Permit (451) CITY OF TIGARD ELECTRICAL PERMIT
1111
COMMUNITY DEVELOPMENT Permit#: ELC2014-00128
T t O AR O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/15/2014
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16580 SW 85TH AVE
Project: Clean Water Services Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Sludge hopper-low voltage for motion detectors to the PLC
Contractor: L&K ELECTRIC Owner: CLEAN WATER SERVICES
10122 SE SHADY LN 2550 SW HILLSBORO HWY
DAMASCUS,OR 97089 HILLSBORO, OR 97123
PHONE: 971-506-8351 PHONE: 503-547-8177
FAX: 503-663-0343
FEES
Quantity Description Date Amount
1 ea Signal circuit or Limited 03/31/2014 $75.00
Specifics: Energy Panel
1 ea 12%State Surcharge- 03/31/2014 $9.00
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $84.00
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 :re set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.:•. 23 i�
Issued By:�?_ _ Permittee Signature:
F—
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.
Electrical Permit Applicati j CEIVEp FOR OFFICE USE ONLY
City of Tigard Received Q fe /4 "Z�t'� '
Received / r / > p11° t" ��+-6v! U
III 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.591 1 9 2 014 Date/By: Other Permit:
I I c,\I:I 1 Inspection Line: 503.639.4175 Date Ready/By: lurk: RI See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE1 I fj • I1VISION PLAN REVIEW
iii ll�t>t Please check all that apply(submit 2 sets of plans w/items checked 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling Z Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ['Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
.� ❑Addition of new motor load of ❑"A","E","1-2","l-3",
Job no.:6368.044 Job site address: 16580 SW 85th Avenue IOOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Sludge Hopper Repair ['Service or feeder 600 amp,or more.
FEE SCHEDULE
Cross street/directions to job site: pe,,ripii„n I Qt1. I Fee. I 1i tat I *
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq.ft.or less 168.54 4
Tax nrt / l no.: Ea.add'l 500 sq.ft.or portion 33.92 1
p p`[ree Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00
Limited energy,multi-family 7500 2
Install motion detectors to the PLC. residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
® PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:Clean Water Services 401 amps to 600 amps 200.34 2
Address:2550 SW Hillsboro Highway 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Hillsboro,OR 97123 Temporary services or feeders installation,alteration,and/or
Phone:(503)547-8177 Fax:( ) relocation
200 amps or less 59.36 l
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,perpanel
�2 APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42
Business name:Clean Water Services each branch circuit
B.Fee for branch circuits without
Contact name:Joel Borchers service or feeder fee,first 56.18
branch circuit
Address: 16060 SW 85th Avenue Each add'l branch circuit 7.42 2
City/State/ZIP Tigard,OR 97224 Miscellaneous(service or feeder not included)
Each manufactured or modular
67.84 2
Phone:(503)547-8177 I Fax: :( )
dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:borchersj@cleanwaterservices.org Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name 1_ 14, E Li.cri2- , hoc- Signal circuit(s)or limited-energy X See 7576 2
- ,- 1` panel,alteration,or extension. Page 2
Address: to i 2,2, f- 6 N-Rby L_iJ Each additional inspection over allowable in any of the above
City/State/ZIP: -rte b 2 t7-l0$C� Additional inspection(I hr min) 66.25/hr
Vf'Cr )f}`�� �J '/ Investigation(1 hr min) 66.25/hr
Phone: 9 7/- 50(, --g 3 5 j Fax:(4303) lob "634 3 Industrial plant(I hr min) 78.18/hr
< 1- — Inspections for which no fee is 90.00/hr
CCB Lie.: 157 3.4,1,4, 1 electrical Lic.: _ligoC Supt .Lie.: 41475E specifically listed(t/x hr min)
/ J ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ® ` _ Subtotal: �aj•�°
Print name: V 0 Date: Plan review(25%of permit fee):
State surcharge(12%of permit fee): V.00
Authorized signature: TOTAL PERMIT FEE: g q.CO
r 42. 0/, This permit application expires if a permit is not obtained within 180
Print name:t,"?.. „4„) Date: i ' days after it has been accepted as complete.
* Number of inspections allowed per permit.
(:\Building\Permits\ELC_Permit p_ELR_ERE.doc Rev 05/21/2013 440-46I5T(11/05/COM/WEB
Electrical Permit Application-City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description l Qt,. I Fee I Total
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26
OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above: _
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
Boiler Controls
n Clock Systems
Data Telecommunication Installation
I Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
Landscape Irrigation Control*
n Medical
I I Nurse Calls
I Outdoor Landscape Lighting*
® Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013