Permit ELECTRICAL PERMIT
IN Ci Y OF TIGARD
COMMUNITY DEVELOPMENT PERMIT #: ELC2008 -00551
DATE ISSUED: 9/30/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 113B0 -00600
SITE ADDRESS: 16580 SW 85TH AVE ZONING: I -P
SUBDIVISION: SEWER TREATMENT PLANT LOT : JURISDICTION: TIG
PROJECT: CLEAN WATER SERVICES
Project Description: Adding and altering (2) branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVCI FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
CLEAN WATER SERVICES FARNHAM ELECTRICAL CO.
2550 SW HILLSBORO HWY 1050 LAFAYETTE AVE
HILLSBORO, OR -9379 MCMINNVILLE, OR 97128
Phone: 503 - 681 - 3600 Contact #: PRI 503 - 472 -2186
FAX 503 - 472 -4042
FEES
Description Date Amount Reg #: ELE 36 -3C
[ELPRMT] ELC Permit 9/30/2008 $53.50 L[C 1217
[TAX] 12% State Surchar 9/30/2008 $6.42 SUP 4949S
Total $59.92 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: ‘e o r e Permittee Signature: 5----2 `` Jl -,2/ ^/
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 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.
111 11111 116
From: 09/30/2008 09:36 4368 P.003/006
e
Electrical Permit Application
City of Tigard ed
Receiv
�.1� Revew : AV ermit No.: � —c-07 F—
a 13 125 SW Hall Blvd., Tigard, OR 972 N DJ �• 1 �� ' 5/ +Gr Plan Date /By: Review
'' 1 • Phone: 503.639.4171 Fax: 503.598.1 �/ Other Permit: /. [J(�
Inspection Line: 503.639.4175 r Date Read Ready/By: t � � FB f
7IGARL] q 0 Y o / Set en i 1nr
Internet: www.tigard- or.gov d O Z Notified/Method; Supplemental Information
TYPE OF: WORK
, ` .�,{11
❑ New construction ® Addition/alteratior0R1 [ j�1S1U14 Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition El Other: tt��l��l ❑ Service or feeder 400 amps or more Building over three stories.
01: where the available faul t current El Marinas and boatyards.
CATEGORY -OF CONS UC110N -' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000
El 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building El Commercial -use agricultural
�' g amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
•, ,JOB SITE iiNFORMAIION `AND LOCATION larger separately derived system.
❑ Emergency system la
❑ Addition of new motor load of
Job no.: 82645 Job site address: 16580 SW 85 AVE 100HP or more. occupancy.
❑ Six or more residential units, ❑ Recreational vehicle parks.
City/ State/ZIP: TIGARD, OR ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: CLEAN WATER SERVICES ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: SC1�ULE - •
Description 1 Qty. 1 Fee 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less _ 145.15 4
Tax map /parcel no.: 25113/30 Ea. add'l 500 sq. ft. or portion 33:40 1
. PI iON • OF : WORK above sq. ti ential
d 75.00 2
DESCRI
Limited e y, re
(with a
ADD /ALTER (2) BRANCH CIRCUITS AS DIRECTED. Limited energy, multi - family
residential (with above sq. ft.) 75.00 2
- Services or feeders installation and/or relocation
200 ` ❑ TENANT amps to or less
RTY r oR+NEA ': . - , •
80.30 2
�,PROFE
"' •` 201 amps to 00 amps 106.85 2
Name: CLEAN WATER SERVICES 401 amps to 600 amps - 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 2550 SW HILLSBORO HWY Over 1,000 amps or volts 454.65 2
City/ State/ZIP: HILLSBORO, OR 97123 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)681 -3600 Fax: ( ) 200 amps or less 66.85 _ 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 -
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch cttnuits with 5
Business ❑ �UCA� 0 CONTACT' PERSON above service or feeder fee,
each branch circuit 6.6 2
name: , 7} � a I) jc!A) B. Fee for branch circuits
Contact name: c/ i l (,R g� v/ poor without service or feeder fee, 1 46.85
t.� ow, I first branch circuit 46.85 2
Address: ON p Each add'I branch circuit 1 6.65 _ 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: 3 t„) Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 - 2
E -mail: Pump or irrigation circle 53.40 2
. CONTRACTOR , Sign or outline lighting 53.40 2
Business name: FARNHAM ELECTRIC CO. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 1050 NE LAFAYETTE AVE extension. Describe: Page 2 2
City/ State/ZIP: MCMINNVILLE, OR 97128 Each additional inspection over allowable In an _of the above
Phone: (503) 472 -2186 Fax: (503) 472 -4042 Per inspection 62.50
- Investigation per hour (1 hr min) 62.50
CCB Lic.: 01217 Electrical Lic.: 36 -3C Suprv. Lic.• 4949S Industrial plant per hour 73.75
Suprv. Electrician signature, required: • ..� . ELECTRICAL :PERMJT FEES. '
� 1 L.. Subtotal: 53.50
Print name: JEFF FARRAND . q Date: 9/29/08 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 6.42
Authorized signature: TOTAL PERMIT FEE: 59.92
Print name: Date: This permit application expires If a permit Is not obtained within 150
days after It has been accepted as complete.
* Number of inspections allowed p
per
I: 1BuildingtPer :niW \ELGPermitApp.doc O5! 23 /06 440.4615T(I1 /05/COIv1/WEB P pe permit.
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: EL.C2.008-00c61
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/-301200C#
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: • 0/27/2008 TIME: 7 PAGE: '18
SITE ADDRESS: 16! SW 85TH AVE CLASS OF WORK:
SUBDIVISION: SEWER 'TREATMENT PLANT LOT #: TYPE OF USE:
PROJECT NAME: CLEAN WATER SERVICES
DESCRIPTION: Adding and altering (2) branch circuits. (tp ot.tcc,‘}r
OWNER: CLEAN WATER SERVICES, PHONE #: 503..681_3000
CONTRACTOR: FARNHAM ELECTRICAL CO, PHONE #: 503_472_2106
Inspection Request Scheduled For: Date: 10127/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 077199-01 503-314-7390
Corrections/Comments/Instructions:
/ V \
•
A PASS PARTIAL APPROVAL 0 CANCEL NO ACCESS
• ' fl CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G Nci3 L' Date: lop:pi Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: I:YI s. tna0 (7t1°;')1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1E3/301200F1
Phone: (503) 639 -4171 ICI
Inspection Requests (24 Hrs.): (503) 639 -4175 .._.'� 1
INSPECTION WORKSHEET FOR DATE: 10/1/2000 TIME: 7 02AM PAGE: ,
SITE ADDRESS: 16580 SW 85TH AVER CLASS OF WORK:
SUBDIVISION: SEWER Td I TIEATME =N7 PLANT LOT #: TYPE OF USE:
PROJECT NAME: t .LEAN WATER SERVICES
DESCRIPTION: Adding and altering (2) branch circuits.
OWNER: CLEAN WATER SERVICES, PHONE #: 503.681 -3600
CONTRACTOR: FARNHAM ELECTRICAL CO, PHONE #: 503-472-2186
Inspection Request Scheduled For: Date: 10111008 Pour Time:
Code # Inspection Description _--Confir # Contact # Message
106 Q0Crak?i tto■1nl(f)
195 Mi;:c. In ' pection 076134 -01 \ 503 -314 -7390 N
Corrections /Comments /Instructions: \ \`
PAS _ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: NQ 1..< Date: I.0 • •1 Phone #: (503) 718- lil`ib
From 09/30/2008 09:36 11368 P.0031006
Electrical Permit Applicatior - '::g . 'iii i:.ii_..i',.' .:::':.'.::::•.:'!.'.-.:•...:...:,::::.
. .. . .. .. . . . .
''•'::::.,: . City of Tigard 1 -Cit Received .47
'ermit No Ei
.: c_ cv - - 5/
.11 ' • 13125 SW Hall Blvd., Tigard, OR 9722, (1 1101 P v / - -
:;. 1 Phone: 503.639.4171 Fax: 503.598.19 ji,i, --- ` Date/By: 1 Other Permit: ,.. 0 & - 7 • Inspection Line: 503.639.4175 cpt Date Ready/By: lois: 0 See Page 2 for
4IGARD
. .. ' - • Internet: www.tigard-or.gov
W i)
9 q 2 u Notified/Method: 7Zt Supplemental Information
:.:,' .,:iiii .i. il 10:-._,: ,, :i:;A: , ;.:i...::;',;' , : ''.A:::.:;:-.::
0 New construction El Addition/atteratiott104 j i NiSit.. Please check all that apply (submit 2 sets of plans w/items checked below):
V h o Service or feeder 400 amps or more 0 Building over thiee stories.
0 Demolition 0 Other: 11/3"1 where the available fault current 0 Marinas and boatyards.
CATECOItY exceeds 10,000 amps at 150 volts or ['Floating buildings.
less to ground, or exceeds 14.000 0 Commercial-use agricultural
El 1- and 2-family dwelling IS:1 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA
IV or
JOSITE .INFORMATION4ND)I*ATION.i':',:,.:;:PNiq::.551:;j'i:', E A Ero dd e i r t - m e n nc o y f
7:,.., load of D!!Atter-7,721,?" .. system.
Job no.: 826-45 Job site address: 16580 SW 85 AVE IOOHP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parlcs.
■
City/State/ZIP: TIGARD, OR 0 Health facilities. 0 Supply voltage for more than
CI Hazardous locations 600 volts nominal.
Suite/bldg./apt. no.: Project name: CLEAN WATER SERVICES 0 Service or feeder 600 amps or more.
FEESCHZDULEgi:EMZ.a4
Cross street/directions to job site: Description i Qty. 1 Fee. I Total I • '
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less _ 145.15 4
Ea, add'l 500 sq. ft. or portion 3340 1
Tax map/parcel no 25113B0
Limited energy, residential
75.00 2
MV; . (with above sq. ft)
ADD/ALTER (2) BRANCH CIRCUITS AS DIRECTED. Limited energy, multi
residential (with above sq. tt.) , 75.00 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
0 i 201 amps 10 400 amps 106.85 2
Name: CLEAN WATER SERVICES 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 2550 SW HILLSBORO HWY
Over 1,000 amps or volts 454.65 2
City/State/ZIP: HILLSBORO, OR 97123 Temporary service or feeders installation, alteration, and/or
relocation
Phone: (503)681-3600 Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 1 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: _ n
A. Fee for branch circuits with
0 iiiiiiiie. j i 4 l'1 i' K1 .:':,'!' - .,'::,. ';'' : 1 : - :: ,:: i:E .' .!_:NI:i . 0;.?
NTACT PERSON above service or feeder fee,
6.65 2
each branch circuit .
Business name:
.e._ ”
. ncil , Still (- B. Fee for branch circuits
Contact name: K.) , ,,d-iTh. , .Afq 1201' . without service or feeder fee, 1 46.85
46.85 2
MP" ' ..,....,,..„ . ix y , . fifSt branch circuit
1 r , ,
_
Address: ON '.) ) Each addl branch circuit 1 6.65 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: ( 1 /7(7.)4 Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) / e Reconnect only _ 66.85 2
E-mail: Pump or irrigation circle 53.40 2 -
i :', 1 .t i ,' , . 1 ; : :.'1,:!'t. i i , '::, , ,!.'::::•CONTRACTO11 . :,-.1:: ! ...:tt.::::::,:::k.j,::5::;;i:,* . i;i - ,;: ::,;.:1;a" Sign or outline lighting 53.40 2
Business name: FARNHAM ELECTRIC CO. Signal circuit(s) or limited-
energy panel, alteration, or
Address: 1050 NE LAFAYETTE AVE extension. Describe: Page 2 2
City/State/ZIP: MCMINNVILLE, OR 97128 Each additional inspection over allowable In any of the above
Per inspection 62,50
Phone: (503) 472-2186 Fax: (503) 472-4042
Investigation per hour (1 hr min) 6250
CCB Lic.: 01217 Electrical Lic.: 36-3C Suprv. Lic.. 4949S Industrial plant per hour _ 73.75
. ' ..'" 1 : 13,, : , .:::.:,.; . .:..:ELECTItICAL':.PERMEIT:FEES:- : ' , P'
Suprv. Electrician signature, required: ' -
' .:...r( I . ..0 Subtotal: 53.50
Print name: JEFF FARRAND If Date: 9/29/08 ,_ Plan review (25% of pemiit fee):
State surcharge (12% of permit fee): 6.42
,
Authorized signature:
TOTAL PERMIT FEE: 59.92
This permit application expires If a permit is not obtained within 180
Print name: Dee:
days after It bas been accepted as complete.
* Number of inspections allowed per permit.
RBuildingTermits\ELC-PennhApp.doe 05/23/06 440-4615T(11/05/COM)WEB