Permit CITY OF TIGARD ELECTRICAL PERMIT
•
COMMUNITY DEVELOPMENT Permit #: ELC2010 00672
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/09/2010
Parcel: 2S11313000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Clean Water Services Subdivision: SEWER TREATMENT PLANT Lot: 0
Project Description: Miscellaneous process modifications in Solids Building and SRF Building. (26) branch circuits and low voltage for
instrumentation.
Contractor: FARNHAM ELECTRIC CO Owner: CLEAN WATER SERVICES
1050 LAFAYETTE AVE 2550 SW HILLSBORO HWY
MCMINNVILLE, OR 97128 HILLSBORO, OR 97123
PHONE: 503 - 472 -2186
PHONE: 503 - 681 -5100
FAX: 503 - 472 -4042
FEES
Quantity Description Date Amount
26 crt Branch Circuits wo /Purchase 12/09/2010 $241.68
Specifics: Service or Feeder
1 ea Signal circuit or Limited 12/09/2010 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12% State Surcharge - 12/09/2010 $38.00
Electrical
Type of Const:
Occupancy Grp:
Total $354.68
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. Al work will
be done c\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: Ore.. law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 01 -0010 through OAR 95 01 19 ou may obtain a copy of the rules or direct questions to OUNC by calling 503. 87 or 1.800.332.234
Is ed By: - � /9 � , ��" cY Permittee Signature: /` e •N••- 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 I STALLATION ONLY
SIGNATURE OF SUPR. ELEC'
/"W tom Date: 2 /40 LICENSE NO. go/ 5
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.
Electrical Permit Appl r L, � r r i,'' i�cz'ii I lti��= +tit- #()�l�iv�
City of Tigard _ -_ _ __. � _ _
D E 3 Recdved
�° 13125 SW Hall Blvd., Tigard, OR 97 22 3 Plan O' 0 Date/By: l'°2 /� AO / Permit No.: She'd/0 -QQ672
Plan Review
® r ' - Ph 503.718.2439 Fax: 503.5 Other Permit:
— 8 i ° O F TIGARD Dat
` : `I - - - -- 1 IL +I7; I nspection Line: 503,639.4175 Date Ready/By: Juris: ® See Page 2 for
` -:_ ` : 1 Internet: wwyw.tigard or.gov BUILDING DIVISION Notified/Method: Supplemental Information
i
TYPE OP'IVORK - PLA,N:REVIE1Y
❑ New construction atAddition/alteration/replacement Please check all that apply (submit 2 sets of plans w/itcros checked helms.):
❑ Service or fecdei 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault torrent ❑ Marinas and boatyards.
" " CATEGORY : QF CONSTRUCTION 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 Igi Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
separately derived system.
JOB SITE':INiFORMATION; AND' LOCATION ,.: Addition of new motor load of ❑ � A ", "E" "1 -2" "1 -3 ",
Job no.: Job site address: 0 65 - g0 SW 8 5+1 441- 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /Slate /ZiP: "l6 ( 1_0_4-, Q e, ail 2 Z I — ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: D0A- S51I2 f. p LAS ❑ Service or feeder 600 amps or mare.
. ":JEE`SCHEDULE ;: '
Cross streelldirections to job site: DIA 21.1. . RO t 4 - . R,L,/ 0 Description l qty I Fee I Total l
/ New residential slogte- or mull- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
F.S. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Z S 113 (3 00060c. Limited energy, residential —
DESCRIPTION': OF -WOR& (with above sq. R.) 75.00 2
Limited energy, multi- family 75.00 2
WA 551 11? .-- 1Zo.ir_.4. ' . 1M L 5 Cdz1, LAI, 0-4.S firtoci SS residential (with above sq. R.) _
Services or feeders installation, alteration, and/or relocation
o765 INS SoLLOS fasN,il,O "^/b /WO S2.r 200 amps or less 100.70 2
ti'PROPIRTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2
C . J , , # Th 'e n, /� 1,
401 amps to 0 amps 200.34 2
Nanle: tl/" W f� Y 601 amps to 1,000 amps 301.04 2
Address: 16 (,Q 5L-3 ets S I 4r'. Over 1,000 amps or volts 552.26 2
City/Slate /ZIP: 'T1 GA.(l..f) 0 /t, o -7 2 2 ¢ Temporary services or feeders installation, alteration, and/or
relocation
Phone: (Se72 S A 8l g 3 1 Fax: ( t) 5 7 ' ( ° j ri 6 200 amps or less 5936 1
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, le e, nt, or exalt ge . accor$ pg to s RS 447, 449, 670, and 701. `t amps to 599 amps 168.54 2
( Branch circuits- new, alteration, or extension, per panel
Owner signature: (ti �f S 2 010 A. Fee for branch circuits with
• • ' 3 above service or feeder fee,
APPI,ICA,NT `: " .; - CONTACT PEIiSQN . ; : ° • -.: � _:.
each branch circuit 7.42 2
Business name: (�f},J tJ q yz� 5t2V 1 Li 5 ; !�ulLy / FA-c- (ii I-`t B. Fee for branch circuits without
11 service or feeder fee, first ) 56.18 567, It- 2
Contact name: i 2 6,3 4 "k" !C branch circuit
Each add'l branch circuit 25 7.42 lee ,5 2
Address: I (, t) 6 O St.. gs-12-, AJL Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP:
TIGA•rt_Q 1 (9 2 _ ell 1 - 2 -4 dwelling, service and/or feeder 67.84 2
Phone: ($v) s4'7 d 1 d• Fax: : (.5 S47 Q 1 69 Reconnect only 67.84 2
E-mail: r rec(fbtn�e„+sr∎ ,1./1 tit 5 , Oif or o
Pump o irrigation circle 67 84 2
Signor outline lighting 67.84 2
.; _. /� � ham :CONCTOR
TRA' ` . ,:., / tJ . - Signal circuits) or limited - energy
Business name: F t / n ham ' l t " Y t t l%, Eacb additional inspection over allowable n any of theab e 2
Address: /6,-_-) I� E 1 a -- -( ( I j (� V Additional inspection (1 hr min) 6625/ hr
City/Slate /ZIP: (V CM t l n I t v i (l ` 0 0 t17 2 investigation (1 hr min) 66.25/ hr
i Industrial plant (1 hr min) 78.113/ hr
Phone: (' q 7) -4218(C Fax: (503 ) [/ 7.2 - (/9 V„), inspections for which no fee is
0 ) 2 17 3 -3 li g6 1 / 5 specifically tilted (',s hr min)
90,00/hr S
CCB Lic.: El ectrical Lie.: " � Suprv. Li c.: . - -
: Ei: EC'' 1�iIGAL `PERI►tI'C'FEES'-: - `. -
Subtotal: t0 8
Suprv. Electrician signature, required /� _ Plan review (25% fee): � ,\J
Print name: .111 • 411 J - 7 , D at e: / / C 1 3 $ .00
l �- State surcharge (12% fee):
(/ TOTAL PERMIT FEE: 35 to
Authorized signature: 4: �� 2r� _ . �{ .
l Thb permit application expires if a permit is not obtained n ;thin 180
da y s after It alf has been accepted as complete
Print name: j (� � (� RA �� [Date: I I / Zt9 26 Q . Number of inspec rnstd per pe
islkuilding\Perta u ELC- PennaApp.dor 07/01/10 t / 440- 461ST(l1i05/COM/WEe
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: • •
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY :.
Fee for each, commercial $ 75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecorrununication Installation
❑ Fire Alarm Installation
❑ 1-1VAC
C z Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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