Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00072
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/02/2011
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Project: Clean Water Services Subdivision: SEWER TREATMENT PLANT Lot: 0
Project Description: (1) branch circuit for additional lighting.
Contractor: CONDUIT ELECTRIC Owner: CLEAN WATER SERVICES
19461 SW 89TH AVE 2550 SW HILLSBORO HWY
TUALATIN, OR 97062 HILLSBORO, OR 97123
PHONE: 503 - 692 -1428 PHONE:
FAX: 503 - 692 -3652
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 02/02/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/02/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 0 952 - 001 -0090. Yo y o tain opy • e rules o • irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
� c
Issued Byl' �it� f'� � ` - Permittee Signature:
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 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.
From:CONDUIT ELECTRIC 5036923652 01/28/2011 18:05 #530 P.001/001
A 7i7 1 !ANdc-, 5 ‘..5", 8 - e9C.p0
Electrical Permit Application .v7i) FOR OFFICE I SL ONLY
City of Tigard 6 \N1 V Received . i a I 1 MrpligirifiligNikliginfloll, ,
N • 13125 SW Hall Blvd., Tigard, OR 9 I
Plan Review
• I Phone: 503.639.4171 Fax: 503.598.' ei 1) % Date/By: Other Permit:
IL i A R i , Inspection Line: 503.639.4175 Juric El See Page 2 for
Internet: vvww.tigard-or.gOv ,‘,,,,\ _ 1 0 _Rai: Ready e as h y o : d:
- 1= - i4 Supplemental Information
t:itit :(:■1(*)Itj
0 tVi..t:.
New construction is Addition/alteratio t Please check all that apply (submit 1 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories
0 Demolition 0 Other: $ where the available fault current 0 Marinas and boatyards.
610:01/3:01401WitritiOis(;:'kci exceeds xce grn o
ds at 150 14 or E ... ..tin ..
dings .,
0 1- and 2-family dwelling til 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 or
larger separately derived system
.' . ::.': BEA=coyfsneYstweLtor load of 0 "A", "E", "1-2", - 1-r,
100HP or more. occupancy.
Job no.: Job site address: 174 6 t .,-, A c le ,<" 414 •
v t / ---' 64) if .1 --' 0 Six or more residential units. 0 Recreational vehicle parks.
,,g.
City/State/ZIP: -7-( ()/ Z 9 zaef 0 Health-care facilities
13 Hazardous locations. 0 Supply voltage for more than
600 volts nominal.
Suite/bldg./apt. no.: Project name: c fr ,, w i i,,, i ..„._, crArti ,,,.," 0 service or feeder 600 amps or more.
' ..--
Cross street/directions to job site: Description 1 OD% I Pee. 1 Total I .
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential
67.84 2
., .''DESCRIPTION Ot4VOitiC (with above an It) .
Limited energy, multi-family
Cl -- --- L-1 r-/-1.-----c-tiF _ residential (with above sq. It) 67.84 2
_
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
13 4iiiiiiiiiri)0**R3::::; 201 amps to 400 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: ( ) I Fax: ( ) 200 amps or less 59.36 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, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 -
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with t
' .':,'; tONTACTIERSON .:. :::: a fee 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first t
0
5&,/
Contact name: branch circuit 56.18 2
Each addi 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: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
. .:`.1•:•::",:f.:',; , ;: , , -. 1 . :-.::.:,' ; ' : ':..:1':.:;•::: , : , :: : ',. i ::: • , • ':,:.•,', • :., Signal circuit(s) or limited-energy
Business name: (Y) .I'r. / % ../.....2_6_..:,,7-72(c panel, alteratmn, or extension. Page 2
Each additional inspection over allowable in any of the above 2
Addr ess: /9 'i ( ( Su) , 4 ( )'4 Additional inspection (1 hr min) 66.25/hr
Investigation (1 hr mm) 66.25/ hr
City/State/Z1P: 41 r.: (..41 ., C(/..7 "._/. O/2. i 9 ?el Ce -2_ . Industrial plant (1 hr min) 78.18/ hr
Phone: (6213) 6,9 2 , 'c' 2t6 I Fax: (S 4 , - 2._ - &1.5-7 s ins pe pect cifi tl y s f
90.00/ hr
CCB Lic.: / ? I Electrical Lic.:24 I Suprv. Lic.: q50/ s ELECTRICAL PERiVillrFEES}.'•: '.:: •
Subtotal: 2 , ( -8
Suprv. Electrician signature, required: • ar , Plan review (25% of permi s--6
t fee):
Print name: ck . , Date: Stale surcharge (12% of perntit fec): c 7 q
_____
TOTAL PERMIT FEE: W t
Authorized signature: ---7
This permit application expires if permit is not eh ined within 180
days after it has been accepted as complete.
Print name: Date: i:3_,
' Number of inspections allowed per permit.
IABuildineerrnits\ELC-PermitApp.doc 10/01/09 440-4615TO 1/05/COWWEB