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Permit CITY OF TIGARD ELECTRICAL PERMIT i ° COMMUNITY DEVELOPMENT PERMIT #: E 00679 DATE ISSUED: 12/19/20/19/20 08 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 11380 -00600 SITE ADDRESS: 16580 SW 85TH AVE ZONING: I -P SUBDIVISION: SEWER TREATMENT PLANT LOT : JURISDICTION: TIG PROJECT: CLEAN WATER SERVICES Project Description: (27) branch circuits. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 26 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: CLEAN WATER SERVICES OREGON ELECTRIC GROUP 2550 SW HILLSBORO HWY 1010 SE 11TH AVE HILLSBORO, OR 97123 -9379 PORTLAND, OR 97214 Phone: 503 - 681 -3600 Contact #: FAX 503 - 535 -2763 PRI 503 - 234 -9900 FEES Description Date Amount Reg #: ELE 26 -95C [ELPRMT] ELC Permit 12/19/2001 $219.75 LIC 203 [TAX] 12% State Surchar 12/19/2001 $26.37 SUP 4549S Total $246.12 REQUIRED ITEMS AND REPORTS This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By: , Per mittee Signature: E t @ � �_ 11 . t I g 0 }� it (�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'N: 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. . . RECEIVE , Electrical Permit Application FOR OFFICE USE ONLY City of Tigard DEC 1 8 2 03 die a , et _ 0 S _'� Permit No.: L _�.: • 00 ( q - 13125 SW Hall Blvd., Tigard, OR 97 Ohm Raview II I m : Phone: 503.639. 9OI OF T errrtit: ` - , �� 4171 Fax 503.598.1 � } DaateiB . T I r A R D Inspection Line: 303.03.R gUIIDING DIM I W to K /Mc r cn l I n s Internet: www.tigard- or.gov t,{e cuMCthod SUPPIementallnformatiOn TYPE OF WORK P REVIEW ew construction © Addition/alteration /replacement Please check all that apply (submit z s uLi of plans w /items checked below); ❑ Service or Ibeder 400 nmps or more ❑ Building over three stories. ❑ Demolition El Other: where the available fault current El Marinas end boatyards. CATEGORY OF CONSTRUCTION • • exceeds 10,000 amps at 150 volts or El Floating buildings. has to ground or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1 - and 2 family dwelling Commercial/industrial El Accessory building ansps for all other instanatians. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fite pump. El Installation of 75 KVA or ❑ Emergency system. larger separately derived system. .10B SITE INFORMAT AND LOCATION ❑ Addition of new motor load of ❑' n , °>r7 , "1 - "I - 3". Job no.: c 9r��� 5 ` Job site address: J 3S1 IOOIIP or r ed occupancy, ❑ S i x or more resi • un In Reettatlonal vehicle parks. City /State/ZIP: 1 l Cs '�'� a 2 ce 7 Z 41 El Health-care facilities. 0 Supply voltage for more than El Hazardous locations, 600 volts nominal. Suite/bldg. /apt. no.: Project name' e k e es.11 W ci., \- -e'r' ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: D onipuan Lgt J Fen roam 1 • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no,: 1,000 sq. tt or less 145.15 _1_4 Tax map/parcel no.: Ea. add"! 500 sq. R. or portion - 33.40 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK • (with above sq. R.) Limited energy, multi-family 75.00 2 CO 14 V2 'A 004 -r l a vt • E COL3r L 1 WC Ci,C C` residential (with above sq. f _) ` _ Services or feeders installation, alteration, and/or relocatIon (`CO c G_i 200 amps or less 80.30 2 b. PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 1 (f./}t t j AT 2. , £2 t] l ( 5 401 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/ZTP' Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 _ 1 Owner installation: This installation is being made on property that I own which is not 201 snips 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 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A Fcc for branch circuits with ❑ APPLICANT 1 Q 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 P�(„> 2 first branch circuit Address: Each add'l branch circuit lc, 6.65 172 ,C0 2 Miscellaneous (service or feeder not included) City/State/ZTP: 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 name: f `` Signal circuit(s) or limited- Busin rk_ .E c.A -Y`■_ C energy panel, alteration, or Address: / 0 f 1.7 6 / (44,,, g. «tension Describe: Pagc2 2 City /State/ZIP: -Po , ,•`A.., a i•-• 7 , 9 Each additional Inspection over allowable In any of the above Per inspection 62.50 Phone: 5 ) '- foe Fax: ( ) �',�s -' c7-76 Investigation pet' hour (i hr mint 62.50 CCB Lie.: • p3 t>,ic : - �� Suprv. Li99.: Cr Industrial plant per hour 73.75 "ft wl s ' T : , . ELECTRICAL PERMIT FEES ` Suprv. Electrician signature,requirer: Subtotal: Cpl '.7.3 Print name: %_c_ xr\. 01 6-- E I t , f7 1 � Date: Plan review (25e % % ofp ermit fee): T _ 1 ' ` l "£► State surcharge (12 of permit fee): , 1 x (0� Authorized signature: TOTAL PERMIT FEB: c/S 5 This permit application =Ores If a penult is not obtained wlthln l30 Print name: Date: days after It has been accepted as complete. O u - — * Number of inspections allowed per permit. l� ` 1,Z S£Z -d Z00 /100'd li17-1 891Z9£5£O9 OAS 01810313 80 -11088 101£:11 80OZ -81 -030