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Permit Er . CITY OF TIGARD ELECTRICAL PERMIT If COMMUNITY DEVELOPMENT Permit #: ELC2009 -00111 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/05/2009 Parcel: 2S 113B000600 Jurisdiction: Tigard Site address: 16580 SW 85TH AVE Subdivision: SEWER TREATMENT PLANT Lot: 0 Project: Clean Water Services Project Description: Install (4) branch circuits. Owner: FEES CLEAN WATER SERVICES Quantity Description Date Amount 2550 SW HILLSBORO HWY HILLSBORO, OR 97123 4 crt Branch Circuits 03/05/2009 $66.80 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 03/05/2009 $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 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: (\■'\j„ ,� 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 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. "009/MAR /03 /TUE 02:18 PM Conduit Electric FAX No, 5036923652 F fP1 Electrical Permit Application FOR OFf IC:E IISE ONLY City of Tigard Internet www -ldnil Blvd., Tigard, OR '� 13125 S C ���+� >''e" 3 . 3 • d4 pem,;t No.: , • . r 6 R' * Plan R Other Per Review mit: phone: 503,639 4171 Fax: 503.5 • Date18 i ---- See rage z for T t Inspection Line: 503.639,4175 't00 Date `� Reedy�Y Supplemental Information t ; alt t? www.tigard-or.gov 3 ° `"1' • \i ..., +S NOl1.N•^Y "• L 4 1t w,. & -�, w�1' .J! '�'ATJAh� " • . : " a �,.1 :! y,.+.,, v,.: . i. )E:;. • .t. , V. &r.. :, '• Mi ■ , .N. ,1 y ''y -.. ∎' 1 .. At, • S ..Sl+ ".,. , :p; :3 i.1 ' 'a: �'�'," • ' y ' '' j{I!•' . tv''i • 1 J ©.� ' . 1 1.{ " ' ' �•I.k, -.. '.. ,' . ' " �,�. l e c hea t a >. i a at 4P �i :' 4 ^SI?� e w co n;.!y ' tt ,+ : c v. K ' ` o& ' te :; : '" ° ` ' � . eek all that 1 (submit Sala of plans wfrteme checked below); 'i ...r '.4i+ . Please app 5' ❑ New construction ❑ Addition/altera f g 1 i - ° h al Service or feeder 400 amps or more ❑ Bnr7dine over thee stories. Where the available fault current El Marinas and boatyards. El 17cmolition /! Other: a; +J _,. volts or pFloatin boil !' s ; .t; r r;. „cb, exceeds 10,000 amps et 150 $ buildings. a• �' `?d ' a >Jy �ky+n ! '' i t�;�l ' :r7 *:a J r to ground, or exceeds 14,000 ❑ Commeroialruse agricultural ' •siZFV>;•�'>% 1 �` Nv' �1` 1�, G�lu �ti�7l�il,.�r : ,., : .��.??;' 1 � , .. r�! : : less Sro d, ❑ 1- and 2- family dwelling 12 Commercial/industrial ❑ Accessory building amps for all other installations. Ala of 75 l:Vw or . 0 builder ❑ Other: CI pfYe pomp ';'1 MUlti- fer]Dll Q 4- 4 ❑ Emergency system• larger separately derived system. tion 4 4V”' :r" rr'la> i .. ''" a 44 � Yr (a " 6 .�r=t 3 TIA' t ^ :!41 r3 ❑ Addition ofnew motor load of "A'' �„ ., u -3 'A`'rtS : T '. , '7 :;.,..,.,.• _ �....... — ^ 1001 or mole. . Job no.: r Job site address: b C C . ( ❑ six or more residential units. d Recreational vehicle parka. y ❑ Healllvicere facilities. • 0 Supply voltage for more than City/State/LIP:. "Tc 0 � " L 1 '' � ❑ Hazardous locations. 600 volts nominal. i 0 Q Swore. or feeder 600 amps or mae . r Suite/bldg./apt. no,: • Project name: 1 hay G . gii .a "". A; . ... i , ,• ..' ; G T :i+, ":'i" ,011 i Cross street/directions to job site: Desolation • New residential single- or multi-family dwelling unit. includes attached garage. 1,000 sq. ft or less 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. it, or portion 33.40 I — Tax map /parcel no.: Limited energy, residential 75,00 2 p , S e'. _ . , -.. h � t � ' : v.if.m ;F' $• - " t'i u u . • 5 t i -�.t y a (with above sq. $) 1:" ,i fa;�, ; 3�r�N i ,: M .F? '1 - 4 - 6 7,, fir;, i` ►�lil. rIgl ; R — ' , • . '.:1'TF:: �" �, \. S_x,J: . ; '° ;, :: „}.I d % fit Limited enczgy, multi family 75.00 2 residential (with above sq, } • - .i If Services or feeders installation, alteration. and /or relocation • • 200 amps or less 8030 2 y � (, :[ p r' 4 5',y •J:r r'x�i *� ` • 'k.. ii 201 amps to 400 amps 106.85 2 'S 4 , '.. ., . ,a a ... � k I . g A ii 401 amps to 600 amps 160.60 2 Name: • 601 amps to 1,000 amps • 240.60 2 I • Address: Over 1,000 amps or volts 454.65 2 j Temporary services or feeders installation, alteration, and/or 1 City/State/ZIP: relocation — �— 200 amps or less 66.85 1 i Phone: ( ) F { ' 201 amps to 400 amps • 10030 z I Owner installation: This installation is being made on property that I own which is not 401 amps _ to 599 amps 133.75 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel Date: A Fee for branch circuits with Owner signature: I y r '�I L . feeder fee; 6.65 each above serv or 1 M ' r x.. a 4 b)�r tLTt _ :: � h . 4 branch circuit 2 I Business name: B. Fee for branch circuits e� • without service or feeder fee, 46.85 (7 2 t branch circuit i l Contact name: {,rs Each add'l branch circuit 3 . 6.65 1 ( % Address: ' iviiseellaneous (service or feeder not included) Each manufactured or modular 90.90 2 S City/State/ZIP: dweliin • , service and/or feeder Phone: ( ) Fax ( ) Reconnect only ll 66.85 2 Pump or irrigation circle 53,40 2 � ; � t � yiR r ; ar r _ r''' P •n -' re n ,,,' " Sign or outline lighting 53,40 2 ''.,» �? " ..cr w•. # s� ` 7! `! , ,ai.� m. Signal circuit(s) or limited Business name: Conduit Electric energy panel, alteration, or extension Describe: Page 2 2 1 Address: 19461 SW 89 Ave l Each additional inspection over allowable in an ' of the above _ . City/StateJZl]?: Tualatln OR 97062 Per inspection 6250 Fax (503) 692 investigation er hour (1 h radw? •- - 6230 ' • ' ' "' j, Phone: (503) 692 ( ) ,.,. ..... .. I plant per hour 73:15 • Electrical Lic,: 26 -905C Suprv. Lic,: 45013 p CCB Lie.: 109669 K: �� :��1;rp :;w'„�1a��+ , "'B(x7(�4'C -, .���.` . '.' "t'�? �•�';; '''� � 1 P(^k�,'.'� -� I Suprv. E lectrician signature, req uired:' Subtotal: L plan review (25% of permit fee): Print name: Charles Parker Date: ? State surcharge (12% of permit fee): • TOTAL PERMIT FEE - Authorized signature: .! r , . This permit app expires If a permit is not obtained within 180 Print name: Date. days alter it has been accepted as complete. --- ' Z ,umberof inspections allowed per permit. LUBnilding\PermitetELC TamitAppdx 05125/06 440:e615T(] 11U5/C0M/wEB