Permit n CITY OF TIGARD ELECTRICAL PERMIT
114 a, COMMUNITY DEVELOPMENT Permit #: ELC2009 -00400
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Subdivision: SEWER TREATMENT PLANT Lot: 0
Project: Clean Water Services
Project Description: Install /alter (5) branch circuits to replace fans and for misc upgrades.
Owner: FEES
CLEAN WATER SERVICES Quantity Description Date Amount
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 5 crt Branch Circuits 08/04/2009 $73.45
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/04/2009 $8.81
Electrical
Contractor:
FARNHAM ELECTRICAL 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 $82.26
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 OAR 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: ' l 1 l. i AZ Permittee Signature: ✓ ;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.
• - -, it• From :' 07/29/2009 11:33 #974 P. 001/002
Electrical Permit Auplication � �1/� I [ OFFICE USE t:)NLY
�r g � VV eceived ( `(01
II Dar :. Permit No.:
City of Tigard I ♦ �pQq . 00
• 13125 SW Hall Blvd., Tigard, OR 97223 U l 2 9 ZOOS
I � Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 D Other Permit:
T I GA R1) Inspection line: 503.639.4175 Date Ready /By: See Pag 2 for
Internet: www.tigard.or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE'OFeW LUH UIVISIUN "
❑ New construction ',Addition/alteration/replacement Please check all that apply (submit d sets of plans w /items checked below):
❑ Service or feeder 400 amps or more I7 Building over three stories.
❑ Demolition ❑ Other here the available fault
. _.. w suet a current 0 Marinas and loo
' s etyard s.
CATEGORY - OF,:CONSiRUCTION ;'+ exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
El 1 - end 2 -famil dwellin `��{`� mmerciallindustrial hss to ground, or exceeds 14,000 ❑ Commercial -se agriculture/
Y g Wo ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump.
JOB SITE INFORMATION AND ergeacy system derived system.
Installation of 75 KV A or
❑ huger separately der!
w. ❑ Addition of new motor load of ❑ "A", "E", "1-3",
Job no.: q 9 - (/ I Job site address: 1 SW t S 4104— ❑ Six no more. er ann.
-I Six o or r more residential units. ❑ Recreatioonal vehicle perks.
City /State/ZLP: T aGt rot f ell- ZZ V ❑ Health-care facilities. ❑ Supply voltage for more than
Y �� ❑ I
Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: U Project name: ❑ Service or feeder 600 amps or more.
I�u.rharn 1/J1NT P ... ,... ;..
Cross street/directions to job site:
Description I Qty. I Fee. I Total ' =``a: '" FEE<SCl3�OI'E` : ; W:: ':<; : ''
.. ..,
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Tax ma / Ea. add'! 500 sq. R. or portion 33.40 1
p parcel no
• Limited energy ential
; f , :;DESCRIPIION : , OF., WORK : (with above sq. a) d 75.00 2
,.
0o
�r /!'Gl« /, t/� g Limited energy, multi- family
40. IcYA . (UJ i� dead. residential (with above sq. ft.) 75.00 2
t
Services or feeders installatlon and/or relocation
200 amps or less ass 80.30 2
PEBTY::OVN1VEIt` :.;
�, � �^` °" .. .. I :. ?:" `� _TEU " ::.,; ,: , _201 amps to 400 amps 306.85 2
Name: Clem_ P J,- 5e,r vi Cp./2.. 401 amps to 600 snips 160.60 2
601 amps to 1,000 amps 240.60 2
Address: A 1 0 5t,,J S S Over 1,000 amps or volts 454.65 2
'�/ ,�/� ' /
Temporary services or feeders installation alteration, and/or
City/State/M.. ` ' Q r • og 9 .2 2 7
relocation n '
Phone: (507 )43 y ... Fit 1 ? q. Fax: ( ) 200 amps or less f _ 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 si store _Branch circuits — new, alteration, or extension, per panel
A. g° Date Fee for b
ee or ranch circuits with
; ...:.: ❑ ; APPLICANT .. :,.. , I:' ; ,, : : ` ; CONTACT.PERSOI „ . "•'E ; above service or feeder fee,
each branch circuit 6.65 2
Business name: I�„rn.hr B. Fee for branch circuits
Contact name: without service or feeder fee, I (/
are q °, first branch circuit 46.85 /` & 2
Address: - — Each add'! branch circuit
4/ 6.65 24, 4,0 2
Miscellaneous (service or feeder not Included)
City/State/ZIP: Each manufactured or modular 90,90 2
Phone: (jab ) I F es:: ( ) - dwelling, service and/or feeder
Reconnect only 66.85 2 w
E -mail: • Pump or irrigation circle 53.40 2
:,.: `CONTRACTOR . ;.r Sign or outline lighting 53
,... - .. ,. ., , .40 2
Business name: ) // /� Signal circuits) or limited -
�/l Vh.a� Q l� Yi Eft° GThG (. energy panel, alteration, or
/0.s.-0 N 6.. L04 a�ao , ,_ Are.
extension. Descrbe: Page 2 2
Address: /D.
City/State/ZIP: i, 11
M� m �„�►VI P, /g. Each additional inspection over allowable in an of the above
Phone: (53 ) L'42.. a Fax ( Spy ) t Per inspection 62.50
I g�i2� I �` 2 . HD 1 / � Investigation per hour (1 hr min) _ 62.50
CCB Lic.: 5 Electrical Lie.: 3c Suprv. Lic.: C/6�ry5 Industrial plant per hour — 73.75
ELECTRICAL PERIYIIT FEFS -' :: i , : :.: ::
Suprv. Electrician signature, required: c /, Subtotal: 15, V.S"
Print name: �/ ` D Plan review (25°.6 of permit fee) : -- tat S�e "� 1 1� �� State surcharge (12% of permit fee): `t, 8 I
Authorized signature�d/ n , 2
,,C 4...;1....3 '` TOTAL PERMIT FEE:
Print name: w F� e ek el v�. Date: 7 - 2 9 ^ O 9 This permit application expire if a permit Is not obtained within 150
�A9 days after It has been accepted as complete.
l:\ Building1Permhs \Elc.PermitApp.doc 05/23105 • Number of inspections allowed per permit.
44D-0615T(1 ]/OS/COM/WF8
OA CZ \1 et AbfoLmS