Permit Irl ,CITY OF TIGARD id,....... 081 ELECTRICAL PERMIT
PERMIT ISSUED 12 ELC2006-00735
COMMUNITY DEVELOPMENT
DATE ISSUED: 12/27/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S11380-00600
SITE ADDRESS: 16060 SW 85TH AVE ZONING: I -P
SUBDIVISION: SEWER TREATMENT PLANT LOT : JURISDICTION: TIG
Project Description: (1) branch circuit for wiring in Treatment Plant Services Building conference room.
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:
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 SCHULZ ELECTRIC CO
2550 SW HILLSBORO HWY 447 NE 18TH AVE
HILLSBORO, OR 97123 -9379 HILLSBORO, OR 97124
Phone: 503 - 681 - 3600 Contact #: PRI 640 -3304
FEES
Description Date Amount Reg #: ELE 34 -309C
[ELPRMT] ELC Permit 12/27/200( $46.85 LIC 81488
[TAX] 8% State Surcharge 12/27/200( $3.75 SUP 3541S
Total $50.60 REQUIRED ITEMS AND REPORTS
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 wi • ccordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
mor han 180 days. 1 ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
0 952 - 001 -0010 through • • - • .2-01 -0100. You may obtain copies of these rules or direct questions to O at 503.246.6699 r 1.800.332.2344.
Iss ed By: _ _4 /� `' Permittee Signature: 'C p,t ,
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 ST' LATION ONLY
SIGNATURE OF SUPR. ELEC'N: A .'�/ . _ 4 / DATE: /. .9- 7/0 6
LICENSE NO: 3 5f/ 5 /
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.
p.7
Electrica Permit Application 6C L� - J41
FOR OFFICE liSE ONLY '
C ity of Tigard Received Permit No.: ei.e a - 0473
1111 ° 13125 SW Hall Blvd, Tigard, OR 97223 pan Review
0 Phone: 503.639.4171 Fax: 503.598.1960 DaWB . Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By runs: la See Page 2 for
( Internet: www.tigard- or.gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction yl Addition/alteration/replacement Please check all that apply (submit a sets of plans wfitems 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.
p � less to ground, or exceeds 14,000 El Commercial-use agricultural
12 1- and 2-family dwelling P° Commercial/industrial 0 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 ",
/6,406.0 I0011P or more. occupancy.
Job no.: Job site address: s w ee
/T vtf 0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: 1. ❑ Healthcare facilities. ❑ Supply voltage for more than
� � / `�� P 0 � R- 91i locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: / ) / ❑ Service or feeder 600 amps or more.
I !� ��t i jl FEE SCHEDULE
Cross street/directions to job site: oe.r tptem 1 Q4. 1 Fee. 1 Tet I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: • Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
/� / Limited energy, multi - family
/ ._Ter. brZ �j)je_/ /� ]-/J eeht. ib". Z 7 / / residential (with above sq. ft.) 75.00 2
rif ` l e L ' ` a , / �� . ,�. Services or feeders Installation, alteration, and/or relocation
�J, /V .. • - �r 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑TENANT . 201 amps to 400 amps 106.85 2
Name: C LLB 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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 599 amps _ 133.75 _ 2
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,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
• without service or feeder fee
Contact name: , first branch circuit r 46.85 K.6
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
• CONTRACTOR Sign or outline lighting 53.40 2
•
Business name: Sc. /yuL2 , ., Signal circuit(s) or limited -
e E� G C.:C)+ energy panel, alteration, or
Address: Z/6/ 7 Al. 5 /13 E- extension. Describe: Page 2 2
City /State/ZIP: 1 1/ 7 7/5 b, D Q ! '7 /iR/ Each additional inspection over allowabk in any of the above
/ / Per inspection 62.50
Phone: ( Fax: �� � �� � 99 (� 3 7' 1 6 � �/ +�
T Investigation per hour (I hr min) 62.50
(,
CCB Lie.: a Electrical Lic.: y -310 p Suprv. Lie.: 35w.... 5 Industrial plant per hour 73.75
!v ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: qua „33S Print name: Pa J'�'� S'GJ,L Date a l ..-- /2/z ?/D Plan review (25% of p fee): -
State surcharge (8% of permit fee): 3 ,7 , 7
Authorized signature: TOTAL PERMIT FEE: F . l'c)
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ BuiId ingTamits\ELC- PermitApp.doe 05/23/06 44W61 ST( I I/0S/COM/WEB
Electrical Permit Application - City of Tigard - ••
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL. WORK ONLY:.:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I :\&dldingPamiu\ELC- PamitApp.doe 03/21/06