Permit p CITY OF TIGARD ELECTRICAL PERMIT
'`1 ' COMMUNITY DEVELOPMENT ELECTRICAL
ELC2021-00617
Date Issued: 11/17/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S114AA00600
Jurisdiction: Tigard
Site address: 16555 SW 85TH AVE
Project: Clean Water Services-Cogen Subdivision: None Lot: None
Project Description: 4000 Amp feeder.Site locations-16555&16605 SW 85TH Ave.
Contractor: FIVE STAR ELECTRIC INC Owner: CLEAN WATER SERVICES
756 SW BAILEY AVE 2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 HILLSBORO, OR 97123
PHONE: 503-324-0948 PHONE:
FAX: 503-324-0973
FEES
Quantity Description Date Amount
1 ea Services or Feeders-Over 11/16/2021 $552.26
Specifics: 1000 amps or volts
1 ea Plan Review Electricial 11/16/2021 $138.07
Type of Use: COM 13 ea Info Process/Archiving-Sm 11/16/2021 $6.50
Class of Work: ALT
$0.50(up to 11x17)
Type of Const: 1 ea 12%State Surcharge- 11/16/2021 $66.27
Occupancy Grp: Electrical
Total $763.10
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 throuah OAR 952-001-0090. You may obtain a coov of the rules or direct Questions to OUNC by callino 503.232 1987 or 1.800.332.2344.
Issued By: Hc{, -j Va-w De,We-ge. Permittee Signature: Ow Ap-p-tiZa41.0-0,
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'N 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.
S
RECEIVED - 1
Electrical Permit Application FOR OFFI('I:I:SE 0\7.Y
City of Tigard OCT 2 0 2021 Received/,//26 2o2/ Permit 4; E D21-C( ei 9
13125 SW Hall Blvd.,Tigard,OR 97 ' V OC TI AHU Plan Rev (/
g � T I f la Plan Review y �J
Phone: 503.718.2439 Fax: 503.598.'H A _DaterBy: f r f 7/Z� Re ced Permit fr:
T I ii;V.D Inspection Line: 503.639.4175 3UILDING DIVISION Ready llatc-By: � ® See Page 2 for
Internet: www.tigard-or.gov Milled/Meth f I 163- Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction 5 Addition/alteration/replacement — Rise check all that apply(submit 2 sets of plans w!items checked).
Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: S
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
►0 Commercial/industrial ❑Accessory building �I less to ground,or exceeds 14.000 El commercial-use agricultural
❑ I-and 2-family dwelling
•-' for all other installations. buildings.
El Multi-familyEl Master builder 0 Other: tFiream
0
Fire pump. ❑Installatiotion of 150 KVA or
JOB SITE INFORMATION AND LOCATION t 0 Emergency system, larger separately derived
Job#: I L ,.1 j 6
'1 Job site address' j� ... "lye, /t 49 s ❑Addition of new motor load of system.I OOHP or more ❑
City/State/ZIP: `�;U\tl V L 01�Z2-y ❑Health-care more residentialaie units. R occupancy.
i�.i �' ❑ (aeilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:CA�(� ,�,y- co( 7r� ❑Hazardous locations. 0 Supply voltage for more than
`lJ� v" 0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
----_-�- Description QIv. Each Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
—-- 1,000 sq.B.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,
residential
t ,(k ( _n .k ,t (with above sq.tl.) 75.00 2
�� \ �� Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
— — Renewable Energy ❑ Sec Page 2
0 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps i 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 1 552.26 6521(4,2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
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
pt APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension, t er panel
A.Fcc for branch circuits with
Business name: PVC " j'y i OtcAy'G above service or feeder fee, 7.42 2
i i t"� each branch circuit
Contact name: 1 rt(c C B.Fee for branch circuits without -
Address: 1 3(4 ) c vservice or feeder Cce,first
Ave,` branch circuit 56.18 2
City/State/ZIP: i -0 QV il LS Each add'I branch circuit 7.42 2
,��`` {u� Y I Miscellaneous(service or feeder not included)
Phone:( .6) "3L 0001 Fax::( ) Each manufactured or modular '—
I dwelling,service and/or feeder 67.84 2
Email: ,-ril service
T.V ;� ,re t , ,-7(ei Reconnect only 67.84 2
__! CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ,c `} f 2, �: �LC 1� Sign or outline lighting 67.84 2
Address: v\ Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State%ZIP: Each additional inspection over allowable in any of the above
- Additional inspection(1 hr min) 66.25'hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00i hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00 hr
CCB Lie.: An t Electrical Lic.:3L.1, jo, Suprv.Lic.:(j j I S specifically listed l'A hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: pa-- Subtotal: $ 2 74,1
Print nam a c7c,v) .7t 11 Date: 1U12o1L1 WPlan Review Required(25%ofpennitfee): _ I'A 0g1
�/7 State surcharge(12%of permit fee): - , ,'Y•'7
Authorized signature: t.�f� TOTAL PERMIT FEE: l (00
1 This permit application expires if a permit is not obtained within 180
Print name: �fv fl !c �. '�c Date: i U1ZQ jZ I days after it has been accepted as complete.
VV''V`'��� 1 1 III ` Number of inspections allowed per permit
I:'•Duildingl'emrits',ELC I'ertnnApp_EI.R_ERE doe Rev !17i2015 440-4615T(I I:OSiC'OMM'Et