Permit CITY OF TIGARD ELECTRICAL PERMIT
' ° • COMMUNITY DEVELOPMENT Permit#: ELC2013 00478
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/13/2013
Parcel: 251138000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Clean Water Services Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (3)200 amp or less services/feeders for Aeration Basins 2,3&4. Work is in electrical room between basins 3&4.
Job No.80.6566
Contractor: TICE ELECTRIC Owner: CLEAN WATER SERVICES
5405 N. LAGOON AVE. 2550 SW HILLSBORO HWY
PORTLAND, OR 97217 HILLSBORO,OR 97123
PHONE: 503-872-8230 PHONE:
FAX: 971-230-3330
FEES
Quantity Description Date Amount
• 3 ea Services or Feeders-200 08/13/2013 $302.10
Specifics: amps or less
1 ea 12%State Surcharge- 08/13/2013 $36.25
Type of Use: COM Electrical
Class of Work: ALT •
Type of Const:
Occupancy Grp:
Total $338.35
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. ATTENTIO . n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 t rough OAR 2 1- 09 . You may 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:
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.
08/09/2013 11:54 Tice Electric Company (FAX)5038728275 P.002/003
e
Electrical Permit ADDli ii?%. EIVED
wiz mil( 1. I sI.(0,1.1
City of Tigard A 1 2 n "`a $�� �.�.% �tNa_ a a,0/3.Doy7
Ili
II 13125 SW Hall Blvd.,Tigard,OR 9'1P13 2013 013 Plan Ram
~ Phone. 503.718.2439 Fax paeyg. Other Permit
I I,:.1 I.(2) Inspection Line: 503.639b1�v�TIGARD Data seady/By: iiiill ' See Page 3 for
Internet .dgatd-or. ILDING DN1'10N NotiBbd/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction gAddition/al1eration/replacement Please abode all that apply(submit 1 sets of plans.w/ilems checked below);
❑SeMae Or 6Se4er 400 amps or more 0 Braiding over One awe*.
o Demolition 0 Other: where the available 9nit oaneet ❑Marinas and boatyards.
CATEGORY OP CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings,
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ I-and 2-family dwelling aCommeralal/indusnial 0 Accessory building
as all other installations. buildings.
❑Multi-fanfy ❑Master builder �0��; O Fns map. O Dwalialo
a Ws KVA or
JOB SITE INFORMATION AND LOCATION 0�genty system. huger aepamtaly derived system'
0 Mthou of now motor load of ❑°A","E"; 12,•13,
Job no.:80.6566 Job site address: W 85TH 100h1P or mom, occupancy.
D Six or more residential Imhs. 0 Reereatioael vehicle parka
City/StatetZIP: T1GARD/OR/97224 /(OS&O O Health-care tkoahlsa 0 Supply vokage for mete than
C�f� (�fir£, ❑Hazardous locations. 600 volts nominal.
Suite/bldgiapt.no.: I Project name: WEG VFD D Seneca or Ouder 600 amps or more.
J€4.ai0 1_S BEE SCHEMLE
Cross street/directions to job site: — ' pnetiepon 1 3o I sec. I Thai 1 -
- f lam` / New reaideotiai single-or multi-dimity dwelling.unit
- • includes attached garage.
Subdivision: I Lot no.: 1,000 eq.R or iess 16834 1 4
• Ea.add'l 500 eq.R or portion 33.92 1
Tax map/parcel no,:
Limited energy,residential 75.00 2
DESCRIPTION OP WORK (with above sq.ft.)
Limited energy.muld-thmily 75.00 2
INSTALLING 3 VFD TO EXISTING MOTORS. residential(with above sq.lt.)
Services or feeders installation,altei'itloa,end/or Monition
• 200 amps orless 5 100.70 302.10 2
0 PROPERTY OWNER 1 0 TENANT 201 amps to 400 amps 13356 2
Name: 401 amps to 600 amps 200.34 1
- . 601 amps to 1,000 amps _ 301,04 2
Address: Over 1,000 amps or vole 55226 2
City/State/ZIP: Temporary- services or feederslnstailation,alteration,and/or
relbeatibn
Phone:( ) I Fax:( ) 200 amps or lass 59.36 1
Owner Installation:This installation is being made on property that I own which is not 201 amt's to 400 amps 129:08 _ 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 01 amps to 599 amps 168.54 2
Branch circuits-net alteration,or extension,per panel
Owner signature: Date: A.Pee for breach circuits with
0 APPLICANT I lo CONTACT PERSON above service or ibeder the, 7.42 2
. oath branch circuit
Business name: TICE ELECTRIC ti) - 3,4 f - 73r-) B.Pee for branch circuits without
service or finder fee,fiat 56.18 2
Contact name: CHAD ASKEW «.,¢.-0 tM- branch circuit
Each addl branch circuit 742 1-r
Address: Miscellaneous(service or feeder not Included) —
City/State/ZIP:
Each menuti:ctured ormodular
_ dwelling,servioe andlor feeder 67:84 2
Phone:(503 ) 341-7339 I Fax::( ) Reconnect only 67,84 2
E-mail: Chede( tlCeelt3oh IC nom Pump or irrigation circle 67.84 2
•Signor outline lighting 67.84 2
CONTRACTOR Sigaal cireuit(s)or limited energy
Business name:T10E ELECTRIC COMPANY panel,alteiadon,or extension. Paget 2
Each additional inspection over allowable In any of the above
Address:5405 N LAGOON AVE Additional inspection(1 hr malt) 66.25/hr
City/State/ZIP:PORTLAND/OR/97217 lovmriaativn(1 hr min) 6625/hr
Industrial phmt'(1 br min) 78.18/hr
Phone:(503)873-8230 I pax:(971)230-3330 lnape tion4 fbr which no the is 90.00/hr
pr ' Medically listed(54 hr min)
CCB Lic.: 166 4179111 Electrical Lic.: -126C �'Suprv.Lie.: 33045 L✓ ELECTRICAL PERM*FgE$
`.-3 up tv.Electrician signature,s rxuired -- Subtotal: _
302.10
✓
Plan review(25%of permit fen):
Print name: LOWELL ARNO Date: 8/9/2013 State surcharge(12%of permit fax): 36.25
TOTAL PERMIT PEE: 338.35
Authorized signature:
Ms permit application expires'if*permit U not obtained within 180
Print name:
days after allow been accepted as camptete• ()_
I Date: • Number oPmspsedane autocue per permit /pJ,t lr/
08109/2013 11:54 Tice Electric Company TAX 728275 P.0011003
( 7.7:1; TICE
ELECTRIC COMPANY
5405 N Lagoon Ave Portland,Or 97217
Phone: 503/233/8801
Fax: 971/230/3330
Fax
To: City of Ttaard From: Theresa Hollan
Fax: 503-59&1960 Panes: 3
Phone: Date: 8/9/2013
Re: Electrical permit aDDlicittion CC:
Urgent ❑For Review 0 Please Comment Please Reply ❑Please Recycle
Thanks
Theresa
503-8724230