Permit q CITY OF TIGARD ELECTRICAL PERMIT
Permit #: ELC2013 -00289
III 2 COMMUNITY DEVELOPMEN
Date Issued: 05/22/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 5/22/2 000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Clean Water Services Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (1) branch circuit for lighting upgrade
Contractor: CONDUIT ELECTRIC Owner: CLEAN WATER SERVICES
19461 SW 89TH AVE ATTN: ACCOUNTS PAYABLE
TUALATIN, OR 97062 2550 SW HILLSBORO HWY
HILLSBORO, OR 97123
PHONE: 503 - 692 -1428 PHONE:
FAX: 503 -692 -3652
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 05/22/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/22/2013 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 throug. a A. 001 -0190. 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:
Q/17 /f",/
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 603.639.4176 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.
From:CONDUIT ELECTRIC 5036923652 05/21/2013 16:19 #601 P.002/002
Electrical Permit Applicati°� FOR OFFICE USE ONL
ihi City of Tigard 1V�LEIVED Received .� Per mit No n -
• 1 3125 SW W Hall Blvd., Tigard, OR 97223 Plan a Review oZ � (� j �tV
' ' _ Phone: 503.7182439 Fax: 503.598,1W 2 1 2013 /B y : w / 4.- y . Other Permit:
1 n kb Inspection Line: 503.639.4175 Date Ready/By. lur' ® See Page 2 for
Internet: www.ltgard Or.gov CITY OETIGARD Notified/Method:' Supplemental Information
TYPE O v S ING DNISION PLAN REVIEW
P lease check all that apply (submit 2 sets of plans w /items checked below
❑ New construction Addition / eratton / replacement )
❑ 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
❑ I - and 2- family dwelling ® Commercial/industrial El 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 0 Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E', "1- 2 ", "I -3
Job no.: I '3 s ^' q-� Job site address: 1 S � /2' Sty S�` t Six or or more occupancy.
{ I. 0 r� /J" ❑ Six or more residential units ❑ Recreational vehicle parks.
City /State /ZIP: • / , Olt— 1 ❑ Health -care facilities 0 Supply voltage for more than
V try- t, •P" I ❑ Hazardous locations. 600 volts nominal
Suite /bldg. /apt. no.: Project name: a feeder amps or mo re.
(�S p tt.r l t -a d. ❑ Service or fd 600
FEE SCHEDULE
Cross street/directions to job site: aneription 10ev- Fee.
I I Total I •
New residential single- or multi - family dwelling unit.
' Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft. or less 168 54 4
Ea. add'l 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.)
- j
y� � Limited energy, multi- family 75.00 2
,_J : /' r $ At r ae- - residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation _
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: -
_ 601 amps to 1,000 amps 301 04 2
Address: Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP:
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not -
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 signature: — Date: A Fee for branch circuits with
[I APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: b K i lA �- j�. p 1� r nC�� B. Fee for branch circuits without
1 " service or feeder fee, first
Contact name: 1. I ki C-1(-- /O branch circuit 56 18 g 2
c { y E ach add'I branch circuit 7_42 2
Address: ,t ` t3gG I S �5'I ' J'` J- 1 j Miscellaneous (service or feeder not included)
Z Each manufactured or modular
City /State /ZIP: '7 4.I4 tit ae C 7 064 dwelling, service and/or feeder 67.84 2
o
Phone: ( So3) tl (t�' /1.42_45.- Fax: : ( .5 - 6) 6 y.a. - 36s-d Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
�AA E ^ ,� panel, alteration, or extension. Page 2 2
Business name: Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr mitt) 66.25/ hr
- Investigation (1 hr min) 66.25/ hr
City/State/ZIP: - -lT Industrial plant (1 hr min) 7818/hr
hone: ( ) �� r't Fax: ( )
Inspections far which no fee is
specifically listed (/ hr min) 90,00 / hr
CCB Lie. ; Q i lD 6 ectrical Lic.: at- g acc S uprv. Lic.: t / S ELECTRICAL PERMIT FEES
// ' - - --
444///""
Subtotal: S/ t g
Suprv. Electrician signature, required: 1
J Plan review (25% of permit fee):
Print name: ( A O,, 4 P �� Date: 5 Zi- 13 State surcharge (12% of permit fee):
TOTAL PERMIT FEE: t [ p /
Authorized signature: This permit application expires if a permit is not obtained 180
days after it has been accepted as complete.
Print name: Date: _- • Number of inspections allowed per permit
• 1 V3uildmg/Permts\ELC- PermiiApp doe 07/01/10 440451 v05'COML14E13