Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00007
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/24/2011
TIGARD 9 Parcel: 2S 113B000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Clean Water Services Subdivision: SEWER TREATMENT PLANT Lot: 0
Project Description: Electrical TI for work in Filter Tunnel.
Contractor: DND ELECTRICAL CONTRACTORS INC Owner: CLEAN WATER SERVICES
PO BOX 3 2550 SW HILLSBORO HWY
MCMINNVILLE, OR 97128 HILLSBORO, OR 97123
PHONE: 503- 472 -4003 PHONE:
FAX: 503 -472 -3668
FEES
Quantity Description Date Amount
3 ea Services or Feeders - 200 02/15/2011 $302.10
Specifics: amps or less
3 crt Branch Circuits w /Purchase 02/15/2011 $22.26
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 02/15/2011 $38.92
Electrical
Type of Const:
Occupancy Grp:
•
Total $363.28
Required Items and Reports (Conditions)
This pep is issued s , '-ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be d• e in accordance with - pprov - • •lans. 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 I- , require •u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-101-0010 , rough OAR 95 - , r 1 -0r : P. may obtain a c•py of the rules or direct questions to OUNC by calling 503.232.1987 or 1 0.332.234 .
Iss . • By: 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:
CONT • CTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' _ , • A, ; 1 I e e e _ Date: aye/
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.
Electrica I pplicati nn .'. --�.'' bull (H.I.R - F. t Sh:OyLA
City of Tigard R eceived
I Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.718.2439 Fax: 503.59y 9T A.6 `.. t' Date/B : Other Permit:
I _ 1:1-1 Inspection Line: 503.639.4175 �- E 1 ASION Date Ready/By: kris. ® See Page 2 for
Internet: www.tigard- or.gov , -1, , . ' Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans 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 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: / ..S 6 5 i,U1 V SO f v� I Six or or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 7/ . 3 ►'l Q (V 9 ] ii ❑ Health -care facilities. ❑ Supply voltage for more than
S / / / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: / Y ❑ Service or feeder 600 amps or more.
t Y S R ti � i r, v P t ra t S FEE SCHEDULE
Cross street/directions to job site: 1 Description I Qty. I Fee. I 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
W .. r e 3- V F p. t G �y L t_ , IV 1 e 3 , .„1 -5 residential (with above sq. ft.) _
/ r1 Services or feeders installation, alteration, and/or relocation
�CU t li 3- 1V FPS ,. 200 amps or less 3 100.70 3t., /6 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
/ 401 amps to 600 amps 200.34 2
Name: G / e �a f t r S t ( ✓ , r •• _rj 601 amps to 1,000 amps 301.04 2
Address: l G p 6 6 S' y 6-4--i Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: 3 } t^ 6 `' 7,) j q relocation
Phone: (5'.3).,5f 7 / '7 7 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 3 7.42 �' a 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circui _
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR o f r /(7 Signal circuit(s) or limited- energy
panel, alteration, or extension. Page 2 2
Business name:
N.� E . 1 E.C e ( n
Cof arz.$ lTrC. Each additional inspection over allowable in any of the above
Address: 2_o (q f e Co L U i r> C4- Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: ri l yin 0 iiCe, O 2 q lam- 8 Industrial plant (1 hr min) 78.18/ hr
Phone: (5?; ) 2,17, _ ( 4 -- I Fax: ( ) 4 7a _ 3 6 Inspections for which no fee is 90.00 / hr
specifically listed (% hr min)
CCB Lic.: .: // rv. Lie.: 539 g Electrical Lic.: b -35C Su p 3 1 8 ELECTRICAL PERMIT FEES
� wad Su: 5g./...3 �0
Suprv. Electrician signature, required: 1/0 , lX/ Plan review (25% of permit it fee):
Print name: m , 8 ( ,/Vig.p DEg fl E v C; Date: cz la ( /2 O / 1 State surcharge (12% of permit fee): gg, ?2
TOTAL PERMIT FEE: 3 to 8 4 g.'
Authorized signature: ,Er) We d fa ' Jlik... pe application expires p
This permit a licatioo ex Tres iC a permit is not obtained within 180
NI . D ate: a days after it has been accepted as complete.
Print name:
Dw &ID. /� E->a� l a / / 2L) f * N um b er o inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615'r(11 /05 /COM/WEB