Permit CITY OF TIGARD ELECTRICAL PERMIT
II I COMMUNITY DEVELOPMENT Permit #: ELC2009 -00147
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/09/2009
Parcel: 2S 1138000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Subdivision: SEWER TREATMENT PLANT Lot: 0
Project: Clean Water Services
Project Description: Filters 1 through 4 reconstruction project. Install (6) branch circuits.
Owner: FEES
CLEAN WATER SERVICES Quantity Description Date Amount
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 6 crt Branch Circuits 04/09/2009 $80.10
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/09/2009 $9.61
Contractor: Electrical
FARNHAM ELECTRICAL CO.
1050 LAFAYETTE AVE
MCMINNVILLE, OR 97128
PHONE: 503 - 472 -2186
FAX: 503 - 472 -4042
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Total $89.71
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the
180 days. ENTION: •regon law requires you to follow the rules adopted by the Oregon Utility Notifi - • Center. Those rules are set forth in OAR
952 -001 010 through OAR • -• 81'.. You may obtain - copy of the rules or direct questions to OUNC by calli ,. • 46.6699 or 1.800.332.234 . _
Issue By: ► L � — — �� Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N 7 9 C�
1 1 �_ Date: /
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
- - l9 b$O 8E Ave,.
A From: RECEIVED 04/01/2003 14:46 11373 P.002/003
Electrical Permit Application A -1 2009 '•01z 0' 11(1- u5I ONI -'
City of Tigard Received .
� Permit No.: di 411 • oda 17
• 13125 SW Flail Blvd., Tigard, OR 911 r OF TIGARD Plan Review -
e Phone: 503.639.4171 Fax: 503. Date/By: Other Permit:
inspection Line: 503.639.4175 11C�91NG DIVISION Date Ready/By: /B : lint:
1 1 G A R 1P dy Y RI See Page 2 for
Internet: www.tigard or.gov Notified/Method: T C_ Supplemental Information
' TYPE OF WORK PLAN REVIEW
Please check all that apply (submit sets of w /items checked below):
❑ New construction ❑ Addition/alteration/replacement
❑ 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 ,000 amps at 150 volts or ❑ Flossing buildings,
less to gro or exceeds 14,000 ❑ Co - use agricultural
❑ I- 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 ", "E ", "1 -2 ", "1 - ",
Job no.: Job site address: 05030 SU■/ S5t� Ave, Six or ormon Rccancy.
OJ f1V � ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: j O � ,, � �� c1°( ❑Heal -care facilities.
tY ❑ Supply voltage for more than
(���� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: bea n W (Ail Nr AcP`• ❑ Service or feeder 600 amps or more.
Cross street/directions to job site:
Dew'ipdon I Qty, 1 Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145,15_ 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential
75.00 2
' DESCRIPTION( OF WORK • ., Lim (with ited above enetg .R.)
multi - f amily 75.00 2
(.t4) V e C ( - ' reidential (with above sq, ft)
Services or feeders Inat and/or relocation
200 amps or less 80.30 2
;13 PROP OWNER . 0 TENANT r 201 amps to 400 amps 106.85 _ 2
Name: ean y U , li c �p s 401 amps to 600 amps 160.60 2
l� 601 steps to 1 ,000 amps 240.60 2
Address: (00 .Stns S Ave. Over 1,000 amps or volts 454.65 2
City/State/ZIP: - 1Oot i op, q - Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503) ,.,,/ -, _ 8i - . Fax: ( ) 200 amps or less 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 9 amps 133.75 2
Owner signature: Date: _ circuits 59 — new, alteration, or extension, per panel
A. Fee for branch circuits with
® ; APPLICANT I • 0 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, 1 46.85 2
first branch circuit
Address: Each add'l branch circuit A 6.65 2
Miscellaneous (service or feeder not included) _
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) -
Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
II Signal circuit(s) or limited-
Business name:
A V 1 - energy panel, alteration, or
Address: \QCr) `V L , a . Il ctlj l p�e_, extension. Describe: Page 2 2
City /State/ZIP: MC'Mi A 4 1 e C 0 Q "l "t _ Each additional inspection over allowable in any of the above
Per inspection
37) LO ' . 7 `` rl� I Fax: - E1 �r ig 62.50
Phone: (
' E "_ tee , _ ° � (, . � � �` (� - 404." investigation per bolo (1 hr min) _ 62.50
CCB Lie.: () IZl Electrical Lie.: 3( y 6 Suprv. Lie,: 1 p Industrial plant perhour 73.75
12. • `] • l Q 7� Ji (r ELECI R[CAI. PERMIT FEES
Suprv. Electrician s required: l 1� r�,:_. _ Subtotal: 4, \
Print name: rc' eVe l / e i r - Date: y A i log Plan review (25% of penttit fee):
f
State surcharge (12% of pem
, mit fee): t
Authorized signature: 4. .c.. """ / ,,, `
��•,.ls� s . 'f�': �v t a,s,„,..._....., TOTAL PERMIT FEE:
' / This permit Print name: /� F ,t,,/} �/ /, �,! °f f
LEI 8 1� Y r >'t Y s• 1 V c✓ N, il r : � Date: i I ermit application expires if a penult Is not obtained within 180 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I;\ Building \Permits\ELC.PermitApp.due 05/23/06 440 -4615T(11 /05 /COM/WEB
From: 04/01/2009 14:46 11373 P. 003 /003
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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY 7777 7 7
Fee for rach commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: 18uildinglPamits\ELGPemitApp.doc 03/23/06