Permit &/1 /1
CITY OF TIGA ® ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00247
T(GA kti 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/20/2010
Parcel: 2S105DB00400
Jurisdiction: Tigard
Site address: 13425 SW 154TH AVE
Subdivision: Lot: 0
Project: City of Tigard - Menlor Reservoir
Project Description: (1) 201 -400 amp temporary service and (4) branch circuits. 5/28/10, changing temp service to
permanent service.
Owner: FEES
TIGARD WATER DISTRICT Quantity Description Date Amount
8777 SW BURNHAM ST, PO BOX 23000
TIGARD, OR 97223 1 ea Temp Services or Feeders - 05/20/2010 $125.08
201 to 400 amps
PHONE: 4 crt Branch Circuits w /Purchase 05/20/2010 $29.68
Service or Feeder
1 ea 12% State Surcharge - 05/20/2010 $18.57
Contractor: Electrical
BENTON ELECTRIC INC 8 da Electrical Permit 06/01/2010 $8.48
34037 EXCOR ROAD SW 1 da 12% State Surcharge - 06/01/2010 $1.02
ALBANY, OR 97321 Electrical
PHONE: 541 - 967 -1244
FAX: 541- 967 -8257
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $182.83
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 -- ordance • 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. • ENTION: Oregon , w r-- ires you to follow the rules adopted by the Oregon Utility Notifica - nter. Those rules are set forth in OAR
952 -0.1 -0010 through OAR 952 -0 -0100 Y7 'may obtain a copy of the rules or direct questions to OUNC by c- ' _4 1. r • •699 or 1.800.332.2344,
Iss ed By: C " Permittee Signa _ ' °147 r
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 ONL
..
SIGNATURE OF SUPR. ELEC' _-� t Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Ara'
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00247
Date Issued: 05/20/2010
TIGAFZD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S105DB00400
Jurisdiction: Tigard
Site address: 13425 SW 154TH AVE
Subdivision: Lot: 0
Project: City of Tigard - Menlor Reservoir
Project Description: (1) 201 -400 amp temporary service and (4) branch circuits.
Owner: FEES
TIGARD WATER DISTRICT Quantity Description Date Amount
8777 SW BURNHAM ST, PO BOX 23000 1 ea Temp Services or Feeders - 05/20/2010 $125.08
TIGARD, OR 97223 201 to 400 amps
PHONE: 4 crt Branch Circuits w /Purchase 05/20/2010 $29.68
Service or Feeder
1 ea 12% State Surcharge - 05/20/2010 $18.57
Contractor: Electrical
BENTON ELECTRIC INC
34037 EXCOR ROAD SW
ALBANY, OR 97321
PHONE: 541 - 967 -1244
FAX: 541- 967 -8257
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $173.33
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 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
Issued By: s ` r Permittee Signature: QA✓' 1pf _ r1 Zf e -e 27() N
,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 an inspection that business day.
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.
MAY -28 -2010 10:31A FROM: TO : 15035981960 P. 2/3
Electrical Permit Applicat` CEIVED I:oit 0FFK�h: tltil, ()Nil
City of Tigard r Received
` � g � DatrJB Permit No.: � , , L
e t 13125 SW Hall Blvd., Tigard, OR 972 IV 2 S L. . Plan Review
Phone: 503.639.4171 Fax: 503.598.1'9W Date /B : Other Permit:
' 16 A It a Inspection Line: 503.639.4175 .� OF ' r] C j AR� A� gale Ready /By: kris: ® See Page 2 for
Interact: www.ligard or.gov C� 1 g , I � I� Notiliicd /Method: Supplemental Information
"G . , h , .iP f J {� I1 r r fII lit !! I! 1( r n ;�u t��;u�u� ry,+ V IV.:', +t n ; . I; I :I" j ;
I. i. I i i!;ri.... i ! 111110 It l lW 31,1 111100 ` •Mr-1 1 �iiil�lt� I t ,.rr N i i 1 1 r d f 1. f t ; .•ii ., i .
,l i I J. i li - I t , t r' 'd irtl ! ,�• it t! o�!Ifi 1 ;, ,C
® New construction ❑ Addition /alteration /replacement Please check all that apply (submit a sets of plans w /items checked below).
❑ Service or feeder 400 omps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marina and boatyards.
`, I' alit / 9 1/11111111 II r:(n !4r I, 1 ,. n,,nr WNMIIi i t r .u,t ti �� `�1� •';rf'�' :' I• • ;, .• 1 • l .'1 t i ' i exceeds 10,000 amps at 150 volts or ❑ Floating buildings
;;; ii1 nq q '!1fi�(' 11pIi1 1 ' • (,�� � �l I M I I , �tftl� .'.' i hvt;,., }rI f {,P j',I,'�1,;:` 1 I Li
„IIt1 �;l,;It111B'�n,'.d(1, 1!i (, •f �dl'iirpT�lnuual iAG111tl i6, ^, �,;� �r>a , :..�' :ira+i;•r.. 11;1 i7,�.: �, :, hi;. {i,ode,
less to ground, or exceeds 14,000 ❑Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for nll olherinstallations. buildings
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
11 i114Pi g N I. n ' ' , .n , I '! i^ y i4 "' :Ili �1�; t' ❑ Emergency system, larger separately derived system.
I la w ar m nm , r i n i 8 Y Y
t� j + r.
jj li �4 s l li {(�� • I1 � R U I I'[i r h j ii i l ' 1 Nl l ` � 0 Addition of new motor land of ❑ "A" „ @•, "1 - 2" "I - 1 „
u�l.,tlt,lii ! �.11 :�1f ,!5;11 � �f�L� •l1lN,Ill,,l ➢Ilnlll���).11�1��' � a 1,P1 ��� �, (11 1- ,IIn�t�l,!'l� {, -`�: , 1 , 0
Job no.: Job site address: 13425 SW 154th 1 00fiP or more. occupancy.
❑ Six or more residentinl li ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, Oregon ❑ Health -core facilities. ❑ Supply vol!nge for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bid g' /a P t. no.: 1 Proj ect name: ❑ Service or feeder 600 amps or more lull}, Ir i II !f!!!If, ft!i! :,irfJilldT�lrll'� i !11 t'R P i 0#404t} , , Ill
9 1 ,� I( I IRi ii, 1
�'�l(i,,,ll,f
Cross street/directions to job site: Description I Qty. 1 Per. 1 Total I ' r
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: f Lot no.: 1,000 sq. R. or less 168.54 4
En, add'l 500 sq. R. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
t I1 i r it i i;1 i ' t ! !!! I! {,� i :q n i ^ K. n , 1 ' ' f ri li , i j H n i. i , 1 1 ' t ill R.)
67 84 2
iit t 1�, 1. I it i , 1, , o R' t , n 1 N a Q , 1! l
L.,. u, I' ' IJ ". r ll: i1,t I li ,11' r; 1„ 16 }!1. a.a u Ir +,,lli i rr..(t ' . (with above sq. Limited energy, multi- family
service for Mentor Reservoir �J't�'. C�j5wi-� P e( , residential (with above sq. R.) 67.84 2
_ Services or feeders installation and /or relocation
� fl 4n P j ) � p Rj1, oJ f e i L tie. - 200 amps or less 100.70 2
,
: !.! .l'tiiii�l f
l''i m ,A h e m �dl iiaEi i �' ` d 8 �il � � : ? „il ii i i . ' ioil g iil i;i I uN f • 1 0 ,1 1 ■ Ifs r'4 rr
'1 !l: ft i 'r ' , 1 ,; Ji 1, 1)4 201 amps to 400 amps 1 133.56 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
idress: Over 1,000 amps or volts 552 26 2
--- Temporary Temporary services or feeders installation, alteration, and /or
City /State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 1
201 amps to 400 amps 1 25.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps t 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, niteraliu, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
ti . a 1i A n i1 ... uu ', oboveserviceorfeederfee, 742 419".5r 2
i "�•' II l ai I 1�'''1 :'iii hl , (till I ll U Lh a 1'j „,i.11 ii'roll !i!,
' y ' r, ��te{ �{N, t. 'ai,., 1 11 { i, ;, 1 ,:r,.! I! ilu: each branch circuit !till, i! ��IanGr�uAl :�'"t;t;�tY.`CY�:i���albil�� .111 }��It�t�lui7LiiLLI� ,.
13. Fee for branch circuits without
Business name: service or feeder fee, first
56.18 2
branch circuit
Contact name: Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/Slate /Z1P: dwelling, service and /or feeder
Reconnect only 67.84 2
Phone: ( ) 1 Fax: : ( ) Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 07.84 2
• rr iG, 11! i i I Id , i 11! f;;,1t , IU ,1 „ n Signal circuit(s) o ener
1, ener gy
; 1 ! 1' i n1hl 1 . . 91 1.! }ni. I }11i N } rr i 1• i 111 l gn )
t,_ ,l, , I, I, ,r..1 ! (�' �1 } }1{ I 11 'i } panel, alteration, or extens Page 2 2
Business name: Benton Electric, inc. Each additional Inspection over allowable in any of the shov
Additional inspection (1 hr min) 66.25/ lir -
Address: 34037 Excor Road SW Investigation (I hr min) 66.25/
City /State /ZiP: Albany, OR 97321 Industrial plant (I hr min) 78 18 /hr
(
Phone: (541) 967 -1244
1 F ax: (541) 967 -8257 Inspections for which no fee is 90.00 / hr
s.ecificall listed %hr min
CCB : 4213 4 Electric 1 Lic.: 22.84C i Suprv. Lic.: 2067S ' ,1,' d 1;)'il,,ii,1 'I-;i7 Uir(111R1, ' A.I ' ::�G.', M `�i 'i ff.§ ' ;
Lic. Subtotal:
. . Electrician signature, requir Plan review (25% of permit fee):
4 e: 5 - - Statesurcharge(12%ofpermitfee): W571
-- Print name: Gerald O. Sheffield TOTAL PERMIT FEE: -i'2'8-
Authorized signature: 'this permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 1 Date: • Number of inspections allowed per permit
440 1 I/OS/COM/WEB
1 l8uitd i na\P ermits1ELC •Permit App
Aoc 10101/09
MAY -19 -2010 03:12P FROM: TO: 15035981960 P. 1/2
Electrical Permit -N ; lc, ilNI FOR orrlc'I: 1I SF. ONLY of Ti I' Received • • �c R OI
t 5 �' t t --1 Date/B : / /
° 13125 SW HMI Blvd., q R 7 10 p .X/11 �- Plan Review i a
g Phone 503.639 4171 503 59R 19! Date/13 • Other Permi ' �t1/ • -�.O�- j 16.
I C. A It 1)
Inspection Line. 503.639.4 7 TlGAF a9 i u Date Ready/By: la See Page: for
Internet. www.ligar Notifi ed/Method. Supplemental Information
���� • c • p p015
l l ,1 IIaaltI I d ..t Uhl t 'm{ �g� y 1.1 ! �yi ,frill ll,. -. I P!, ' i ' I�( ' llll+;l'l l' q{ . y a Y\ 1 : .�, �' ii
�ry II !j ,lj'1 j 1 11 ! 1 I 1 y 'Ml, . f 7 I , i r11 !' 1 : 'I 1i , ! t I� �,�+ G O!' ;,
!it.1i� �3sw.1ti.�,,.. - s:q�,,� M111$itil!� . 151 L ,,u�C!:M��I,a., I�if�.,., 111 1, i ,1, ,.�•!I ?. :."f�di".11,. 4 ��'��, L � I...,�I}llj
® New constnietion ❑ Addition /alteration /replacement Please check all that apply (submit 1 sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the ;wadable fault current ❑ Marinas and boatyards
• � i , 'I { ` , 'I l 1 l(j l i l I l'' 214 1. ; rl ' i i ., li" 'aN exceeds 10,000 amps at 150 volts or 1:1 Floating buildings.
I . }� ; ' � I 'S . ?.1 � t ' ..: � � i � Ulf a U, 1 , . 1 , . I' �
. � 1 i 1, r t' J ,a
less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire p ❑ Installation of 75 KVA or
u � 1 ,. I ,, .. ,r ; •r,, n:.' ❑ Emergency system. larger separately derived system.
1�
91 1j hh'I4U Si It IA'1'ION A • 1.011 11 , l •r#k;i l , I . I „; p , itl I ���f� iii }. , i i d11 ��N{ •�1 r • Il ,t� ."'yn'. � t .z., � ii,f�a5� ❑Addition of new motor load of ❑ "A” "E" "I.2" "I.3"
i001-1P of more occupancy
Job no Job site address: 13425 SW 154th Recreational vehicle arks.
❑ Six or more residential writs. ❑ P
❑ Health -care facilities. ❑ Supply vol for more than
City /State /ZIP: Tigard, Oregon ❑ Hazardous locations 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Mentor Reservoir ❑ Service or feeder 600 amps or more IICJ
1 1i;`; it l !�Il'G
1 1 . 'I,t,;li!1011Ilii'I' 1 fl . 11.4110 lti „ yl J I TI!
Cross street/directions to job site: aeon flan t'E'ii�i17 ,� •
New residential single- or multi- family dwelling Unit.
includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R. or less 168,54 4
Ea. add'/ 500 sq. R or portion 33.92 1
•1 ax map /parcel no.: �{p Li energy, residential ::: i' 1 1 ' 1 dill 1 1 t'i ats; OR WORh;, i i;. Jr ; of iudy Limited energy, multi - family 2
temporary service for Mentor Reservoir
residential with above s.. R. _
Services or !ceders Instnllntion /or relocation
200 amps or less 100.70 2
, t j . , l } ;c;i : �� 1 m , i a sl ,'ppt' 1 1 l d !hI�I 201 nm s s 133.56 2
` y 1P Ucd.1i Gthi to 400 amps P
n. .i' (l�tllt: I �').:,.. , a, � d = 1::: 401 amps to 600 amps 200.34 2
Name: City of Tigard 601 amps to 1,000 amps 301.04 2
!dress: 13125 SW Hall Blvd. over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
- City /State /ZIP: Tigard, Oregon relocation
200 amps or less 59.36 1
Phone: ( ) Fa ( )
201 amps to 400 amps I 125.08 125.08 2
Owner installation: This installation is being made on property that 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. idrnnch circuits - flew, alteration, or extension, er panel
Owner signature Date: A, Fee for branch circuits with
above service or feeder fee, 4 7 42 29 68 2
_ i 'l ' hl;il�'i 4 •[�'In141'I 1' ❑ CO AG pi,1 Rl3„ Q i }Ir! 11 • r r; each branch circuit
B. Fee for branch circuits without
Business name: service or feeder fee, first 56.18 2
branch circuit
Contact name: each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Reconnect only 67.84 2
Phone: ( ) �h' ' ( ) Pump or irrigation circle 67.84 2
E - mail: �, Sign or outline lighting 67.84 2
� j ;. i 7,: ;' ;. „ itift• .,1,,',I'P N'I'RA(1'OR • 'Il;;iiltiift;., 1 ,'.`a`rtj , ''.1i:F - i�l t?tl;l Signal circuit(s) or limited-energy in panel, alteration, or extension. Page 2 2
Business name: Benton Electric, Inc. Each additional inspection over allowable in any of the abov
-
Address: 34037 Excor Road SW Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State/ZIP: Albany, OR 97321 Industrial plant (1 hr min) 78.18/ hr ,
541 967 - 8257 Inspections for which no fee is 90 00/ hr
r )one: (541) 967 - 1244 Fax: _. ( ) s ccficall listed h hr min
ti 1C $u rv. Lic.: 2067S , t ' ,:i! : :I SIRI , ' ° 1 4Sltij }!Ut)i�a4zS JB 'Y �•�1 ; i i t1 ''I ill • / V CCB Lic.: 4213 electrical Lic.: 22 .'- P Subtotal!
Jr
ifr �uprv. Electrician signature, require• i / iJL'J” iL�.L� Plan review (25 % of permit fee): 0
v. - _
Date: May 1 ' ; X 010 State surcharge (12 % of permit fee):
lnt name: Gerald O. Sheffield I. TOTAL PERMIT FEE: . 1911111 '
This permit application expires If a permit is not obtained within I80
Authorized signature: This after it has been accepted as complete. q 3_1
J [ - �
Print name: Date: • Number of inspections allowed per permit. } '
440 -461 ST(I I /OS /COM/WEB
p,WuitdingTermits\ELC- Permi1App doc 10/01 /09