Permit CITY OF TIGARD ELECTRICAL PERMIT
m COMMUNITY DEVELOPMENT Permit #: ELC2012 -00143
T I G A R. I? 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/15/2012
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Project: CLEAN WATER SERVICES Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Electrical for boiler replacement.
Contractor: BENTON ELECTRIC INC Owner: CLEAN WATER SERVICES
34037 EXCOR ROAD SW ATTN: ACCOUNTS PAYABLE
ALBANY, OR 97321 2550 SW HILLSBORO HWY
HILLSBORO, OR 97123
PHONE: 541 - 967 -1244 PHONE:
FAX: 541 - 967 -8257
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo /Purchase 03/15/2012 $108.12
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/15/2012 $12.97
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
Total $121.09
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 -0090. You may obtain a co.y of the rules • •' •= • uestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued Byf'- -'3 �-- _��s 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.
Mar 14 12 03:28p Benton Electric 5419678257 p.1
Electrical Permit Application
-‘\1V19 FOR OFFICE USE ONLY
City of Tigard
ill • 13125 SW Hall Blvd., Tigard, OR 97
Pla
Phone: 503.718.2439 Fax: 503.598. 6
tit '0\1- Received . 127M111112
Date/I3 .:
n Review
Date/By: " Permit No.: -- Z „Aro - # do/93
Other Permit:
.- TtGARD ‘
Inspection Line: 503.639.4175 a a Due Ready/By: - ri,1. , I 65 See Page 2 for
-----,
Internet: www.tigard-or.gov *I's / 6 • otiaed/method: Suppkmental Information
C10,. '
1. :::':%,;:;7.. ''',. •':-'4 I.: ....II: I s't `. 1 ;1 : p ...tiepeOp.Vgjiiik.- .13 % ‘i,... :,..;:i' V 1I; ; ',..A . ,. : ,.7! 4tRi..';
0 New construction 2] Addition/alteration Please check all that apply (submit 2. sets of plans WI terns checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
ID Demolition 0 Other: $ where the available fault current 0 Marinas and boatyards.
: C:: .:.;.: .!.; ' . :::- :.-•., .. - ) , ,i 4 : '.. : -7 ; ,.:- . 1 cP4 :I. .0 ..Oristiff:icligN,: :::: -.:. . .-:.,•:- ,: ..!::. 3; :7;::::J.,...,, -.;.::;; ,.,•1.; wiceeds 10.000 amps at 150 yaks or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Conunercial-use agrieutural
0 I - and 2-family dwelling EJ Commercialtindustrial 0 Accessory building amps for all other installations. btu 'dings.
0 Multi 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
larger separately derived system.
1(:4)i 0). H : : ' ' ' ... ''': ::::4:.: ':. : i.- : ::' :: 1:1 i : f tor load of 0 "A", "1 "1-3",
J ob no.: Job site address: 16060 SW 85' Avenue 100HP or more: OCCUNIACy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard, OR 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts noininal.
Suite/bldg./apt. no.: Project name: Durham Wastewater Plant CIService or feeder 600 amps cr more.
." •:.;; ''.: - .SC40.1. 11 .;t r . .: .'.!....:C: :.--.,... ...'.
Cross street/directions to job site: D i escription Qty. I flee I Taint I
' New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
E. midi 500 sq. R. or portion 33.92 I
Tax map/parcel no.: . Limited energy, residential
75.00 2
. -......:...)3E.12101 . 110$41r,, ! 7;0*iii;e...'': -e• :• 11 .` 1:. ;.. 1. . 1...: . ' .......:'. :: (with above sct ft)
Limited energy, multi-family '
75.00 2
Ostara recovery boiler replacement residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
::: ..' : - . ; : : • • ,..• I : V r f l O P P t i t . . # . • : O , V i t i R . I : - . : . , 1 ' . : . . . 4;.:. I J pi$Akif":". cl" 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
, . 601 amps to 1,000 amps 301.04 2
kddress: Over 1,000 amps or volts 552.26 . 2
Temporary services or feeders installation, alteration, and/or
Cit) /Stale/ZIP: relocation
Phone: ( ) Fax: ( ) , 200 amps or less 59.36 I
- 201 amps 10 400 amps 125.08 2
Owner installation: This installation is being :nade on property that I own which is not
01
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 4 amps to 599 amps _ 168.54 2
Branch circuits - new. alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
7 • ': . ..:••:-,• ; -; • . : ,].., E T upt ,::,!..'.:::... .• .;:: ...... .0: tors-TAcT .1 = .0 1?!:‘.'.?;.-. above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18
56 2
Contact name: branch circuit .18
Each add'I branch circuit 7 7.42 51.94 2
.
Address: Miscellaneous (service or feeder not included)
Each manufactured or module:
City/State/ZIP: dwelling. service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Rx only , 67.34 2
Pump or irrigation circle 57.84 2
E-mail: '
Sign or outline lighting 67.84 2
:;:i; • - ••••••••' •••. ''.• - • :•::•,;' 1..i'J.1 .f il 4; .: :'-.4dON'rEidv.cloR ..;!,;-.,:',-, - , ''.:..Y • N.. ':. -: ''. $ 1.:'i Signal circuit(s) or limited-energy
Business name: Benton Electric, Inc. panel, alteration, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: 34037 Excor Road SW Additional inspection (1 hr min) ; 6625/ hr
Investigation (1 hr min) : 66.25/ I'S
City/Stale/ZIP: Albany, OR 97321
Ir.dustrial plant (1 hr min) 78.18/hr
Phone: (541) 967 Fax: (541) 967 Ir.spections for which no fee is
90.00/ hr
sgecificaLx listed (Vs hr min)
CCB Lic.: 4213 , / ure I Electrical Lic.: 22-84C I Suprv. Lie.: 2067S , , ..•: ri"::!/;:7! -':' !,:l':i IELEATCAll MOO FEES r
- Electric' .i
r A - 7/1 // lob b 3 . Subtotal: I 108.12
sig Vi at, required: Plan review (25% of permit fee):
Print name: Gerald 0. Sheffield Date: 3-14-12 State surcharge (12% of permit fee): 12.97
TOTAL PERMff FEE: 121.09
Authorized signaZflA e . This permit application expires ire permit is out obtained within 180
days after it has been accepted as complete.
Print name: I Date: • Number cf inspections allowed per permit.
IABoiklinVermitsELC-PermilApp.doc 07i01/10 44C-4615T( I ItOSICONI/WEB
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