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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00665 • DEVELOPMENT SERVICES DATE ISSUED: 9/9/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2 S 113 B0 - 00600 SITE ADDRESS: 16580 SW 85TH AVE ZONING: I - SUBDIVISION: SEWER TREATMENT PLANT LOT : JURISDICTION: TIG Project Description: Temp service. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 1 PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: CLEAN WATER SERVICES OREGON ELECTRIC CONST /GROUP 2550 SW HILLSBORO HWY 1010 SE 11TH AVE HILLSBORO, OR -9379 PORTLAND, OR 97214 Phone: 503 - 681 -3600 Phone: 503 - 234 -9900 FEES Reg #: LIC 203 SUP 4460S Description Date Amount ELE 26 - 95C [ELPRMT] ELC Permit 9/9/2005 $80.30 [TAX] 8% State Surcharge 9/9/2005 $6.42 REQUIRED ITEMS AND REPORTS Total $86.72 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, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503 - 246 -6699 or 1- 80 -2344. 4ft4 Issued By: � i1 /w Permittee Signature: /94( 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. - Electrical Permit Application C � FOR of Flcl t sr_ ON Ll • !�"7 City of Tigard ���I �1 C1 Da aeyd — r'j �� P No. : °( ...C2 KJ 0) 6 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 (� *. a *� Date/By: Other Permit: ��� 0 20 Inspection Line: 503.639.4175 ;, '� �_. Date Ready/By: turis: 0 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: j I ( Supplemental Information TY L } t VI PLAN REVIEW f Pleas check all that apply: ❑ New construction Ad . 13 0 erat PP y' ❑Service over 225 amps, comm'l ['Hazardous location ❑ Demolition ❑ Other: ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION . of 1- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑ Multi - family ❑ Master builder JV Other:/EA/Ot//A 024 ['Building over three stories ['Feeders, 400 amps or more ❑Occupant load over 99 persons ❑ Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑ Egress/lightingplan RV park Job no.: 059,..- I Job site address: / 6 �" � a- Qt/ ❑Health -care facility ❑fie': ! , Submit 2 sets of plans with any of the above. City /State/ZIP: - 776AzD o2 77224 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: I Project name: ©✓(,' 4 "4 ( O7 P FEE* SCHEDULE Description FEE* Qty. I Fee. I Total I ** Cross street/directions to job site: New residential single- or multi -family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less / 80.30 80,30 2 Al PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: el.-Ad 4 ,- cE G.« 601 amps to 1,000 amps 240.60 2 Address: /(x0 640 S 4) gs'' KY� Over 1,000 amps or volts 454.65 2 O � (� 9 .2 } Teat only 66.85 2 City / State/ZIP: 77044,0 Temporary services or feeders installation, alteration, and/or relocation Phone: () 7 8, 7J C I Fax: ( ) 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 600 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel ❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'l branch circuit 6.65 2 City /State/ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 - Phone: ( 1 I Fax: : ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: Oregon Electric Group Address: 1010 SE 11th Ave Each additional inspection over allowable in any of the above Per inspection 62.50 City /State/ZIP: Portland, OR 97214 Investigation per hour (1 hr min) 62.50 Phone: (503) 234-9900 I Fax: (503) 535 -2763 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: 203 I Electrical c.: 26 -95C I Suprv. Lic..„,446 VWS Subtotal 80,3 Suprv. Electrician signature, required 4 9 )4 Plan review (25% of permit fee) t Print name:6i Q d ow A G�[/� JJ��!!��"�� DateS r was- State surcharge (8% of permit fee) 6, f�2 �eR'�.� V l'/ w w TOTAL PERMIT FEE s6 ,7 Z Authorized signature: This permit application expires if a permit is not Obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. CITY OF TIGARD BUILDING DIVISION PERMIT #: EkcZ00S_OOw:s— 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 9. 3` , 0 5 - TIME: PAGE: SITE ADDRESS: 1 SO si;S" p1/4v • CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message VG\ r. t. ..--c.— - Corrections /Comments /Instructions: PAS n PARTIAL APPROVAL n CANCEL n NO ACCESS I FAIL [ ( CALL FOR INSPECTION ADDITIONAL FEES ASSESSED 3 Inspector: Date: Phone #: (503) 718 - 1. -'1Llic,