Permit .CITY OF TIGARD ELECTRICAL PERMIT
° '� P ERMIT #: ELC2006 -00736
COMMUNITY DEVELOPMENT
DATE ISSUED: 12/27/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S1 13 B0 - 00600
SITE ADDRESS: 16580 SW 85TH AVE ZONING: I -
SUBDIVISION: SEWER TREATMENT PLANT LOT : JURISDICTION: TIG
Project Description: (1) branch circuit for wiring for conference room in Administration Building.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 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: 1 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 SCHULZ ELECTRIC CO
2550 SW HILLSBORO HWY 447 NE 18TH AVE
HILLSBORO, OR 97123 -9379 HILLSBORO, OR 97124
Phone: 503 - 681 -3600 Contact #: PRI 640 - 3304
FEES
Description Date Amount Reg #: ELE 34 -309C
[ELPRMT] ELC Permit 12/27/200( $46.85 LIC 81488
[TAX] 8% State Surcharge 12/27/200( $3.75 SUP 3541S
Total $50.60 REQUIRED ITEMS AND REPORTS
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 th.. _ ! .4ys. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notifi - Center. Those rules are set forth in
OM C- • 52- 001- 0010't rough OAR : " !O -1100. You may obtain copies of these rules or direct questions to • 4 - t 503.246.6 or 1.800.332.2344.
Iss ed By: ) 0i .�(] / 11 A / Permittee Signature: 4 , ' eike. / ely. . . _
,
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:
6 • NTRACTOR I STAL TION ONLY
SIGNATURE OF SUPR. ELEC'N: f/ _ � .d .,4 ... .._ DATE: 0/
LICENSE NO: 3S /
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 Applicatio l 1.� r01( OFFICE USE ONIN •
`' City of Tiger Permit No.: d • 7 0
° 13125 SW Hall Blvd., Tigard, OR 9 23D 2 0 2001 Plan Review
' Phone: 503.639.4171 Fax: 503.598. ' .1 Date/13 . (kha Permit
TI G n I: D Inspection Line: 503.639.4175 : ' OF Ti 'AR :Ii Date Ready/By Jwis: ® See Page 2 for
Internet: www.tigard- or.gov BUILt. NG or s N Notified/Methcd Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 0 Addition /alteration/ replacement Please check all that apply (submit 2 sets of plans wfrtems checked below):
❑ Savior 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.
❑ 1- and 2- family dwelling OCommercial/industrial ❑ Accessor buildin less to ground or exceeds 14,000 ❑ Comme
-use agricultural
Y g 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", "1 -2 ", "1 -3 ",
•
Job no.: 1 Job site address: /( /6,5e0 S 2 , o , 100HPormore. oaupa cy.
8.7 I/[� 0 err more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: �2 e7 ❑ Health-care facilities. ❑ Supply voltage for more than
77 TrTtTy ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: P roject name: CIeee yt. W C(4112-3,- v i ❑ Savior or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: oeur+ptlon I Qty. I Fee. I 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
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
/ 4.).S r}i - P ,-- / i residential (with above sq. ft.)
/�` _ ! , f - Services or feeders installation and/or relocatio
t N �i fir" = may'" �"�rO 200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: - 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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 599 amps _ 133.75 _ _ 2
Branch circuits - new, alteration, or ex tension, r panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ 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: ( 46.85 L 2
first branch circuit _
Address: Each add'l 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
Business name: 41 I,p,' • Signal circuit(s) or limited -
�G L- C �/C t cb - energy panel, alteration, or
Address: / 4 7 Ate 463 4.- eI �- extension. Describe: Page 2 2
I
City /State/Z �/5 4 b ),. 0 !T 9 7./.25‘ Each additional inspection over allowable In any of the above
` p / Per inspection 62.50
Phone: (5z0 [.>, (it) 7 I Fax: (3), . P9' Investigation per hour (I hr min) 62.50
CCB Lic.: 8/y1...32 Electrical Lic. v e , Suprv. Lic.: S ,_ Industrial plant pa hour _ 73.75 _
8 �? ELECTRICAL PERMIT FEES '
Suprv. Electrician signature, required: '/ �) Subtotal: ....... y-6..815 -
Print name: Z D : Z 7 - 0 Plan review (25% of permit fee):
�� State surcharge (8 %of permit fee): 3. 7
Authorized signature: TOTAL PERMIT FEE: This permit 7) ,40
Print name: Date: Thermit application expires if a permit is not obtai within 180
days after It has been accepted as complete.
• Number of inspections allowed per permit
1: Uiuitd 'mg\PerminWELC- PamiuApp.doe 0521/06 440.4613T(I1/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDE NTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY: .
Fee for each commercial $75.00
system
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
El Other
To tal number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \&rildingTmniu\E1.C- PamitApp.d« 03/23/06