Permit CITY OF TIGARD ELECTRICAL PERMIT
S COMMUNITY DEVELOPMENT Permit#: ELC2016-00412
T l G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/26/2016
Parcel: 2S114AA00600
Jurisdiction: Tigard
Site address: 16555 SW 85TH AVE
Project: Clean Water Services Subdivision: None Lot: None
Project Description: Electrical for gas purification heat trace on drains.
Contractor: TICE ELECTRIC Owner: CLEAN WATER SERVICES
5405 N LAGOON AVE. 2550 SW HILLSBORO HWY
PORTLAND, OR 97217 HILLSBORO, OR 97123
PHONE: 503-872-8230 PHONE:
FAX: 971-230-3330
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 05/26/2016 $56.18
Specifics: Service or Feeder
1 ea Plan Review Electricial 05/26/2016 $14.05
Type of Use: COM 1 ea 12%State Surcharge- 05/26/2016 $6.74
Class of Work: ALT Electrical
Type of Const: 21 ea Info Process/Archiving-Sm 05/26/2016 $10.50
Occupancy Grp: $0.50(up to 11x17)
Total $87.47
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 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. A ENTION: Oregon . r=• es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-1 s 1-0010 through OAR 952- -0090 Y. may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 r 1 00. 2.23A-�
I sued By: k 1 ', ', Permittee Signature: l
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' �, .:� /L�_� Date: �—a(Q (..i
41111111111P ---
LICENSE NO. 37 7r'5
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 1.01(()III( I. I SI ()NI 1
City of Tigard GI V CL+ Received
[� rr G DateBy: t _ Permit#: `!—C a
IN 'I 13125 SW Hall Blvd.,Tigard,OR 9722 EC Plan Review �! / ��I v% /6y ��
■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: /!S�/ 4, Related Permit#: /G _
P� A7
Inspection Line: 503.639.4175 MAY 18 2016 Ready Date/By: ,,. -7-- .....c
See® Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Methor5./ft4r� /` j /��.- Supplemental Information
TYPE OF woI4CtTY O((F��T�G`,P Dw' I ev,141 S.` PLAN REVIEW
New construction > Utliab tAtD1V1v�ON Please a,o,.,...l that apply(submit 2 sets ofplans w/items
❑ ®Addition/altera PP Y checked):
O Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault current ID Marinas and boatyards.
CATEGORYOF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps forallother installations. buildings.
❑ Multi-family 0 Master builder 0 Other:
0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#:80.7413 I Job site address: SW 85TH AVE ❑Addition of new motor load of system.
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:TIGARD,OR 97224 //051S-S" 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 1 Project name:CLEAN WATER SERVICES ®Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total i •
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
INSTALLING GAS PURIFICATION HEAT TRACE ON DRAINS. (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq,ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER f 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT ® CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:TICE ELECTRIC CO above service or feeder fee,
7.42 2
each branch circuit
Contact name:KEVIN SHANNON B.Fee for branch circuits without
Address:5405 N LAGOON AVE ervice or feeder fee,first 1 56 18 56.18 2
branch circuit
City/State/ZIP:PORTLAND/OR/97217 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)341-7317 Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: kevins@ticeelectric.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:TICE ELECTRIC CO Sign or outline lighting 67.84 2
Address:5405 N LAGOON AVE
Signal Iern or limited-energyxens0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:PORTLAND/OR/97217 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)872-8230 Fax:(971)230-3330 Investigation(1 hr min) 90.00/hr
Email:theresah@ticeelec.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 166 Electrical Lic.: 26-126C Suprv.Lic.: 3940S specifically listed(/2 hr min)
ELECTRICAL PERMIT FEES /
Suprv.Electrician signature,required: Subtotal: 56.18 +�"
Print name: BOB RICHARDSON Date: 5/18/2016 ®Plan Review Required(25%of permit fee): 14.05 f
State surcharge(12%of permit fee): 6.74
-, Authorized signature: TOTAL PERMIT FEE: 76.97
LL��/ � This permit application expires if a permit is not obtained 'thin 180
Print name: ,i/40✓ ";‘..A.4 S"-, Date: 5:!$,.20/4 days after it has been accepted as complete. �,
* Number of inspections allowed per permit. �f rV t✓0
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440.46151(11/05/COM/WEB
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16555 SW 85TH AVE, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00412
Jeff Grove
Violation Summary:
Inspector Contractor