Permit I
CITY OF TI RD E CT R CAL PER MIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00532
T t G A R >L 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/28/2010
Parcel: 2S114AA00500
Jurisdiction: Tigard
Site address: 16375 SW 85TH AVE
Subdivision: Lot: 0
Project: Clean Water Services
Project Description: (1) temporary service and (3) branch circuits. 9/29/10, adding (2) additional temporary services.
Owner: FEES
CLEAN WATER SERVICES Quantity Description Date Amount
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 1 ea Temp Services or Feeders - 09/28/2010 $59.36
200 amps or less
PHONE: 503 -547 -8177 3 crt Branch Circuits w /Purchase 09/28/2010 $22.26
Service or Feeder
1 ea 12% State Surcharge - 09/28/2010 $9.79
Contractor: Electrical
FARNHAM ELECTRIC CO 2 ea Temp Services or Feeders - 09/29/2010 $118.72
1050 LAFAYETTE AVE 200 amps or less
MCMINNVILLE, OR 97128 0 ea 12% State Surcharge - 09/29/2010 $14.25
PHONE: 503 - 472 -2186 Electrical
FAX: 503 - 472 -4042
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $224.38
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 a • • = ce wi • proved 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. ATTE ION: Oregon la re• ' _ you to follow the rules adopted by the Oregon Utility Notificatio er. Those rules are set forth in OAR
952 -001 -0 • 0 through OAR 952 -00• " 00. ou • = obtain a copy of the rules or direct questions to OUNC by calling 246.6699 or 1.800.33.2344.
i
Issu• • By: — � IL Permittee Si. . t
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.
CaII 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.
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00532
T [ GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/28/2010
Parcel: 2S114AA00500
Jurisdiction: Tigard
Site address: 16375 SW 85TH AVE
Subdivision: Lot: 0
Project: Clean Water Services
Project Description: (1) temporary service and (3) branch circuits.
Owner: FEES
CLEAN WATER SERVICES Quantity Description Date Amount
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 1 ea Temp Services or Feeders - 09/28/2010 $59.36
200 amps or less
PHONE: 503 -547 -8177 3 crt Branch Circuits w /Purchase 09/28/2010 $22.26
Service or Feeder
1 ea 12% State Surcharge - 09/28/2010 $9.79
Contractor: Electrical
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 $91.41
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT ON: Orego aw re•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 through OAR 952 -r • 0100. •u may obtain a copy of the rules or direct questions to OUNC by calling 51)2. 6.6699 or 1.800.332.2344.
Issu d By: /
• • ' _ Permittee Signal
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' _ / Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
From: 09/29/201 13:47 #992 P.002/003
R ECEIVED
Electrical Permit Application, FU Ik OFFICE F �U$ ONLY �P 2
City of Tigard 9 2010 Received
III • 13125 SW Ha11 Blvd., Tigard, O'• 1 .t Dan Review
Date/13 : �. r
g . F Plan
Phone: 503.639.4171 Fax I 6 11 Q lYr � TIGARD DateB : Other Permie
i I , A is I Internet: www.ti Inspection Line: 503.639.417 a G D D ate Ready/By: turn: ® See Page 2 for
and -or. ov I V I �I�I tl Notified /Method:
g g Supplemental Information
` ;'TYPE O1? WORK ° ** REVIE
❑ New construction ❑ Addition/alteration/replacement Please cluck all that apply (submit, sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other. where the available fault current ❑ Marinas and boatyards.
1 c trk6oRY OB co.r s ti7CT1or'r n r exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
JOB SITE aNFb. AT IQN A1s1p L . . s. Emergency systein. larger separately derived system.
:.r ;, ❑ Addition of new motor load of ❑ "A" "E" "1 -2 "I -3
Job no.: n �✓ 1 - ' v Job site address: (® 61S �+P ® 100tiP or more.
❑ Six or more residential units. occupancy,
v CAW e1 V✓ `� AVe • T lV L ❑ Recreational vehicle parks.
City /State/ZIP: 1,50„ 4, V ❑ Health -care facilities. ❑ Supply voltage for more than
1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE . :SCHDI)I) ; E '
E
Cross street/directions to job site: De 1 4n. I Fee. j Total I ,
New residential single- or multi - family dwelling unit.
LlJ 1Tit I :L'' `1111, 4 ■ :) ' .1i�. A _ Includes attached garage. .
Subdivisi .n: >�',� 20 to ..e0 32 Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'I 500 sq. ft. or portion _ 33.92 1
. Tax map /parcel no I nited ener residential
_ ISSRIP'UO,,:OF WORK R.) a 75.00 2
n dry,res t
(with above sq.
ma . Limited en, multifamily 75.00 2
(Z) ' c o ext rm residential (with above sq. ft.) S ervices or feeders Installation and/or relocation
.,,E3 PR0) OWNI R . ' VVV ❑ TIr' 111 t�31iT vi ;: 2 01 amps to 4 0 amps 133 56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps OT less 2 59.36 11$ r
Owner installation: This installation is being made on property that I 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 68.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
?) :APPLICA1 T I,.. JJ CONT4C1'4I $SO!I ".,;' or fe er f 7.42 2
above service ed ce
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail
G ONTitACTOR i or outline lighting 67.84 2
.. ; :.. , . . ,. ,, " .::: . . ., -. _ s ,. _' Signaleircuit(s)orlitnited- energy
Business name: ' r � panel, alteration, or extension. Page 2 2
��4JJJ Each additional inspection over allowable in any of the above
Address: I070 1[E' t e.. Additional inspection (1 hr min) 66.25/ hr
City/ State/ZIP: H"Y _ li n vttl e 012 61°1125 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: tcz 4.7 Z Fax: (J 412 qbq z Inspections for which no fee is 90.00 / hr
T specifically listed (Yr hr min)
CCB Lic.: 0124Z Electrical Lic.: eLQ•'3C Suprv. Lic.: 4 1 11 . EI C'1'li,!I0 PERMIT FE-BS.
Suprv. Electrician signature, requl "_ ._______ Subtotal. , lQj
Plan review (25% of permit fee):
Print name:S l/e / � / � � %
l ewer Date: 1I2R/ [ o State surcharge (12% of permit fee): 14,
�/ TOTAL PERMIT FEE: [32R-t
Authorized signature: �'/ /i
�'�( This permit application expires If a permit is not obtained within 180
days after it has been accepted as complete.
Print name: war D I , Date: et/ 10 • Number of inspections allowed per permit.
1:\ Building \ Permits\E•LC•PermaApp,doc 0701/10 440- 4615T(11/05. COM /WEB
Electrical Permit Application RECEIVED FOR OFFICE: USE: ONLY
City of Tigard Received Date /B y Permit No.: c ,o- 0053 • • 1 3125 SW Hall Blvd., Tigard, OR 97223 R 'D . L� G
:� 13 S E P 2 4 2 p 1 p Plan Review it:
Phone: 503.639.4171 Fax: 503.598.1960 Date /B : Other Perm u Mao ^Gt,1,/
T 1 G i1 K D Inspection Line: 503.639 Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified /Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
❑ New construction V Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current
❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
Tess to ground. or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling >r Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E' . "l -2 ", "I -3 ",
Job no.: 1OD 31_ Job site address: I (o 57 sw e5Ari 100HP or more. occupancy.
5 0 Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: -non ra 6 12_, ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 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. fl. or Tess 168.54 4
Ea. add] 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. fl.)
Limited energy, multi - family
R otre et /1FCIY t /� /� 1 �/1 V 1 Ce-. residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: • 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less I 59.36 I5, 3 b 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel _
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 47 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 3 7.42 22, 26 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: lit _ E I L c CO - panel, alteration, or extension. _ _ Page 2 2
�l ■ Each additional inspection over allowable in any of the above
Address: ' %p 1 Lcifaciett, Ave Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: IV l� v lI A1 1 V 1,`� O� t J 71 7g/ Investigation (1 hr min) 66.25/ hr
J I o /� !/ Industrial plant (1 hr min) 78.18/ hr
Phone: (5 :) 47Z -D gt Fax: (go 47Z [ 64.2 - Inspections for which no fee is
specifically listed ('h hr min) 90.00 / hr
CCB Lic.: 01 1 Electrical Lic.: 3(e -3( Suprv. Lic.: 4eV45 ELECTRICAL PERMIT FEES
�v (25% Subtotal: 81 , (D2. Suprv. Electrician signature, required
v Plan review (25 /o of permit fee):
Print name: `1.Q), e 4 Date: t l Zt 110 State surcharge (12% of permit fee): q t , c
�� TOTAL PERMIT FEE: Do , 41
Authorized signature: f� ��/
Y
# � v � � y► � This permit application expires if a permit is not obtained within 180
Print name: Date V a 1 D r V. 1 A 112,11 I `' U days after it has been accepted as complete.
• Number of inspections allowed per permit.
1: \Building \Permits \ELC- PermitApp.doc 07/01/10 440- 4615T(11/05/COM /WEB