Permit fi 4 CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2009-00675
. T t G A.RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/29/2009
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Subdivision: SEWER TREATMENT PLANT Lot: 0
Project: Clean Water Services
Project Description: Add /alter (2) branch circuits for HVAC.
Owner: FEES
CLEAN WATER SERVICES Quantity Description Date Amount
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 2 crt Branch Circuits 12/29/2009 $63.60
wo /Purchase Service or
PHONE: 503 - 789 -3564 Feeder
1 ea 12% State Surcharge - 12/29/2009 $7.63
Electrical
Contractor:
FARNHAM ELECTRIC CO
1050 LAFAYETTE AVE
MCMINNVILLE, OR 97128
PHONE: 503 - 472 -2186
FAX: 503 - 472 -4042
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 at 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 thr ugh AR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: C i (lin g c ,Od;J Permittee Signature:
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' J n Date:
LICENSE NO. mil' ^ (J
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
„PI om: RECEIVED 12/28/2009 16:30 #726 P.003/003
- Electrical Permit Application : iii.: . :.,....
.
I rclric >rllu use:ciN1;�
City of Tigard C TY OF TIG A ' e,ived
° 13125 S W Hall Blvd. Ti aid, OR 97. Other Permit: _ I Permit No.: r '7
Y p� 1 Li _I - ' _mid t
0 g 4P�� tEN r��V� '?
• n •
' Phone: 503.639.4171 Fax: 503.598.19 t Date/B l e :T Inspection 503.639.4175 Rn 2a`Q lg. Rd ho June: l Supplemental
Internet: Si See Pent2 for Information t meC www.tigard -0r.gov Notified/Method: (�
TYPE: of WOItB
pt;ANr >av1w
❑ New construction )(Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /uems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition El Other:
where the available fault current ❑ Marinas and boatyards.
' , ;CATEGORY OF ; CONSIRLJGTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
El 2- family dwellingCommereial /industrial ❑ Accessory building less to ground, or exceeds 14,000 ❑ Commercial -ase agricultural
g amps for all other installations. buildings.
❑ Multifamily ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or
J
JOB ; SITE INFO AND LOCATION t larger l separatelyderived system.
El system
❑ Addiion of new motor load of
q 17 - 1 bp &'ii ❑,.A....E,...,_Z„ vehicle Job no.: Job site address: A ve. 100 HP or more.
occupancy.
T i gard 3 OR 011224 �ftl ❑ Six or more residential units. ❑ Recreational voltage vehicle oat an
City/State./ZIP: ❑ Health-care facilities. ❑Supply voltage fur more than
Project name: 12 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Pro 1 D ag j1 W I T > ❑ Service or feeder 600 amps or more
Cross street/directions to job site: .,;FEE;;3CI gDVLE . __,
_Description 1 Qty. 1 Fee i Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: i Lot no.: 1,000 sq. ft. or less
168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. R or portion J 33.92 1
' r '; :,,!. 7 DESCRIPTION OF' WOR ' .. t; :. F , u , residential
Limited energy, resid
67.84
.. . M...i ,r ;,...:::... (with above sq. R.) 2
41 I, 1- . _ . - Limited energy, multi family
�► l l B . t :i,1 _ residential (with above sq. R.) 67.84 2
Services or feeders instafatlon, alteration, and/or relocation _
a ® 200 amps or Tess 100.70 i 2
_,,, PROPERTY O 'NiER .' tti :;TENANT «i . �' V 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
—
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 i 1
Owner installation: This installation is being made on property that 1 own which is not _ 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 168.54 2
Owner signature: Date: Branch circuits — new, alteration, or extension, der panel
c n r - APPLICANT, y ., ? . ,. A. Fee for branch circuits with
,; „ - ,:❑ CONTACT PERSON_::, x , above service or feeder fee,
e each branch circuit 7.42 2
Business name: FAIflA �A , IAA E 1 f bh 1 ` (, C V 11 (J _ B Fee for branch circuits .
Contact name: John s � � � � y� ` �' ( without service or feeder fee, ' BIN ��
CJ n first branch circuit 56.18 • 2
Address: , 05D I V /JI A• Each add'l branch circuit l 7.42 7.42 2
j t !p 111 Q 11 O � I��f C _ _ Miscellaneous (service or feeder not Included)
City/State/ZIP: —
__��,_��,�yyyy LllLLL ll, 1p l 111 ( 7( Each manufactured or modular
dwelling, service and/or feeder 2
Phone: ( 50 3) 472. • 2! KO Fax:: ( s03 4.72 -4042 Reconnect only 67.84 67.84 2
E-mail:
Pump or irrigation circle 67.84 2
::;;;;' -; . ,< i.,.. �� :�.. i_. ...,,. ,CONTRACTOR . � ,,.,. :., : � Sign or outline lighting 67.84 2 2
Business name: Farnham giec1, co. Signal circuit(s) or limited -
�l a t/ pl �/ energy panel, alteration, or
Address: D • 0 1 _ .1 i, • '„\ a. , e. extension. Describe: Page 2 2
City /StateJZIP: .
` ! F 0 Each additional inspection over allowable in any of the above
Phone: ( Per inspection 66.25
� / '' 8' ” i�j . jnvestigation per hour (1 hr min) . _ 66.25
,Av CCB Lic.: 01711 Electrical Lic. : • 5G Suprv. Lie.: d ,/ Industrial plant per hour 78.18
Suprv. Electrician signature, re quir [' . `E LECIRICAL FEEB' :•..
. Subtotal: 63„ fiCi
Print name: . 1_1 , Date: 12. Z6 di- Plan review (25% of permit fee): 44„
• State surcharge (12% of fee): .y r_
Authorized signature: A 1. C9
AI a 1 d ? �1 L ' o f TOTAL PERMIT FEE: -7 I. Zs
Print name: As . let Bova Date: 12) 24/C This permit application expires if a permit is not obtained within 180
1 f x / days after it has been accepted as complete.
• Number of inspections allowed per permit.
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