Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
Permit it: ELC2012 00545
Date Issued: 09/19/2012
T l (3 ARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Parcel: 2S1136000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Project: DURHAM AWWTF Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Install (8) branch circuits and (4) low voltage for instrumentation
Contractor: LIBERTY ELECTRIC LLC Owner: CLEAN WATER SERVICES
PO BOX 1681 ATTN: ACCOUNTS PAYABLE
CLACKAMAS, OR 97015 2550 SW HILLSBORO HWY
HILLSBORO, OR 97123
PHONE: 503 - 752 -6694 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 ea Limited Energy 09/19/2012 $300.00
Specifics:
8 crt Branch Circuits wo /Purchase 09/19/2012 $108.12
Service or Feeder
Type of Use: COM 1 ea 12% State Surcharge - 09/19/2012 $48.97
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $457.09
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 0 R 52 -001- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1 80000 332 23344
Issued By: i Permittee Signature: A f [ �N'1 W•w
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 the next available inspection date.
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.
. • s. .
From Brien Myers Fax: (603) 483-0860 . r z ,----,,_„„. 598-1960 ..:..: Pege; . of 3 5:05 .....:y. :;:. „._.: :. .....,,,.......,.,:_:,:...
• ' Electrical Permit Application j,;(: . ...,..„:„...:..,.._,.._....._:,...._ ..,....,
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1 .101? no : 1 Joh site address • 16060 SW 85 As e . ,_,
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1 Ci,y. Tigard, OR 97224 ' 0 Tle..4111-eAl.' fi..-,htics 0 Supra' ‘oltae ... fp, moi 3 ti I
1 0 ti.f.,,,1-,s I, II...I!, 600 , 11,!!': IIIMIII I
1 Suitt:411dg /apt. no.' ' Project name: Durham A WWII- 0 serssee in fcedci cal map, in mote 1
-,..::• -,•-•:, ,-, ' - ' - F - EF, SCHEDULE
I Cross Sli eel/direct 10 ' pi) Site: SW Durham Rd & SW 85' Ave i ..
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i 1 NC% residential single- or multi-family thsclling unit. I
I-- 1 j Includes attached garnge. :--
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1,,4.)os,i It cf. less 1 1GS 54
• 1 tilidiViNilln: I (ii no.. I !
' La. add 1.300 sci ft oi pomon 1402
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Fax map/parcel no.: Limited enern, residential
7.1,10 2 — .
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• " , I.,mtiod eneryy, ititilii-Tamik
75.00 I 2
I Install (3) 15A branch circuits, (3) 20A branch circuit and (4) 4-20mA 1 , residential (with above slit i__ ... ________
- --- -- 1 I Services or feeders installation, alteration, and/or relocation
1 instrument circuits ! 200 amps or less I 100 70 [2 I
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- ROPRT - WNEW:- - : : -- - - . .• • - '- .. - :TENANT.- • - -...- . - - . -01 . LnIPS to 40U fa ults I _,., 36
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I ' 4,11 amps to 60u amps 1 ,-• I 200 .34 2
Name: , •--'
. I _ _ _ 601 amps to 1,000 amps
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, I Address. Over 1.000 snips or volts ' _..„
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- Tverporttr■ son in., or tenlers installation. Aril •arot!. and/sr
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-, 200 amps or 1,3,; . i'. '•'6 I I i :
I hone. ( ) I " \ ( ) os I ' 25 I 1
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I ON% Ow ner installation: This installm ion is hcing made on propert■,' thal 1 o \i, n s' itch is not 201 amps to 400 am 1 08 1 '' . ----
-F1/1 ifillps 10 599 mops 1 I I or; )4 I 2 1
- I intended for sale. lease, rent. or - exchange. accordine to ORS 447. 449, 670. and 701.
Branch circuits- new, alteration, or extension, per panel 1
1 Owner 'sigrialoR ptite• A ra: cor !nand, :”...ttitS 11 to) [ i 1 21
_...__.. . , ..._ _ _______ V
abnfo scrvize or Icederf,:e. 1
's .0 . APPLICANT:: : " - • - --.. .- .. • 1=1 (..07.§.., i , PulsoNt." , I 742 i
_., . . . . . . each Nanch olcua 1 1 i 1
- Busulk.'s nante: 1i Ice for hnineli encluts ,, th To' i I
, SCCNICC to feeder f-,:e in st I 1 1 c6 18 , '
i6 i q
branch nni i ■
I Contact name: '_. i
Eac742 I '
t h add branch Lifted 7
I 1 I 1 21
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\ cldrc Nlisecilancou. (service ni feedef not included) -----,
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OmState/ZIP' ----- - ------------- Each in anufacm r or n
ed iodu lx
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67 84 84 I - 1
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, . dv.elliiiLser,icz nr,dtoi i;.•al,a I
Phone: ( ) lax: . ( ) ..1 RcC01111iXt 010' 87 6.1
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, Pump or irrigettos Lirclo 1 (,7S4 1 1 ,
F.-mail: I r 67 S4 I 2
Sign or outlin lighting
1
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'' - --..- . - ' : • — = - - - - "J- -(D 'IR, ACTPR •••:- •••••••:- -. '' " .. ''' ' --- ' " . -•:' " : :' Sifteal circint(s) or hmited-euel I's 1 , 1 .--- •
D _ - ,,_.. 300 00
1
• 13ttsineis name L panel. alteration, or esteima , :
iberty Electric, LLC age
I • , _ _ I ach JOditional inspection over allowable in in of the :thins_
! Address: P.O. Box 1681 I Adclitconal inspection ( I hr met) I ! 00.25/ hr
1-
I in) 1 1 f'r. 2s.I lirj
I Cit)!StatelLIP Clackamas, OR 97015 investigation i I lir m
Industnal plant i I hr toot) t , 78 I gi lu I
1
Phone (503) 752-6694 ! Fix: t ) Inspections for which no lee is I I
11 u 00.11tr '
, specificaliy listed tI mini I 1_ I
ceril.ic.: 196265 i .., I Electr Lie. 7 .846 i Sopre. I Ie.: 5645S
il--------3-1-M4-Pr— / o b ( I> _ — suni3O111 4 08 12
i Suprv. Electrician sianaturc. ft:muffed Y e Nan review (25% 01 permit lee}
I ---- _ ..........___
I Print ntn,:... lint it / { Date: 9/10/12 State sordlarvc ( I 7.n/f, of net in ii fee)* 48.07
TOTAL PERM11 TEE 45'.09
1 Authofized signnture: . I. • --1---6— ' 1 It lit rtnil npplicaliirii ektrire. if a pet lil , aro obi:lint:LI i‘ithstt NO
dos, Ara ii has urea mceptcd as complete.
•
I 1-'r nt mune; Jim Grohs . TDal :3: 9/10/12
- L .__J. • Nilinher Coh int•pccoens allowed Pei permit
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i'.6011111051'qrrovs\ Cll.-Mimi; 'tip dai fr,V0:110 440--lot 5ill :1051-0MAVEll
From: Brien Myers Fax: (503) 483-0860 To Fa: +1 t503) 598-1960 Page 2 of 3 9/1812012 5.05
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
- . •
Fee for all residential systems combined $75.00
Check Type of Work Involved:
Audio and Stereo Svstems*
LI Burglar Alarm
Li Garage Door Opener*
Li Heating, Ventilation and Air Conditioning System*
acuum Systems*
1 Other-
-- COMMERCIAL
.-„
fee for each commercial $75.00
system
C OAR 918-309-0000)
Check Type of Work Involved:
7 Audio and Stereo Systems
Boiler Controls
7 Clock Si.rstems
• L 1)at2 Telecommunication Installation
Fire Alarm lnstallatton
ri
HATAc
instrumentation
7 Intercom and livf, Systems
17_ 1 andsrape irrigation Control*
• Medical
Nut.,
ouLdt,0,- Landscape 1 .,,hi tr
LI Protectiye Signalini!
Olher
Toial lumber of commercial systems. I
*No licenses are required. Licenses are required
for all other installations
4.3,1(11_ C.Pc.rm:•Apr Ant fr:101:11,
• •