Permit Y
INI �� ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00296
41"RD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/17/2008
PARCEL: 2S 11380 -00600
SITE ADDRESS: 16580 SW 85TH AVE ZONING: I -P
SUBDIVISION: SEWER TREATMENT PLANT LOT: JURISDICTION: TIG
PROJECT: CLEAN WATER SERVICES
Project Description: Install low voltage of radio amplifier. Located in new building southwest of 85th Ave.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: RADIO AMPL X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
CLEAN WATER SERVICES DAY WIRELESS SYSTEMS
2550 SW HILLSBORO HWY 234 NW 14TH
HILLSBORO, OR 97123 -9379 PORTLAND, OR 97209
Phone: 503- 681 -3600 Contact #: PRI 503 -228 -9292
FAX 503- 228 -2439
FEES Reg #: ELE 3- 356CLE
LIC 64950
Description Date Amount
[ELPRMT] ELR Permit 10/17/200E $75.00
[TAX] 12% State Surch 10/17/200€ $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, o ' -issuspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility ification Center: Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules r direct questions to 0 1 C - 03.246.6699 or 1.800.332.2344. `
r<
Issu d By: ,4 i (1/A1 Permittee Signature: AA& A r
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
L
, 1 .t ', ) o i t r ,:Fig I NH4�i � ^rt FOR
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,Flecflrical Permit App • u �,, ;, . ,4, a ' r;�p U SE 0NLy: 1 * =1'r
* A. 1 . 451,f x,4dt`,2i vl40 ��F,,: ,“,- ,5i$ �7srJii4;1'�,�4� .+ct..,�'Fi9sP2 4N . : �P��f4:PI::*�^('..*: . ,vt �' •
4•'', t v Received �� Perm No..
City of Tigard i Date /By (a �� • ''''al a ° 13125 SW Hall Blvd., Tigard, OR 97223 I C a l '' Plan Review
$ 7 Phone: 503.639.4171 Fax: 503.598.1 960 ® Date /By Other Permit:
( I G A R D Inspection Line: 503.639.4175 �'e� A �V Date Ready /By WI See Page 2 for
L1 1ra41 ::nAw. • Internet: www.tigard or.gov G,� ® 0ISI® Notified/Method: 1 Supplemental Information
TYP.i��1�ltlr 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 Found or exceeds 14,000 ❑ Commercial -use agicultural
❑ 1- and 2- family dwelling Et't�ommercial /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.
JOB SITE INFORMATION AND "LOCATION ., ' ❑ Addition of new motor load of ❑ "A ", "E "I- 2","I -3",
Job no.: Job site address: I// (�J� a IOOHP or more. occupancy.
K1 S �d S 5 0 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: r ❑ Health -care facilities. ❑ Supply voltage for more than
1) to b o R. `7 7 a y 0 Hazardous loc ations. 600 volts nominal.
_� ���ttt I
Suite /bldg. /apt. no.: �1d6 Project name: a, _ I t/ect /OI✓�*t ( /4yu/If, 6 ❑ Service or feeder 600 amps or more.
• _ �'• FEE SCHEDULE . '
'
Cross street /directions to job site: Description 1 Qtr. 1 Fee. 1 Total I *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add] 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
�
^ DESCRIPTION OF WORK , (with above sq. 6.)
it 1 I 21- d( n0 / v 4 /4/4- fg/i - f e• ` ,� )Cj Limited energy, (with with ab s . ft above multi-family
J g / Y R. ) 75.00 2
10 S Services or feeders installation, a lteration, and/or relocation
Ati— b , � � 1d M 72a �` o 6..i Ifl . & 0 NM (,A) /C�(vy S 200 amps or less 80.30 2
1� trROPERTY OWNER • . ❑, TENANT - 201 amps to 400 amps 106.85 2
Name: CL £ W�eoe. f S 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: /6 ,5� St 0/ � 5 , Over 1,000 amps or volts 454.65 2
City /State /ZIP: i / 2 . Temporary services or feeders installation, alteration, and /or
relocation
Phone: (S63 ) 6s/ .34C/? Fax: ( )/... t J(, 37 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑, APPLICANT -' I; ❑ 'CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name:
first branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR . Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: 7 I F (aRi . s ytn c ,) / energy panel, alteration, or ��
Address: a 3 I !!� Vim, I q� ex io cri]� Page 2 �J' 2
City /State /ZIP: ' 6 R 1 �Gg-� R. • 5 '7 0 9 Eac additional inspection over allowable in any of the above
` / l/ �j Per inspection 62.50
Phone: (so3) �a c12 2 '
Fax: ( o3) as 8' di 3 / Investigation per hour ( hr min) 62.50
CCB Lic.: 4/ 9 S a Electrical Lic.: �C+� //._ Suprv. Li .: /3 X11 Industrial plant per hour 73.75
//S //II 3 � , t if ELECTRICAL PERMIT FEES:
Suprv. Electrician S'gtl2t , require' 1 /N � a v J Subtotal: 7 •
Print name: �,ln�, 1 ,¢ // Date:/6/6- e Plan review (25% fee):
�X/ �/ State surcharge (12% of permit fee): 91. ®I
Authorized signature: TOTAL PERMf1' FEE: Q , QQ
This permit application expires if a permit is not obtained within 180
Print name: R I � Date: , p f r c ( C7 $ days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ Building \Permits\ELC - PermitApp.doc 05/23/06 440- 4615T(1I /05 /COM /WEB
- 1// --
CITY OF TIGARD
BUILDING DIVISION
A PERMIT #: wows 09296
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/11/2000
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/7/2006 TIME: 7:02AM PAGE: 28
SITE ADDRESS: 16680 SW 85TH AVE CLASS OF WORK:
SUBDIVISION: SEW:LP TREATMENT PLANT LOT #: TYPE OF USE:
PROJECT NAME: CLEAN WATER SERVICES
DESCRIPTION: Install low voltage of radio amplifier. Located in new building southwest of 8th Ave.
OWNER: CLEAN WATER SERVICES, PHONE #: 603
CONTRACTOR: DAY WIRELESS SYSTEMS PHONE #: ED3-228-9292
Inspection Request Scheduled For: Date: 1117/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Lovv voltage 077810-01 503-519-5897 N
IN
Corrections/Comments I T1 structions:
C H. 0 v-4\( te r()_INAV 6
■
a
1 i ra P A S • ' El PARTIAL APPROVAL 0 CANCEL 1 1 NO ACCESS
fl FAIL D CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
‘0
Inspector: ---. NQ (1 Lt : Date: ii, Vil Phone #: (503) 718- ALth