Permit CITY OF TIGARD ELECTRICAL PERMIT
1. .„......
s COMMUNITY DEVELOPMENT Permit #: ELC2013 -00231
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/23/2013
Parcel: 2S 1138000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Clean Water Services Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Install (2) 30A receptacles for odor control ventilation fans
Contractor: LIBERTY ELECTRIC LLC Owner: CLEAN WATER SERVICES
PO BOX 1681 ATTN: ACCOUNTS PAYABLE
CLACKAMAS, OR 97015 2550 SW HILLSBORO HWY
HILLSBORO, OR 97123
PHONE: 503 - 752 -6694 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 04/23/2013 $63.60
Specifics: Service or Feeder
1 ea Per Inspection 04/23/2013 $66.25
Type of Use: COM 1 ea 12% State Surcharge - 04/23/2013 $15.58
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $145.43
Required Items and Reports (Conditions)
This perm is issued subject • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance with app •ved -- - ,s. This permit will expire if work is not started within 180 days of issuance, or ' work is sus ,ended for more the 180
days. ATTENTION: Oregon law •uires you . follow the rules adopted by the Oregon Utility Notification Cente' Tho- - ru s are s,3' forth in OAR
952- 1 -0010 th ugh OAR 952 - 00'090. •u • •twin a copy of the rules or direct questions to OUNC by calling 503.232.198 • .80r 43 44. /
Iss d By: ' / "..._ Permittee Signature: A'
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:
C TRACT 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.
Electrical Permit Application y FOR OFFICE USE ONLY
City of Tigard L.. IV Ea Date/B / Z✓ 3 Permit No UGC 2-0/ 3 /13/ w hone S50 Hall Blvd., Tigard, : 503.718.2439 Fax: 503.59
P OR 97 2 2 3 2 Plan Review
I hone8. fi O t h er P ermit Q
Date/B Pat A_ Paol 3.-- OCVg"9
TIGARD Inspection Line: 503.639.4175 Date Ready/By Juns ® See Page 2 for
Internet: www.tigard or.gov (`lam OF TIGARD Notified/Method Supplemental Information
TYPE ONI4OMPORMSPI 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
❑ 1- and 2- family dwelling //R Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- famil■ ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
TION AND LOCATION ❑ Emergency system. larger separately derived system
JOB SITE INFORMATION I N A Q � [3 Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: S� 8 �7V E Six or or o more re s. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: ri/p� 97�ay El Health-care facilities. ❑ Supply voltage for more than
C l�a� , ❑Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: Project name:p, m ,* k'7 Opp,e 400,0L 0 Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: 5( 1 A/x.0.ml tip f Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
J w 85 1 /41/. 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
/it57-9G J_ (, \ 304 , P2271---- residential (with above sq. ft.) 75.00 2
/ ,! , / Renewable Energy ❑ See Page 2
O 0 ' 69 / 2- (6 -oL Y
G rI i-dr7 F4/' Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( ) relocation
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
Owner signature: Date: Branch circuits - new, alteration, or ex tension, • er panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B. Fee for branch circuits without
Contact name: service or feeder fee, first
branch circuit / 56.18 S* t/U Q
• 2
Address: Each add'l branch circuit / 7.42 7. vg 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
Phone: ( ) Fax: : ( ) dwelling, service and/or feeder
Reconnect only 67 84 2
E -mail: Pump or irrigation circle 67 84 2
CONTRACTOR Sign or outline lighting 67 84 2
Business name: L /AW—' / 02E-e272/0 Signal tt(s) or limited- energy
panel, alteration, or extension. Page 2 2
Address: /0 796, Sg ` 'V / �/ I ,g/ 2 Each additional inspection over allowable in any of the above
_ Additional inspection (1 hr min) / 66.25/ hr 4,6,.4- City/State /ZIP'
j /om 45 / iz 9 7O /5 Investigation (1 hr min) 66.25/ hr
Phone: (543) 76 — 6, 4,9 4 Fax: ( ) Industrial plant (1 hr min) 78.18/ hr
Inspections for which no fee is 90.00/ hr
CCB Lic.: 19( (,5— Electrical Lic.: y6 Suprv. Lic.: 56, y specifically listed ('/z hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: C Subtotal: / T , 84--
- 27,1 41L - 5 . G Date: 11/1-7//3 Plan review (25% of permit fee):
Print name:
f�s State surcharge (12% of permit fee): /5, 0
Authorized signature: TOTAL PERMIT FEE: /q r. 15
This permit application expires if a permit is not obtained within 180
Print name: ""3-iiivi 5 L aeo/./< Date: 7 /5? days after it has been accepted as complete.
// • Number of inspections allowed per permit.
1 \Building\Permits\ELC_ PermitApp_040913 doe 440- 4615T(t1/05 /COM/WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16580 SW 85TH AVE, TIGARD, OR, 97224
Commercial - Electrical
105 Underground/slab cover
05/15/2013 00:00
ELC2013-00231
PASS
Violation Summary:
Inspector Contractor