (2)400A Feeders for Tertiary Backwash Pumps. 3/18/2021:REPRINTED permit to include(2)400 amp feeders.
Contractor: FIVE STAR ELECTRIC INC Owner: CLEAN WATER SERVICES
756 SW BAILEY AVE 2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 HILLSBORO, OR 97123
PHONE:
PHONE: 503-324-0948
FAX: 503-324-0973
FEES
Quantity Description Date Amount
2 ea Services or Feeders-401 to 01/14/2021 $400.68
Specifics: 600 amps
1 ea 12%State Surcharge- 01/14/2021 $48.08
Type of Use: COM Electrical
Class of Work: ADD 2 ea Services or Feeders-201 to 03/18/2021 $267.12
400 amps
Type of Const: 0 ea 12%State Surcharge- 03/18/2021 $32.06
Occupancy Grp: Electrical
Total $747.94
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 OAR 952-001-0090. 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: ,tsvjA/' Permittee Signature: e-
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.
i` 0 - i210I2,1
Electrical Permit Application
s. rw
- City W Hall
li rd /� J P u: C�[ j�{1 �- r rat)J�
is lit ; " hone SW IJall Blvd.,Tigard,OR 97223 A •E _F `�f/
Phone: 503.718_2439 Fax: 503.598.1960 LL/`I s ,j ,1 � 8:
N` it f;A!:[3 Inspection Lim: 503.639.4175 ion Randy Pi. f�` �� -{r �r 0 See Pate 2 far
hammer.: www.tigmd-ar.gov IJiN 2 e LD70 Notified/Method:ethod:.- 116/et '�rfG. r., suppkmedal Information 1
TYPE air WORK wu• 4 t -..if( s "�,,VV PLrRREVIEW
'.i ❑New econstruction Addition/alterationir 1 PIne nkvl�l apply(submit 1 sets ofdanswl8emsdecked):
S �P OF TEGAR
❑Demolition Other DING DIV1S 0 Sery ce ar Buser 40p a ps m wore ❑B ild og avc tb ee ds e.
wine me ava;Lble fault Pared ❑Mama+srd bemycde.
•
CA RP OF CONSI'RU g .� exceeds 10,000 amps at 150 volts or QFIoatngbdldios.
N ❑1-and 2-family dwelling Commercial/industrial ❑A ' i` i` Into gn'und•or xcecda 14,000 ❑eommcmi.t ure agrcolmnl
❑Multi•family Mauler builder Otb fit_ �� tags for all otherinstallations. buildings.
❑Fcc pump. ❑Iostel4nion of 150 KVA or
OB SITE INFORMATION AND LOCATIO W ❑ speecy sraeta larger aepaniely derived
♦.} t 1 10 fl ' ' W � . ll- .es dddioo of yew moor bad of system
� Job#: f �( Job site address: i J / �Iv/L�J 1 or more. ❑'A•..'H,...1-Z'•."Id`.
City/State/DP: 71401141 og I ❑Six or nomreaidwn;aiasi8s.
..'1 !�'• ❑DWth-care facilities. ❑PKTpiioaal vehicle parts.
.j Suite/bldg./apt# Project nam . ' I f /i al .V ,• In f ip Haurdeus toceliom. ❑sutply voJa a for tours than
EI j Semite or feeder 600 amps or more 600 vdn"mini"
ti Cross street/directions to job site:
FEE SCREDULE
1 71
aevlpdoa ow. &a Tow I •
--- New residential single-or multi-family dwelling Knit
Subdivision: Lot#: Lac1udes attached range.
Tax neap/parcel#:2 111'3 g o Q b b D4 LOGO sq.it or less 168.54 4
FB.edd'I 500 sq.ti or portion 33.92 1
t,, DESCRIPTIONTt OF WORK.{ Limited energy,residential
u �XIS 'N f -o�� i®hea ,aala�,n,7y 7s00 2
f .�y r (with alwv6,M R)
residential(with above 6q.B.)
P Rmewabte Energy Q See Page t
:e R TY OWNER i ❑ TEN Services or feeders ioatallation,alteration and/or relocation
Name: aft I
i A a B 201 amps amps orto less00 amps 1 133.70 2
Address:
; ,„To r t�D[�7i l� # t L-! ---- 401 amps to 6oOampa 200.34 �7JA2.
City/State/ZIP: i�iti,A 1 tl f lr 1 601 amps to 1,000 amps 301.04 2
i` Phone:( ) Fax:( ) Over 1,0o0m or volts 552.26 2
relevance
services or leaden lastalladou,alteration,and/or
-! Email: relence
Owner installation:This installation is being made on properly that 1 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 amp:to 400 amps 125.08 2
Owner signate: Dale: I 401 amps to 599 amps 168.54 2
5� APPLICANT ❑ CONTACT PERSON — _Braorh circuits-new?alteration,or enemies,per paced
y1 A.Fee fen bomboteens with�,i Business name: )i Y# ' 40(.(e4 above service or feeder Re 7A2 2
� R 14 each branch rant t
\ Contact name: i B.Fee for blanch darts wtrlewu
q4 Address: a service or feeder fee,Brat 56.18 2
'��J A I branch circuit
-4 Ay/state/zip; '! lj pyp4 Each Perri branch circuit 7A2 2
aw Phone: I 61.l Q^,E ryhiy/ Mlacd4Keors(serWce or feeder out Iadaded84
: • ) 1 Fax:: ) 7 i�l L/sl t Each manufactured or modular
dwelling,servile and/or fees 67.84 2
r-t Email: it n(li YO(j"/j r Qf{/,�•yl'/-. /ly']� _ R connect only 67.84 2
.� �+' s ? CONTRACTOR s Y v• sIl
,I e/' Pump a irrigation nelighting
circle 67.84 2
', Business Haan: �t 1[Il.I P i Sign or outline lighting 67.84 2
is
n v Signal ortatit(s)orlinritdcoergy
a V Address: 1 , w A( �e1AA, Ave, panel,alteration,Or extension. 0 See Page 2 2
City/SlatcilJJ" �'��QI tD// ��' Each additional laspecdon over allowable la any of the above
�/l�� Additional inspection(l hr min) 66.25!1u
,' Phone: :ru, ) . /�. k, Fax: Id, ) !44. i g investigation(I hr nun) 90.00/hr
r a • Indushial plait(1 In min) 78.18/hr
Email: r� /r l / t. o r /i M IA 1 I inspections for which no fee is
CCB Lic.: I541•3 I Electrical Lic.!f +['g I Suprv.Lic.:Kl i y specifically fisted(�h hrmmZ 9D.ON hr
v .\d�" ELECTRICAL PERMIT FEES
Suprv.Electrician sipna lure,required: Subtotal:
Print name: A 1�-I Date: ' 0 Plan Review Required(25%of permit fee):
State
surcharge{i r,6 ofpermil fix>):
Authorized signnta/turree:A' // �l TOTAL PERMIT[77 A ej,1
Print name:`(A`i,{/' 1 . Date:D,1'fl/1 Thbperrnadayl,aaferhaexwbres tf na penult Is not accgrhdascompletn. a180
Y•'W v W P
' Number of inspections allowed per permit.
1:1:tuildkajTenits'E1.C-Pen itapo_mt_eRE doe Rev WI 7,7015 4404615TI I IA3'COMAVEb
RYE STAR ELECTRIC
* * * * * COMMERCIAL/INDUSTRIAL/SERVICE
January 25, 2021
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
Permit#ELC2021-0019
Cleanwater Services
Tertiary Backwash Pumps
16060 SW 85th Ave.
Tigard, OR 97223
To Whom It May Concern:
Please see attached electrical permit application for plan review and (2) sets of electrical plans. This
is to add to permit #ELC2021-0019. Please use the following contact info for additional
details/payments:
Angela Strauss
503-324-0948
adminfivestarelectric.orq
Thank you,
Angela Strauss
756 SW Bailey Ave, Hillsboro, OR 97123 * Phone: (503) 324-0948, Fax (503) 324-0973 * CCB#158231
LICENSED • BONDED • INSURED
FOR OFFICE USE ONLY—SITE ADDRESS: `46/di -L~'
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
T I .;A R ii 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: Permits DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
FROM: Angela Strauss
JAN 2 5 2021
COMPANY: Five Star Electric, Inc.
CITY OF TIGARD I By. err
PHONE: 503-324-0948 BUILDING DIVISko
EMAIL: admin@fivestarelectric.org
RE: 16060 SW 85th Ave.Tigard,OR 97223 ELC2021-00019
(Site Address) C (Permit Number)
Tertiary Backwash Pumps &�N +7tr c i:S
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
2 Additional set(s)of plans. Revisions:
Cross section(s)and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS: Adding plan review to existing permit Pia,v3 S%vMI c w f ji„e. _ ., - t4e
IA711481.
FOR O FFICE USE ONLY
Routed to Permit Technician: Date: a, / Initials: ,la h� .9
Fees Due: [' Yes ❑No Fee Description: Amount Due:
$
Special
Instructions:
Reprint Permit(per PE): ❑ Yes ❑ No _L Done _
Applicant Notified /-g— Date: 3/i.7/21 Initials: , l
I'\I3ui(ding\Forms\Transmittal Letter-Revisi�0)�20.doc
Branden Taggart
From: Branden Taggart
Sent: Thursday, March 18, 2021 1:30 PM
To: Angela Strauss
Subject: Clean Water Services Permit: ELC2021-00019 - 16060 SW 85th Ave.
Attachments: Invoice.pdf
Hi Angela,
The revisions for the Clean Water Services Tertiary Backwash Pumps are ready to pick up now. The balance due is
$299.18, and I have attached an invoice above for you to reference. This fee can be paid online now at https://aca-
prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record number ELC2021-00019 under the Building
tab. There is a 3%service fee for credit cards, but e-checks do not have a service fee.
Once paid, please email the Permit Technicians at TigardBuildingPermits@tigard-or.gov so that we make the revisions
available to pick up. Please note that inspections cannot take place with outstanding fees due. After payment has
been made, inspections can resume.
Thank you,
Branden Taggart
� City of Tigard
Senior Permit Technician
Community Development
13125 SW Hall Blvd
Tigard, OR 97223
(503)718-2449
brandent@tigard-or.gov
1