Permit rIcg:Wg.ta ELECTRICAL PERMIT
a
CITY OF TIGARD
`1, COMMUNITY DEVELOPMENT Permit #: ELC2009 -00578
�T tGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 10/29/2009
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Subdivision: SEWER TREATMENT PLANT Lot: 0
Project: Clean Water Services - SOLV
Project Description: Installation of (2) solar PV panels.
Owner: FEES
CLEAN WATER SERVICES Quantity Description Date Amount
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 1 ea Services or Feeders - 200 10/29/2009 $100.70
amps or less
PHONE: 503 - 681 -3633 1 crt Branch Circuits w /Purchase 10/29/2009 $7.42
Service or Feeder
1 ea Signal circuit or Limited 10/29/2009 $67.84
Contractor: Energy Panel
PACIFIC NORTHWEST ELECTRIC INC 1 ea 12% State Surcharge - 10/29/2009 $21.12
PO BOX 310 Electrical
OREGON CITY, OR 97045
PHONE: 503- 657 -1188
FAX: 503- 722 -9058
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $197.08
Required Items and Reports (Conditions)
This permit is sued subj... to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i accordance with a• •roved 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 la. , •ui -• you to follow the rules adopted by the Oregon Utility No to Center. Those rules are set forth in OAR
952 -00 0010 through OAR 95 •. -01 r Y•u may obtain a copy of the rules or direct questions to QUN _ = - u! • 99 or 1.800.332. 344.
Iss ed By: • L �u Permittee Signa u /` —__ 4/ ifi 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 ONLY
SIGNATURE OF SUPR. ELEC' ,e Y Date: /0 josk9t 9
LICENSE NO. p 9
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.
Electrical Permit Application - ' ,, ''7 l c)�iz "oFFi 11 S t ; Al
City of Tigard DateB Received
a � 019 of
MI Permit No.:e , I'9 ec578
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
- 1 Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
1 1 A It D' Inspection Line: 503.639.4175 Date Ready/By: riliM CO See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ 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 OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
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 pump. ❑ Installation of 75 KVA or
/( /- ❑ Emergency system. larger separately derived system.
6230 JOB SITE .INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "I - ",
Job no.: Job site address: �( Six or or more. occupancy.
�C��'' �� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 5a,,'d f Oa 9,7Z- (� ❑ Haz r dour fcatilocations. ❑ 600 . ly
lar nominal.
Suite /bldg. /apt. no.: Project name: ! eo t,.,c T ce f"Ui c, S ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total [ •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
D Limited energy, multi - family 67.84 2
a_Sara r f J ! �. Nf i S residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocati n
200 amps or less ! 100.70 /W . 2
❑. PROPERTY OWNER I ❑ TENANT , 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
C L ow U,Ic so.c, ZeA . Re+3- (t.� t ('e 601 amps to 1,000 amps 301.04 2
Address: /6 . . ,gYL ( p c Over 1,000 amps or volts 552.26 2
City /State /ZIP: rw Temporary services or feeders installation, alteration, and /or
- ' O 9 �ar Y relocation
Phone: (S ) /' s ,.. ' , 3 Fax: ( ) 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
❑ APPLICANT . ❑ CONTACT PERSON above service or feeder fee, i 7.42 49- 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name:
first branch circuit 56.18 2
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
, f+ Signal circuit(s) or limited -
Business name: c. . �t c_. A ti , e energy panel, alteration, or
Address: P,0 � eoc Flo extension. Describe: f Page 2 41.47 tL
2
City/State/ZIP: -I/� 97cg Each additional inspection over allowable in any of the above
a ,A) C t `ii / Per inspection 66.25
Phone: (9„3) v /` 7 . _ `l s Ex 1 I Fax: 3) 722-S Investigation per hour (1 hr min) 66.25
CCB Lic.: I n K Electrical Lic.: c 6 Suprv. Lic.: 8'c s Industrial plant per hour 78.18
6 1 tj / ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: (�_ C 5,-- Subtotal: / 75 -9p
Print name: �� Date: � G Plan review (25 % of permit fee):
�Q t-t. C ► t+- C' /o °L 7 'O / State surcharge (12% of permit fee): / ",
Authorized signature: TOTAL PERMIT FEE: 19 Z Qg
This application expires if a permit is not obtained within 180
Print name: � Date: 0 5 — O C s permit
after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
• RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n A • udio and Stereo Systems
n Boiler Controls . . .
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n P • rotective Signaling
n O ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC- PermitApp.doc 10/01/09