Permit n CITY OF TIGARD ELECTRICAL PERMIT
g - COMMUNITY DEVELOPMENT Permit #: ELC2013 -00242
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/29/2013
T f''` O 9 Parcel: 2S 113B000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Clean Water Services Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (2) branch circuits for disconnecting and reconnecting actuators
Contractor: BENTON ELECTRIC INC Owner: CLEAN WATER SERVICES
34037 EXCOR ROAD SW ATTN: ACCOUNTS PAYABLE
ALBANY, OR 97321 2550 SW HILLSBORO HWY
HILLSBORO, OR 97123
PHONE: 541 - 967 -1244 PHONE:
FAX: 541 - 967 -8257
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 04/29/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/29/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 OAR 9 2 -001- 90. You m y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
o 4PPLicJ
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.
04 -26- 13;13'52 # 1/
Electrical Permit Applica EIVED I (l'Z 01 1.1(•1. I 'NI : ( "I 1
III City of Tigard Received
nacue : 01-9 r 1 3 s Permit No.: ELL 3013_ O ol.
• 13125 SW Hall Blvd., Tigard, OR 9A1 2 9 2013 Plan Review
I Phone: 503.718.2439 Fax: 503.59g.1 OF Date/B . Other Permit:
T I t; I t n Inspe Line: 503.639.4175 CITY Vl' TIGARD Date Ready/By: funs G ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
: = • . - TYri'AR'
DIVISION
Please check all that apply (submit 2 sets of plans wheel= below):
❑ New construction ® Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑ Marinas and boatyards.
- CATEOCIA OP CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
11] I- and 2 - family dwelling 0 Commercial /industrial ❑ Accessory building less to ground, other er i nceeds ons. ❑Commercial -use agricultural
Y $ amps (droll other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
F.
mergency system. larger separately derived system.
JOB.: SITE : ORMATION "AND LOCATION ' - ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3^
Job no.: Job site address: 16580 SW 85th IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations, 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Durham actuators ❑ Service or feeder 600 amps or more.
job site: I EE SCHEDULE' '
Cross street/directions to
J Description I Qty. i Fee. I ~ Total
New residential single- or multi - fancily 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 7500 2
DESCRII'ITO14 OF WORK a (with above sq. ft.)
Limited energy, multi- family 75.00 2
disconnecting and reconnecting actuators residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
>PROPERTY (,OW_ NER_ - „ ; 1 _ _ TENpN'r -. 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: Clean Water Services 401 amps 10 600 amps 200.34 2
y--- )ddress: 16060 SW 85'h Avenue 601 amps to 1,000 amps 30t.04 2
City /State/ZIP: Tigard, Oregon Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)547 -8175 Fax: ( ) 200 amps or less 59.36 I
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 signature: Date: Branch circuits — new, alteration, or extension, r panel
poi , Al ' PL c r'r - ,;I ':'• ®_ CONTA_CT __ P ERSON A. Fee for branch circuits with
>. - _._ _ _,_ .. ..- - -- above service or feeder fee, 7.42 2
Business name: Benton Electric Inc. each branch circuit
B. Fee for branch circuits without
Contact name: Nancy service or feeder fee, first 1 56.18 56.18 2
branch circuit
Address: 34037 Excor Road SW Each add'l branch circuit 1 7.42 7.42 2
City /State/ZIP: Albany, OR 97321 Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: (541) 967 - 1244 Fax: : (541) 967 - 8257 dwelling, service and/or feeder
Reconnect only 67.84 2
E - mail: nancy@bentonelectric.com Pump or irrigation circle 67.84 2
_ _ - - Sign or outline lighting 67.84 2
Business name: Benton Electric Inc. Signal circuit(s) or limited- energy
panel, alteration, or extension. Page 2 2
Address: 34037 Excor Road SW Each additional inspection over allowable in any o f the above
City /State/ZIP: Albany, OR 97321 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
Phone: (541) 967-1244 ( Fax: (541) 967 - 8257 Industrial plant (I hr min) 78.18/ hr
•
CCB Lic.: 4213
/ 1 1'' 1 Inspections for which no fee is 90.00 / hr
Electrical Lic.: 22 - 84C Suprv. Lic.: 2067S specifically listed (Si hr rain)
ELECTRICAL PERMIT FEg,S',
``uprv. Electrician signature, requir �4 Subtotal: 63..60
'Print name: Gerald O. Sheffield t e: 4 -26 -13 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 7.63
Authorized signature /.9. , Sk {� TOTAL PERMIT FEE: 71.23
!Y / This permit application expires If a permit is not obtained Within NO
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
1:tBuildin \P crmitsttil .C_PermitApp_04u913.Joc 440- 46tST(l I/OS/COM/WEB