Permit CITY OF TIGARD ELECTRICAL PERMIT
1114
s COMMUNITY DEVELOPMENT Permit #: ELC2013 00235
T f G AR.O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/25/2013
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Clean Water Services Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (9) branch circuits for 9 new instruments
Contractor: OREGON ELECTRIC CONSTRUCTION INC. Owner: CLEAN WATER SERVICES
1709 SE 3RD AVE ATTN: ACCOUNTS PAYABLE
PORTLAND, OR 97124 2550 SW HILLSBORO HWY
HILLSBORO, OR 97123
PHONE: 503 - 234 -9900 PHONE:
FAX: 503 - 234 -1001
FEES
Quantity Description Date Amount
9 crt Branch Circuits wo /Purchase 04 /25/2013 $115.54
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/25/2013 $13.86
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $129.40
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 OA 952 -001- 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.23
f Issued By: .4.4 (hat Permittee Signature: 60 49 1 C4 r 1e7�
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.
Electrical Permit Applica CEIVED t ()I: (11 1'1( r I ` ()N L.1
City of Tigard i Received .1
ty g PR 2 20 7 3 K Permit i �� /3 -
III
et
13125 SW Ball Blvd., Tigard, OR 97223 Dm R w ew / ` �3
I Phone: 503.718.2439 Fax: 503.�9�, F TIGARD Date/By: caner Permit
i 1 c r. l Inspection Line: 503.639.4175 Dale Ready/By: loth: fa See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: 'i Supplemental lafecesatioa
❑ New construction Addition/alteration/replacement
7 11111111111 71ease ck all that apply (submit 2 sets of plans wine= checked below):
more ❑ Building over feeder 400 amps or mover three atones.
El Demolition ❑ Other: he available fault current ❑ Marinas and
or ❑ Floating buildings.
10,000 amps at 150 v olts ildings.
round ❑ Commercial-use or exceeds 14,000 al -use agricultura
❑ 1- and 2- family dwelling ® Commercial /industrial El Accessory building r all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: mp ❑ Installation of75 KVA or ncy syst . larger separately derived system.!
❑ Addition of new motor load of ❑ "A" "E" "1 -2" ' 1 3
Job no.: I c ) `"1 Job site address: 16580 SW 85 AVE I00HP or more occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
( :ity /State/ZIP: TIGARD / OR / 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: DURHAM BlO - P INST. ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: _Decrlpu6a qty. pee Total •
New residential single- or multi- family dwelling unit.
includes attached garage.
Subdivision: Lot no,: 1,000sq. ft. or less 168.54 4
Tax map/parcel no.: En, add'] 500 sq. ft. or portion 33.92 1
n °c t�rr sW n t ,.: }sn rwu , xn �ti, ?. a is +1ti , Limited energy, residential
� �+ ' 2 m (with above sq. ft.) 75.00 2
INSTRUMENTS AT residential (with above sq. ft )
Limited energy, multi- family
ELECTRICAL INSTALLATION OF (9) 75,00 2
NEW INS
Services or feeders installation, alteration, and/or relocation
CLEAN WATER SERVICES - DURHAM 200 amps or less 100.70 2 i
201 amps to 400 amps 1 33.56 2
Name: CLEAN WATER SERVICES 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 16580 SW 85 AVE 1 Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and/or
City /State/ZIP: TIGARD / OR / 97224 relocation
Phone: (503)547 - 8175 Fax: ( ) 200 amps or Tess 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 maps to 599 amps 168.54 2
i
Branch circuits — new, alteration, or extension, per panel I
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee, 742 2
each branch circuit
—
Business name: B Fee for branch circuits without
service or feeder fee, first 9 56.18 505.62 2
Contact name: TRAVIS BRINKMAN branch circuit
Each add'I branch circuit 7.42 2
Address: 1709 SE 3RD AVE Miscellaneous (service or feeder not included)
Each manufactured or modular i
City/State /ZIP: PORTLAND / OR / 97214 dwelling service and/or feeder 67.84 2
Phone: (503) 572 -0737 Fax: : ( ) Reconnect only 67.84 2
E - mail: t.w.brinkman a®oregon- electric.com Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Signal circuit(s) or limited- energy
Business name: OREGON ELECTRIC CONSTRUCTION INC panel, alteration, or extension, Page 2 2
• Each additional inspection over allowable in any of the above
Address: 1709 SE 3 R1) AVE Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: PORTLAND / OR / 97214 Investigation (I hr min) 66.25/hr
Industrial plant (l hr min) 78 18/ hr
Phone: (503) 234 Fax: (503) 234 - 1001 Inspections for which no fee is 90.00 /hr
s ifically listed ''A hr min
CCB Lic.: 203 Electrical Lie.: r - 4 P,;(2, Suprv, ic.:
Suprv. Electrician signature, requir r: > _____. Subtotal: 505,62
I , r I Plan review (25 %ofperntit fee):
Print name: • g , .. • IN Date: `l nig State surcharge (12% of permit fee)' 60.67
TOTAL PERMIT FEE: 566.29
Authorized signature," '
,/ ......
4 ,V L This permit application expires ire permit is not obtained within ISO
[-y �� r � n ,/�� %'+� 't days after it bas been accepted as complete.
l/t L
Print name: t��� G ''-^L 1J4L Date: .V' • Number of inspections allowed per permit.
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