Permit A - CITY OF TIGARD . ELECTRICAL PERMIT
PERMIT #: ELC2005 -00479
�' DEVELOPMENT SERVICES DATE ISSUED: 7/6/2005
l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S113B0
SITE ADDRESS: 16580 SW 85TH AVE ZONING: I -
SUBDIVISION: SEWER TREATMENT PLANT LOT : JURISDICTION: TIG
Project Description: Installation of (1) branch circuit and limited energy for irrigation. Job No. 50183
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: 1
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: 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 OES LLC
2550 SW HILLSBORO HWY 5285 NE ELAM YOUNG PKWY SUITE
HILLSBORO, OR 97123 -9379 HILLSBORO, OR 97124
Phone: 503 - 681 -3600 Phone: 503 - 693 -6000
FEES Reg #: LIC 159395
ELE 34 -572C
Description Date Amount SUP 4587S
[ELPRMT] EEC Permit 7/6/2005 $127.85
[TAX] 8% State Surcharge 7/6/2005 $10.23 REQUIRED ITEMS AND REPORTS
Total $138.08
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 f than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules a t forth in 0' R 952 -:0 :8,10 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questi. s to OUNC at
503 - - 6699 ,r 1 - 800 - i• - 234,. .. ------ Issu By: ` _� sL Permittee Sign • r•' i•• rl Mr'i;
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. EL '�_ '. /��� (7 /.5--(--- 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.
Jul 05 05 09:57a Jim + Judy Bunce (5031 693 -8660 p.
Et.ietrica1 Permit Application /� Folz OFFHCE. USE ONLY
City of Tigard ` c) 21441 RDeceived : b7 i . ' A �7 remit No.: 04 - 60 , '
13125 SW Hall Blvd , Tigard, OR 97223 .10 Plan Review
Phone: 503.639.4171 Fax 503.598.1960 �„ (.61,i,,-!1. Date./13y: Other Permit:
Inspection Line: 503.639.4175 r CY ( ' I. Date Ready/By. Juts VI See Page 2 for
Internet: www.ci.tigard.or.us . t1,�NC� f Notified/Method: / Supplemental Information
TYPE OP WORK PLAN REVIEW
❑ New construction Addition/ alteration /replacement Please cheek all that apply:
[3 Demolition [] Other: ['Service over 2.25 amps, cotn'I ❑ Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling rkj Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories [Weeders, 400 amps or more
❑ Multi family ❑Master builder ❑Other
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION /((.0, S sZ ❑Egress/lighting plan RV park
S
Job no.: 5l7 t � Job site address: - 4-4 - J G]/ S 7 Gl /} (/F ❑Heatlh� are facility ❑
Submit 2 sets of plans with any of the above.
City /State/ZIP: 7-7 GA ,O a I Q /Q.. 9 7 Z 7 L CV 'S The above are not applicable to temporary construction service.
Suiteibldg• /apt no.: Project name: T/gRl6R /0tu CI RG L t T
EE* SCHEDULE
E
Deatriptim I Qty. I Fee. I Total 1 I ••
Cross street/directions to job site: 01. a 1-64-p ES 5 L New residential single- or multi -family dwelling unit.
( Includes attached garage.
0 (.(R frifinA 1J•Q S 75 i n / A 75/2, I RE ,f,i T P/-Ai11 7 1,000 sq. 11. or less 145.15 4
Subdivision: Lot no.: Fa add'! 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
___ Limited energy, non- residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
_ �r - dwelling, service and/or feeder 90.90 2
A D ,, )2_0 -I/D LT, 2_7 6 19 / 10� C / l e t-4. / / Services or feeders installation, alteration, and/or relocation
l d .JZAd 200 amps or less 80.30 2 201 arms to 400 amps 106.85 2
R ♦ SPERT% OWNER ` ❑ TENANT 401 amps to 600 amps 160.60 2
Name: J "t 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City / State/ZIP: Temporary services or feeders installation, alteration, and/or
( j r7D 3 flag ( ) relocation
Phone: �' (f � 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 600 azn 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT 0 CONTACT PERSON A Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address:
each branch circuit
Each add'/ branch circuit 6.65 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Thane: ( ) Fax' ' ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
exhmsion. Describe: Page 2 81 2
Business Hartle
n.S 1 jLG 1 RRl6A Ti 4AI
Address: 2 5 N != r LA-n4 ' n �/ Each additional inspection over allowable in any of the above
lZC1 41 6, `� �R/�u/ Per inspection 62.50
City /State/ZIP: j4 L L S 4_ Ed) 0 4 q 7 / 2 4 Si& t 7F_ A (0 0) Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: (SE 7) (p ga _ Q 0 Fax: ( p 3 - g (o ELECTRIC AL PERDIIT FEES*
CCB Lie.: /5 9 3 9 5 Electrical Lie.: _34_ 572 t= . Lic y /.� .s Subtotal 1 2 7, 8 5
Suprv. Electrician signature, required: - ,. >,%. Plan review (25% of permit fee)
Print name ' A I Q �� Date: � ' �/ 1 State surcharge (8% of permit fee) J' Q 2
G Z ( ! � TOTAL PERMIT FEE 1 3 8 . O
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tti-County Bedding Industry Service Board
•• Number of inspections net permit allowed
\e.'Ld`4 Z *- 503 -- 7 / C -- 7 ? g*
CITY OF TIGARD
- BUILDING DIVISION PERMIT #: ELC2005.00479
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/2005
Phone: (503) 639 -4171 � "�10IpuHp�pIiI'
Inspection Requests (24 Hrs.): (503) 639 -4175 _ __..
INSPECTION WORKSHEET FOR DATE: 7/15/2005 TIME: 7.11AM PAGE: 23
SITE ADDRESS: 16580 SW 85TH AVE CLASS OF WORK:
SUBDIVISION: SEWER TREATMENT PLANT LOT #: TYPE OF USE:
PROJECT NAME: CLEAN WATER SERVICES
DESCRIPTION: Installation of (1) branch circuit and limited energy for irrigation. Job No. 50183
OWNER: CLEAN WATER SERVICES, PHONE #: 503.681 -3600
CONTRACTOR: OES LLC PHONE #: 503 - 693-6
Inspection Request Scheduled For: D t 7J15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Electrical final 011517 -01 503-7104986 Y
Corrections /Comments /Instructions:
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RI c ft1/4R cml� ISA Gvall__ C 04,li -.ltn
1 .- 4k\l i nl 91 i rn�Fs Ate` 1 t� 60
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PASS ❑ PARTIAL APPROVAL \CANCEL ❑ NO ACCESS
❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: % Lt Date: 1 f 14 W Phone #: (503) 718 -