Permit I .— ..
CITY OF TIGARD ELECTRICAL PERMIT
11 • COMMUNITY DEVELOPMENT Permit #: ELC2009 -00427
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2009
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Subdivision: SEWER TREATMENT PLANT Lot: 0
Project: Clean Water Services
Project Description: Add /alter (4) branch circuits.
Owner: FEES
CLEAN WATER SERVICES Quantity Description Date Amount
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 4 crt Branch Circuits 08/18/2009 $66.80
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/18/2009 $8.02
Electrical
Contractor:
DUIT LEVEL TOOL CO
19461 SW 89TH AVE
TUALATIN, OR 97062
PHONE: 503 - 692 -1428
FAX: 503 - 692 -3652
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
•
Total $74.82
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 through 0 R 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.
r
Issued By: \..WUVOSI Permittee Signature: �1 9 / c1 1 " 1
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.
Fra CONDUIT ELECTRIC 5036923652 08/18/2009 15:53 #641 P.001/001
Al Electrical Permit Application Rim/ .' FOR OFFI USE ONLY
Received of Tigard /N y: Penn e C.. tl_.
,GW t .00/427
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/(� Permit No. ` (�� /� �• J�
Date/B1':
II
a 13125 SW Hall Blvd.. Tieard, OR 97223 Plan Review
C • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit
T I GA R D Inspection Line: 503.639.4175 Date Ready/By: Juris HI See Page 2 for
Internet: www.tigard or.gov Notified/Method T Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement
Please check all that apply (submit 2 sets of plans sv /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 .
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
. ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ ••A ", •'F.", ••l -2" ••1 ",
Job no.: Job site address: /C 0 ❑ Six or or more. occupancy.
/ i
O skl Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ 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: I Description I On. I 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 I5 4
Ea. add'( 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF' WORK (with above sq. ft,)
Limited energy, multi - family
75.00 2
residential (with above sq. ft.)
Services or feeders installation,_ alteration. and/or relocation
200 amps or less 80.30 2
--- ❑ PROPERTY OWNER ❑ TENANT :-. . 201 amps to 400 amps 106.85 2
' Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2 ,
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
■
I Phone: ( ) I Fax: ( ) 200 amps or less I 66.85 I 1
I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 I 2
I intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
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, 6.65 2
each branch circuit •
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, i 46.85 2
first branch circuit
Address: Each add'( branch circuit j 6.65 I 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
' • CONTRACTOR • • • ` Sign or outline lighting , 53.40 2
Signal panel, alteration, er or limited -
Business name: Conduit Electric
energy panel, alteration, or
Address: 19461 SW 89 Ave extension. Describe: Page 2 2
City /State /ZIP: Tualatin, OR 97062 Each additional inspection over allowable in any of the above
Per inspection I I 62.50
Phone: (503) 692 -1428 Fax: (503) 692 -3652 investigation per hour (1 hr min) I 62.5(1
CCB Lie.: 109669 I Electrical Lic.: 26 -905C 1 Suprv. Lic.: 4501S Industrial plant per hour I 73.75
' ELECTRICAL PERMIT FEES •
•
Suprv. Electrician signature, required: Subtotal:
Print name: Charles Parker Date: Plan review (25% of permit fee):
// State surcharge (12% of permit fee):
Authorized signature: - -- _ ^ TOTAL PERMIT FEE: I '74„ g 2
' This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
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