Permit (2) CITY OF TIGARD ELECTRICAL PERMIT
114
• COMMUNITY DEVELOPMENT Permit#: ELC2019-00887
T tGARL) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/14/2020
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16635 SW 85TH AVE
Project: Clean Water Services Subdivision: None Lot: None
Project Description: Digester Complex: Installing battery backup,switches,and solenoids; Relocating gas burner control panel;
Installing low voltage system for protective signaling and controls.
Contractor: FIVE STAR ELECTRIC INC Owner: CLEAN WATER SERVICES
756 SW BAILEY AVE 2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 HILLSBORO, OR 97123
PHONE: 503-324-0948 PHONE:
FAX: 503-324-0973
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 01/14/2020 $71.02
Specifics: Service or Feeder
1 ea Signal circuit or Limited 01/14/2020 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12%State Surcharge- 01/14/2020 $17.52
Electrical
Type of Const: 1 ea Plan Review Electricial 01/14/2020 $36.51
Occupancy Grp:
Total $200.05
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 52-001-0090. You m • a c r direct questions to OUNC by calling 503.232.19877 or 1.800.332.2344.
Issued By: Permittee Signature:
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 Application FOR OFFICE LSE oNL't
City of Tigard ® Received
• CEIVE »eteBY: /aV3t/oi r o, ' ,. •t#:,no(q_cx) 7
13125 SW Hall Blvd.,Tigard,OR 9 Plea Review
I Phone: 503.718.2439 Fax: 503.598. Date/By: `/7/2 , Related Permit#:
Inspection Line: 503.639.4175 C, ,`_,D�/
T:I G A R.D C 1 Q', Ready Da q ha;s ®See Page 2 for
Internet: www.tigard-or.gov Notified/Method:! 1 J30 , Supplemental Information
. TYPE OF WO E}t- 111-11'M"5v
1 :r PLAN '•... a ,.-
❑New construction 0 Addition/altera ent" Please check all t apply(submit 2 sets of plans w/items checked)-
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition E Other:
where the available fault current 0 Marinas and boatyards.
, ,,- , CATEGOWY,OF_Cp.mmuc riorli am, „_ exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling CJ Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Elamps for all other installations. buildings.
Multi-family 0 Master builder ❑Other: ❑Fire um
--- - _ P P. ❑Installation of 150 KVA or
JOB SITE INFQRMA 0 .��,,�,,,p, �.:ATION El Emergency system. larger separately derived
g51 Addition of new motor load of system.
Job#:FS1' , Job site address 4h ( Vl ❑1. IOOHP or more. ❑'•A•, "E""1 2,•,,•1 g'
City/State/ZIP: T/1rc !, �{7 a-?I ❑Six or more residential units. occupancy.
"`'^'' I `vI.^' '^,� ❑Healthcare facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:nos b, sty } , arnrdous locations. ❑Supply voltage for more than
�'(tRic�Y l.N/ ervrcc or feeder 6(10 amps or more. volts nominal
Cross street/directions to job site: �
Description j Qtv.-I Each I Total 1 •
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: I,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORE
Limited energy,residential
1m5 t to 1 I u t F v1 t (with above sq.It.)
75.00 2
up,, Ida -e i�ullGl�o 50lD�Ua� '
' Limited energy,multi-family 75.00 2
Jae 11.O Ce,.l.x,4` ,1,lY�&n�,L` w l pGl h?Q , C1 1.C t 5tryl residential(with above sq.ft.)
51 PRdQPE 0 TENANT S OWNER OWNER r Renewable Energy f ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 1 L9o. a/\_�j rV 1(...Q() 200 amps or less 100.70 2
Address: pG %Q c i i _.. 201 amps to 400 amps 133.56 2
�C X��l� 401 amps to 600 amps 200.34 2
City/State/ZIP: t+'k LS410 OW )-Z 601� amps to 1,000 amps 301.04 2
Phone:( ) (02..,I - 31000 Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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
❑-CONTACT PERSON : Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Five Star Electric,Inc. above service or feeder fee,
each branch circuit 7.42 2
Contact name:Becca Sinner B.Fee for branch circuits without
Address:756 SW Bailey Ave service or feeder fee,first I 56.18 J •It
branch circuit si 2
City/State/ZIP:Hillsboro,OR 97123 Each add'I branch circuit 2 7.42 11,yq- 2
Phone: 503 324-0948Miscellaneous(service or feeder not included)
( ) Fax::(503)324-0973 Each manufactured or modular
Email bsinner@fivestarelectr►c.org
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
' ) CONTRACTOR
- - - .. Pump or irrigation circle 67.84 2
Business name:Five Star Electric,Inc. Sign or outline lighting 67.84 2
Address:756 SW Bailey Ave Signal circuit(s)or limited energy Page 2 �� 2
panel,alteration,or extension. gii See
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 6625/hr
Phone:(503)324-0948 Fax:(503)324-0973 Investigation(1 hr min) 90.00/hr
Email:bsinner@fivestarelectric.org Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 158231 Electrical Lic.: 34-665C Suprv.Lic.: 5245S specifically listed(4 hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PER10hT FPS
" ��'. Subtotal: p4-ii.Di
Print name: Eric Gerdes / I Date: 0 Plan Review Required(25%of permit fee): 31P , 51
`` -- State surcharge T 2Lo ofRMIT fee): (1. Sy
Authorized signature: 4 TOTAL PERMIT FEE: a00
Print name: This permit application expires If a permit is not obtained within 180
Date: days after it has been accepted as complete.
° Number of inspections allowed per permit.
1:1Buading\Permits\ELC_PermilApp_ELR_ERE.doe Rev 06/17/2015 440.4615T(I1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE'
Fee for all residential systems combined: $75.00
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva n=less 100.70 2
5.01 to 15 kva 133.56 2
Audio and Stereo Systems* 15.01 to 25 kva
200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 I 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
Zi Other: Each additional inspection is
charged at an hourly(1 hr min) 6625/hr I
Inspections for which no fee is
90CQ RPIAL WORK ONLY _specifically r
Ifically listed('/�hr min) OD/h
. d. _�_,., . .., .. , : F41rClttC�./'FzHAII'!;EE)~4:,
Fee for each commercial system: $75.00 subtotal(Enter on rage 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n C• lock Systems
n D• ata Telecommunication Installation
ri F• ire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
rgt Protective Signaling °tW/O-1"D(S
❑ Other:
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
P.\BuildingiPermits\ELC_PermiIApp_ELR_EKE.doc Rev 06/17/2015