Permit m ELECTRICAL PERMIT
4 CITY OF TIGARD �;� COMMUNITY DEVELOPMENT Permit #: ELC2010 -00325
Date Issued: 07/27/2010
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S110BC00900
Jurisdiction: TIG
Site address: 12475 SW BULL MOUNTAIN RD
Subdivision: Lot:
Project: Tigard 10 MG Reservoir Transfer Pump Station
Project Description: Modifications to existing facilities and new pumping building.
Owner: FEES
TIGARD WATER DEPT. Quantity Description Date Amount
8777 SW BURNHAM ST
TIGARD, OR 97223 3 ea Services or Feeders - 200 07/27/2010 $302.10
amps or less
PHONE: 639 -4171 395 6 ea Services or Feeders - 201 to 07/27/2010 $801.36
400 amps
3 ea Services or Feeders - 601 to 07/27/2010 $903.12
Contractor: 1000 amps
BENTON ELECTRIC INC 2 ea Services or Feeders - Over 07/27/2010 $1,104.52
34037 EXCOR ROAD SW 1000 amps or volts
ALBANY, OR 97321 26 crt Branch Circuits w /Purchase 07/27/2010 $192.92
PHONE: 541 - 967 -1244 Service or Feeder
FAX: 541-967-8257 1 ea Signal circuit or Limited 07/27/2010 $75.00
Energy Panel
1 ea Plan Review Electricial 07/27/2010 $844.76
1 ea 12% State Surcharge - 07/27/2010 $405.48
Electrical
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $4,629.26
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 • "' 2- 001 -0100. You,- - • r • rules o ect questions to OUNC by calling 503.246.6699 . 00.332.2344.
Issued By: — =� Permittee Signature: A
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.
This form is recognized by most Building Departments in the Tri- County area for transmitting information.
.Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
BUILDING DIVISION
TIGARD TRANSMITTAL LETTER
a
TO: �. �'�� DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIVED
MAY 1 3 2011
FROM: I Po V t S CITY OF TIGARD
COMPANY: 'i3 6 CA-k e-1 C i fv BUILDING DIVISION
PHONE: 51 1- 9 3 b 5 (--) By:
RE: \2 - 1 5 SUl R LC-90/0 —C-b
ite • t tress (Permit/Case Number)
l l 64-i & e V U j f r Cd4 l i j' )
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
X_ Additional set(s) of plans. Z Revisions: i< I +
Cross section(s) and details. Wall bracing and /or lateral analysis.
Floor /roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other (explain):
REMARKS: F you_A C to,% c7.47hD ,51 !v / I /
FOR OFFICE USE ONLY
Routed to Perm' echnician: Date: Initials: •
Fees Due: M Yes ❑ No Fee Description: J4 t- c ap ,-e j < ,3 Amount Due:
$
Special l8''t It
Instructions:
Reprint Permit (per PE): ❑ Yes No one
Applicant Notified: j 5 Date: 5/201 Initials: 4 7-
1: \Building\ Forms \TransmittalLetter - Revisions.doc 4/4/07
Electrical Permit Application ii p. p y ,-
N m• City of Tigard
q 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 JUN 2 9 •
1-CPAIFO Receive i A A / /.. , .,,,--
1 :, !! 'S.; ..., ,. Date/B : CO 01 WO l 4,, )49
2010 Plan Review
Date/By: UV
1 I Permit No.: cL 04,0(0-‘ C.T...)
2 I rt Other Permit: jek t eteleolr
TIGARD
Inspection Line: 503.639.4175 .. Date Ready/By: J A Juris. El See Page 2 for
A ,II
Internet: www.tigard-or.gov
CITY OF TlitARD Notified/Methoe7 0 2, 4 v •
A - ---, Supplemental Information
tiPE,C4' r) ISIdil ' - :- . ' ,: -:- PLAN REVIEW
Z New construction 0 Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
El Service or feeder 400 amps or more 0 Building over three stories.
El Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION ',' ; - -; - - .: , ,- = exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
El 1- and 2-family dwelling Ei Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder ' 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
larger separately derived system.
JOB SITE , AND LOCATION ' " ' — ' ' " - 0 Addition of new motor load of
Job no.: Job site address: 12475 SW Bull Mountain RD IOOHP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal
Suite/bldg./apt. no.: Project name: Tigard IOMG Reservoir Imp 0 Service or feeder 600 amps or more.
OE"':$004JW
Cross street/directions to job site: North East corner of Bull Mountain RD Description 1 Qty. 1 Fes. 1 Total 1 *
New residential single- or multi-family dwelling unit.
And SW 125 street in Tigard Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 t
Tax map/parcel no.: Limited energy, residential
67.84 2
''' . ::':- .:-...' ,. ',.:.:, >:- : ' ': .,ir , : .: (with above sq. ft )
Limited energy, multi-family
67.84 2
Modifications existing facilities and new pumping building residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 3 100.70 302u 10 2
la;VROPERTY 'OWNER' , --.. ',' ,- , I, . ' x - .0-: TENANT : ' ■.,.,',' '' 201 amps to 400 amps & 133.56 et 2
401 amps to 600 amps 200.34 2
Name: City of Tigard
601 amps to 1,000 amps 3 301.04 403. It 2
' ddress: 13125 SW Hall Blvd. Over 1,000 amps or volts 2 552.26 1104.st 2
Temporary services or feeders installation, alteration, and/or
,:ity/State/ZIP: Tigard, OR 97223 relocation
Phone: (503)639-4171 Fax: ( ) 200 amps or less 59.36 1 ,
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I 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.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
-- g-,mitii;itAst'.;; - :, ,, =',':',:' ' ' '-' 1' ! , '::' ' / 0 . CON:t AO' PERSON '•;:' ' -'' ' above service or feeder fee, zip
7.42 192.9 2 2
each branch circuit
Business name: Benton Electric, Inc. B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: Travis Sheffield branch circuit . .
Each add'I branch circuit 7.42 2
Address: 34037 Excor RD Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: Albany, OR 97321 dwelling, service and/or feeder 67.84 2
Phone: (541) 967 Fax: : (541) 967 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E travis@bentonelectric.com Sign or outline lighting 67.84 2
.";. ' PNTIACT , • --. :.'.. - - • '.:- ' • Signal circuit(s) or limited-energy i —
Business name: Benton Electric, Inc.
panel, alteration, or extension. I Page 2 15- 2
Each additional inspection over allowable in any of the above
Address;...ftentan gyai 2 " ieb Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Albany, OR 97321
Industrial plant (I hr min) 78.18/ hr
Phone: (9I ) 967-1244 Fax: (541) 967-8257 Inspections for which no fee is 90.
/ CCB Lic 4213
7 00/ hr
.:
Suprv. Electrician signature, required: specifically listed CA hr min)
..7 Electrical Lic.: 22-84C .-"Supry Suprv. Lic.: 2067S i,/ ; ,',.':', , ,;1.:1';':!!.: : :- ELEORICALIFERMIrEEES::''
Subtotal: 331 9.02.
. Plan review (25% of permit fee): 81.14. 16
tint name: Jerry Sheffield ...0 OP / '' Date: 6/25/2010 State surcharge (12% of permit fee): 4 05, ii
41010r / TOTAL PERMIT FEE: LiL24. a
Authorized signature: This permit application expires if a permit is not obtained within 180
_
D ate: after it has been accepted as complete.
Print name: Tr Sheffield Date: 6/25/2010 * Number of inspections allowed per permit.
IABuilding\Pennits \ELC-PertnitApp doc 10/01/09 440-4615T(11/05/COM/WEB
W 6:6,9777e....
Electrical Permit Application °°f Oa n1 1 ic.1 t t
Received
City of Tigard Date/B : Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
.� Il ` Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
I' 1 G A it D Inspection Line: 503.639.4175 Date Ready/By: Iuris. ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental lnformation
. • ` - .TYPE OF WORK . ' • _ PLAN REVIEW. . • .
❑ Addition / alteration/ replacement
❑ New construction 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 1ooHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
' FEE SCHEDULE •
Cross street/directions to job site: Description 1 Qtv. 1 Fee. 1 Total 1 *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
. DESCRIPTION OF WORK • • - . . , - • • (with above sq. ft.) . 67.84 2
Limited energy, multi - family 67.84 2
residential (with above sq. ft.)
Services or feeder installation, alteration, and/or relocation
200 amps or less \ \100.70 2
, ❑ PROPERTY OWNER . •❑ ,TENANT YI ' 201 amps to 400 amps 1 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 ampfl 3 301.04 2
Address: Over 1,000 amps or volts -I • 2,, 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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
Owner si nature: Date: Branch circuits — new, alteration, or extension, per panel
g A. Fee for branch circuits with
• ❑ - APPLICANT . I - ❑ CONTACT" PERSON • above service or feeder fee, 26 7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'I 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
Business name: Signal circuit(s) or limited- 4
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 66.25
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour . 78.18
• : .' 1 1 ELECTRICAL PERMIT, FEES :.-
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days 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*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
.COMMERCIAL WORK ONLY: • -
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
In Other o01J1(toL C.1(4.G% 1 'T$
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 10/01/09