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Permit CITY OF TIGARD ELECTRICAL PERMIT `'! COMMUNITY DEVELOPMENT Permit #: ELC2011-00409 TIGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/21/2011 Parcel: 2S 1138000600 Jurisdiction: Tigard Site address: 16580 SW 85TH AVE Project: Clean Water Services Subdivision: Lot: Project Description: (1) branch circuit and (1) low voltage data telecommunications system for rooftop cell tower on the Chemical Building. Contractor: HEIL ELECTRIC CO Owner: CLEAN WATER SERVICES 8425 SE STARK ST ATTN: ACCOUNTS PAYABLE PORTLAND, OR 97216 2550 SW HILLSBORO HWY HILLSBORO, OR 97123 PHONE: 503 - 255 -4074 PHONE: FAX: 503 -255 -4139 FEES Quantity Description Date Amount 1 ea Limited Energy 07/21/2011 $75.00 Specifics: 1 crt Branch Circuits wo /Purchase 07/21/2011 $56.18 Service or Feeder Type of Use: COM 1 ea 12% State Surcharge - 07/21/2011 $15.74 Class of Work: ALT Electrical Type of Const: Occupancy Grp: Total $146.92 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 0 • ! You may obt -' 1 - • • of i s - irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued 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: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: 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. 07/21/2011 10:46 5032554139 i' HEIL ELECTRIC CO PAGE 02/03 r,lecrnitcai rermit Application � FOR OFFiCE USE ONLY of Tigard Reoeived • Dam /Q Permit No : . 13I25 S W q 1Ia11.Blvd., Tigard, OR 7 �� �� — !� r / ` • • � � Plan Review Phone: 503.718.2439 Fax: 503 Date/By; Other Permit: T I GA R.D Inspection Line: 503.639.4175 \ \\' h'�® pate Ready/By' lurlp: 0 See Pstgc 2 for Internet: www•tigard- or.gov J ` q\ c.\ • Notified/Method: --- /C: , Supple/tenor] Information itri p'I �.r i„Jt.ilf.., ii21l {( _ k 1r, �,' , .. "y: i:)I':; � i,..,.,�.. �,,.H.. ' 9 ' i 'l 1. H• I 1 a ;; R'�' t "�' �tr�.�o ,,.' hj l � . 11 , 'r , !R k'o nr ' �� 'L' ;t! ,, n�( ,i i,'1 .l+" "flll;', I,, 4p � ,'„['lil,!" ,�, - �btl,I[ I � �., � ,,,;�.,, ii , ..r,arl,,.:,it�lrili�?,G , ' 11`� r,7. llil(�,'r' Q) VR' f l'l] .i:, h -.,•y ,, . :; ;At ;uL,,,.Si..I* �'t lil...a•, " , j'ai . , , d(en, .i „! -S'�1 , l' t, r. �fi1., � „��11,,r.AP.',;.r: ��; � �N. �f ;IGI;Ii111I!;!j3tIJ��,lar,��,,. ;,;� 1iI:' 1nl; edliVbl�;v, �! �I' I�j�({ h' l: la.,, y�. i{. tl: llt�����' M1' 1?M1T1Af;! lli!! ytlf t; llr�ij� :11'tl {�4 {� {tli ;�lr!:Slti„l'Il�l ❑ New construction ® Addition/alteration / 4,c it Please check alt that apply (submit 2 sets of plans w /itclns checked below); ❑ Demolition ❑ Other `Os' ❑ Service er feeder 400 amps or more El Budding over three stories, where the available fault current ❑ Marinas and boatyards. y? - � " �4a'',:''!•11 hj�IIUIII'EIAt14r3aiJ�2` "':a II :� .. y �,hr.,,., � y -,s'.' "� :) f y;r;. .,!)! 13:'1';- } gnd,;�r'. Ya I i! jl"i� ; r ':�6I ! I O' ' , -l' . „I;' '1 a I ! <131;i,3 ..y,'t' ' exceeds 10000 amps at 150 volts OT i' , Floating ! II'1f 4..f, .,�A„ ,i v. �, { { {I���[jl"I:2�j1��SiYn''{�i� t�?Ir21"ij�r, f:'I!,I`iCil7lf'tfi�l�t, �17,II^1{�, ,Pfill ,� S';(Is dlk +llih',I,I�I, �l��l i� j F!',I, r,�.' ,,,r?,le, I• ❑ $buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultund ❑ I- and 2- family dwelling El Commercial/industrial ❑ Accessory building Damps for all other installations.. buildings, ❑ Mult7i- family ❑ Master builder , Other: Fire pump. ❑ installation of 75 KVA or �, an ,,. „�, lip }�7 (p! "Irvt' °��aa.. � 1 ,.� ,:ac�WU.,.�, ,.,.: ,:, O �, '� n {( "r "r e'ti n: ,ar Fmcr cn s euem, tatel derived g e m. I t ri .,1!,�;�!' . ! ,M ., "+ fy" r '1'''l 11 tK'; ❑ S cY Y larger seen to i.( ;t! I r, 4:,:.:' a��l€ �l5tii�t, �t�, ?i,r`g,,,;;; :�;iS�fi?i�. ,i i F �Z�C I i:� I c. ti "tr;., Y Y , �1,, l.I'niv. r� ,! 1' � , ��, ,�'.� Is {� 1 'Ir j i, 4.. � r,r.11, ' f`' ��, �, Q ��( il�;, �;. tr. Li 1. ;,,il.. {;a�li;�.c,:i <I;,r,,,�, ❑ Additioaafncwmotorloado£ © Job no.: 6755 Job site address: 16580 SW 8S' ST 10012 ar more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: 97224 ❑ Health -care facilities. ❑ Supply velrape for more than no.: Project n ❑ Hazardous locations. 600 volts nominal Suite/bldg./apt. J an ts: G� - ❑ Service or feeder 600 amps or more, �' % 2.� �1.�%t,- ! .• �.e ore. y! k> /'IIPI'ill'97i :': 1 ;" "r' 't J.' } I hi } yha.o :t'•h. ql , Crass streetJdirections to job site: ht; { {R ∎;i, tl* :t!; l!.i F iF$ Q . V ∎Idr gi )4 I �Ell!l,lgl�lgii Description Fos Total New residential single- or multi- family dwelling unit Includes attached garage. Subdivision: I Lot rio.: _1,000 sq. ft. or less 168,54 4 Tax map /parcel no.: Ea- add'! 500 sq. ft. or portion 33.92 I IC r.1.• "'.P ^ "`:^d1i i Ii 31Ai'' %i ;" r' ' : "! ?'i "'a "s .ii. ,.r,. ,.�,,., G,'dl' :,t :• :1,r,�;,, �. i ,�.,�,, _ _ Limited energy, residential „] il I+71( , ; ..7t, s . , , ..... ... � l9. .I . n r,!) Y ( illll) �1t:11f� :l�ll�l5l�i,I)II1'lt�A. 811/ �, �, 7;_ liY! I. �{f(, �.: �' I,] �Il�lnl�l {n�Itl�i�1�C�ITJ�ITA'li a � } "i� :..l�.il �1' :4 �����!'��''�1'���i�' Ir .. }. x.1,.1 { Ij�ll,.it�il!(. :�.iil'i� .(with abovesq.ft.) 75.00 2 i� II „I,1 , ,., IF11 i'iMl r� it :... e . I I,,w;! {.,,�,p{rl ... ,.,I,.,, Lh,.LY,I, Limited energy, multi -family mc WIRING residential ( with above s - ft 75.00 BR c CI - 7� �1��.�t� �r Aka.) � - sq._ - ) „_ a;00,1 p ., L _ J,- & � 6r O +� ` L J 200 or feeders installation, aiteratfan1 ps or less 100.70 relocation !��- 1 � t ( ' c-�V zC 204 m0.70 2 'ijiI ih }loJfl88Ia. i;�. { �� Ir`.. 1 fwi; };li %,PjitIL1•'h.7.- :ih2 :r, ..i., .��,,,..,h' ^rat; :nh!1t1 :1: 201 amps 4 { I (' & { 11� ... eG 11:045 thO1, r A I n;. {, :fi lri1 :l , �'xl ::. I .0.1 i?��tl{i In I � li'!h',.? .,, „Ij., PS to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts I 552.26 2 City/ State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone; ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 2 Branch circuits - new, alteration, or extension, per panel Owner signature: _ Date: A. Fcc for branch circuits with i'�`illi' 1; I } �'` ?� i i � I I .,, ,.,'> t}l!!�.! � i:rf - ii I '� ! 1 ul' 1 � I , � , � , :� Ilf... I p : iI£- f.. �' I P. �iK,�,yy� , ''r'' f.1 t .� ,'.If1' S., 31!�t �jrl s�i :,, (i1{ jlln ji;:fJl,j�l;.. f { -�,.y �07 . ., above service er fee, .i..:, 111 ;w., ..1 .1 i w P. iI �,';IN.. .b„ ,i�.i{?P'4,IA (' ).,,," , , . 1�1' j1 . , Ail , c.S .�,(i� t �,fal' "41,I r "r: ". 7.42 2 each branch ci rcui feed Business name: - B. Fee for branch circuits without service or feeder fee, first 1 56.18 56.18 2 Contact name; branch circuit Each add'] branch circuit 7.42 2 Address. Miscellaneous (service or feeder not included) City /State /ZIP; Each manufactured or modula 67,84 2 dwelling, service and/or feeder Phone: ( ) I Fax: : ( ) - Reconnect only 67,84 2 E -mail: Pump or irrigation circle 67.84 2 pll;ai;l'I I n p� +;;,,. .. ; -,n' v, r ,,,, .., Si gn[ or outline lighting 67.84 2 ., 1 �i , , I {' ! 4 §l 1 I C , .i 1^,i }.' I. 't" :II3. i'! ill tR JP, :� ,r�,.p,.. , :!: , 3 u 'r t; i ,_.t .�� :.,, <.,Illi (hill! Iif,11; 1:,, . :,1!1,1!,. , ,co ,�!gl, ;; ;, >„ll;; �;ar �.1 {li u s •tO I led i t Q lllllr) 1;., .. ....) {t {( „ }�i�;(+ ,,,..� ; :�,t :.. .::: z;t.:ii tf 'd lanai circm s or uru cnerEY Business name: HEIL ELECTRIC panel, alteration, or extension. 1 Pages 2 75.00 2 Each additional inspection over allowable in any of the Above Address: 8425 SE STARK ST Additional inspection (1 hr min) 66.25/ hr City /State/ZIP: PORTLAND,, OR 97216 Investigation (1 hr min) GG -2S/ ilr Industrial plant (1 hr min) 78.18/ hr Phone: (503) 2554074 I Fax: (503) 2554139 Inspections for which no fcc is 434 r I Eli C 1 Electrical Lic - 26 - 66u rv - Lic - 5525S ;; t l a listed - ( mak l,iit 90.00/ hr �' l / specifically t •• - 1 � II`1I Sp •• 1 �,r hlif ?h��. 1��'.�1f�`1Elrs�: � CCB Lic.: 387 ji�Kli` :�,�i'tl�h :; a 1 ter!' ) Subtotal: 131.18 Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: DARRELL GORE bate: 07/21J20Xx - State surcharge (12% of permit fee): 1,-• ► ii 4' „ , - B ✓ � TOTAL PERMIT g� i ., , q� Authorized signature: T l/ !VG(it,/ Tim permit *lineation expires if is peermit t is not obtained Within .i130 Print name; DARRELL GORE Date: 7/21/2011 • days after It has been accepted to complete Number of inspections allowed per permit 1 :\ euhding 1FermilelaLc- Fcr,niIApp,doc 07/01 /10 4404615T(t I/05 /COM/WEB 07/21/2011 10:49 503255413779�� (T HEIL ELECTRIC CO `I�/ fn PAGE 01/01 o. tk-elTht Electxi,cal Permit Application - City of Tigard J Vt) • Page 2 - Supplemental Information • LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined $75.00 RECEIVED Check Type of Work Involved: JUL 21 2 0 1 1 ❑ Audio and Stereo systems* CITY OF TIGARD ❑ Burglar Alarm BUILDING DIVISION ❑ Garage Door Opener* [ 1 Heating, Ventilation and Air Conditioning System=s ❑ Vacuum Systems* 0 Other: I ,. -,. ... ___.�, ; j:i ".� ".�,' T '_...i3 „ - 1 � ` � . . ,.! t ��.p Fee for each commercial 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 El Nurse Calls ❑ Outdoor Landscape Lighting . Protective Signaling ❑ Other Total number of commercial systems: »No licenses are required. Licenses are required for all other installations I: 1DuildinzTcrmiixd1LGfcrmitnpp .doc 01101/10