Permit CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELC2012 -00632
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/21/2012
Parcel: 2S114AA00500
Jurisdiction: Tigard
Site address: 16375 SW 85TH AVE
Project: Cleari WaterServices Subdivision: 1993 -078 PARTITION PLAT Lot: 2
Project Description: Solar photovoltaic installation
Contractor: MPD ELECTRICAL CONTRACTORS Owner: CLEAN WATER SERVICES
PO BOX 173 2550 SW HILLSBORO HWY
OREGON CITY, OR 97045 HILLSBORO, OR 97123
PHONE: 503 - 657 -9173 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 601 to 11/21/2012 $301.04
Specifics: 1000 amps
126 crt Branch Circuits w /Purchase 11/21/2012 $934.92
Type of Use: COM •Service or Feeder
Class of Work: OTR 1 ea Plan Review Electricial 11/21/2012 $308.99
Type of Const: 1 ea 12% State Surcharge - 11/21/2012 $148.32
Electrical
Occupancy Grp: 10 ea Info Process /Archiving - Lg 11/21/2012 $20.00
$2.00 (over 11x17)
Total $1,713.27
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 I in OAR
952- 001 -0010 through 0 952 -0 0 You may obtain a copy of the rules or direct 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:
R
LICENSE NO. `q 3
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.
Electrical Permit Applicati ECF l ED FOR OFFICE. USE ONLY
City of Tigard Date,B Receive : d //A , Permit No.: 14C o 20 /a-eo -3
;� • 13125 SW Hall Blvd., Tigard, OR 9722Q1()v 0 2012. Plan Review. r'r
C
Phone: 503.718.2439 Fax: 503.598.1 Date /B : f / kit `,
Inspection Line: 503.639 /� / ( T Da t e Ready /By: / �,�� tons: ® See Page 2 for
T I C. A I: D
Internet: www.tigard- or.gov � 1 Notified /Method: !/ f/ ///4111 Supplemental Information
TYPE OF"�PORK PLAN REVIEW
,New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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
El I - and 2- family dwelling Commercial /industrial El Accessory building amps for all other installations. buildings.
El Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
o n
❑Addition of new motor load of ❑ "A ", "E ", "I- 2 ", "I -3 ",
Job no.: Job site address: A-� 7 f �, �, Six or or more. occupancy.
❑
A 3 t"' AV— ❑Six or more residential units. Recreational vehicle parks.
City/State /ZIP: ��� ,,,J " � ❑ Health -care facilities. ❑ Supply voltage for more than
`l f ►`A77 7 7_ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: C C - ] .J J L� J ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: cc: vW A ` Description Qty. I Fee,. I Total I *
r ' oc , ` p ) New resident s or multi- family dwelling unit.
.0\71r ,� r V 1 v - � Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: / r" C) /Coot) Li Limited ne y, e d tia 33.92 I
[ J Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. fl.)
t \ P - (� ` Limited energy, multi- family
� e `\.? 7 ( � residential (with above sq. ft.) 75.00 2
� \ \1 {\�_.alAti' �, Services or feeders installation, alteration, and/or relocation
Q \ i , 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps I 301.04 2
Address: Over 1,000 amps or volts 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 168.54 2
Branch circuits - new, alteration, or extension, per panel _
Owner signal re: Date: A. Fee for branch circuits with
APPLICANT ❑CONTACT PERSON above service or feeder fee, i 7 / _ 7.42 2
' ` each branch circuit (�1P
Business name:
1 ‘ B. Fee for branch circuits without
'-' • service or feeder fee, first
Contact names e _,.n 1 J f' branch circuit 56.18 2
c..�` Each add'l branch circuit 7.42 2
Address: 6,1, 7 z , E /' , Miscellaneous (service or feeder not included)
Each manufactured or modular City/State /ZIP: \ r f �/ - ''1ZO 67.84 2
� dwelling, service and/or feeder
( may �2 q 0 _r ) 5 EL C n (D _ n_ I ^2 _ Reconnect only 67.84 2
Phone: `'I �l mil. P ` j Fax: : u (y '�(L "'� (J —
P ump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR 1-15 Signal circuit(s) or limited- energy
Business name: 7 7D e� Qit;. s Y.r i l , panel, alteration, or extension. Page 2 2
/(./�.)
Each additional inspection over allowable in any of the above
Address: -6,„ I, ( 3 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: 06 -6,„
l./1 ('\ I t�" q t�o l� Investigation (I hr min) 66.25/hr
I Industrial plant (I hr min) 78.18/ hr
Phone: 6;3) ( l ' '3 Fax: ( ) / Inspections for which no fee is
✓/ pckifically listed ('4 hr min) 90.00 / hr
B Lic.: ( 2.� Electrical Lic..{. Suprv. Lic.: 317q s J ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: (�� o Subtotal:
to
P lan review (25 /o of permit fee):
Print name:? \ l.‘. �,� � Date:' l - 2„1 ' L State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
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: • Number of inspections allowed per permit.
I :1Building \Perm its \ELC- PermitApp.doc 07/01/10 440-4615T( 1 I /05 /COM /WEB