Permit CITY OF TIGARD ELECTRICAL PERMIT
°. ' COMMUNITY DEVELOPMENT ELECTRICAL
ELC2013 -00342
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/20/2013
T [.0 t11 9 Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Clean Water Services Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (2) 200 amp service and (5) branch circuits for Bisulfite modifications.
Contractor: BENTON ELECTRIC INC Owner: CLEAN WATER SERVICES
34037 EXCOR ROAD SW ATTN: ACCOUNTS PAYABLE
ALBANY, OR 97321 2550 SW HILLSBORO HWY
HILLSBORO, OR 97123
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PHONE: 541 - 967 -1244 PHONE:
FAX: 541 - 967 -8257
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 06/20/2013 $201.40
Specifics: amps or less
5 crt Branch Circuits w /Purchase 06/20/2013 $37.10
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 06/20/2013 $28.62
Electrical
Type of Const:
Occupancy Grp:
Total $267.12
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 OAR • - -r a. Y: may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: • P ermittee Signature:
Q 2° G / e�% 7�
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.
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06 -19 -13 :08:58 # 1/ 2
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Electrical Permit Applicatio EIVED FOR OFFILE t' E ONL1
City of Tigard 1' Received Penrtit No.:
' 13125 SW Hall Blvd., Tigard, OR 97223 V 9 2 13 Damay: 072.0 /3 -' E�02Oi3 A93 y...2_, g Plan Review
' I Phone: 503.718.2439 Fax: 503.5 $ OFTIGL �p Date/By: Other Permit:
T 1 G A RD Inspection Line: 503.639.4175 Date Ready /By: 3urisV I FB See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Ill Supplemental Informat
- „TYPE OF: WORK: - - PLAN ,RE'VIEW •
❑ 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 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 ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 150 KVA or
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION _ ❑ Addition of new motor load of ❑ "A". "E' ,' 1.2", ' 1.3
Job no.: Job site address: 16580 SW 85th Avenue IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR ['Health-rare facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Durham Bisulfite Project ['Service or feeder 600 amps or more.
FEE SCHEDULE '::
Cross street/directions to job site: Description I Div. I Fee. I Total I 4 .
New residential single- or multi - family dwelling unit.
Includes attached garage,
Subdivision: I 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.)
Limited energy, multi - family 75.00 2
electrical wiring for new bisulfite system residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
(] ' OWNER ❑`: T ENANT - : _ ' - 200 amps or less 2 100.70 201.40 2
amps amps to 400 amps 133.56 2
Name: Clean Water Services 401 amps to 600 am s 200.34 2
Address: 2550 SW Hillsboro Highway 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State/ZIP: Hillsboro, OR 97123
Temporary services or feeders installation, alteration, and/or
Phone: (503)681 -3600 Fax: (503)681 -3603 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 extension, per panel
- s0 APPLICANT , • - ` I" - ❑ CONTACT - PERSON A. Fee for branch circuits with
above service or feeder fee, 5 7 42 37.10 2
Business name: each branch circuit
B. Fee for branch circuits without
Contact name: service or feeder fee, first 56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 _ 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: Benton Electric, Inc. Signal circuit(s) or limited energy See
panel, alteration, or extension. Page 2 2
Address: 34037 Excor Road SW Each additional inspection over allowable in any of the above
- City /State /ZIP: Albany, OR 97321 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
Phone: (541) 967 - 1244 Fax: (541) 967 - 8257 Industrial plant (1 hr min) 78.18 / hr
I / inspections for which no fee is 90.00 / hr
.1 CCB Lic.: 4213 Electrical l : 22 -84C Suprv. Lic.: 2067S - specifically listed (r/ hr m[n)
I i fi i 1 Le /( n ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: /Jili/►ti l�l
Subtotal: 238.50
Print name: Gerald O. Sheffield Date: 6 - Plan review (25% of permit fee):
State surcharge (12% of permit fee): 28.62
Authorized signature: TOTAL PERMIT FEE: 267.12 ✓
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
l:U 3uilding\Pcrmits \L•LC_fcrmitApp_ EtR_L•RE.dnc Rev 05/21/2013 410- t6lST(11/o5 /COM/1VEB