Permit it
w ., CITY OF TIGARD ELECTRICAL PERMIT
IN ' COMMUNITY DEVELOPMENT Permit#: ELC2015-00146
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/07/2015
Parcel: 2S 114AA00500
Jurisdiction: Tigard
Site address: 16375 SW 85TH AVE
Project: Clean Water Services Subdivision: 1993-078 PARTITION PLAT Lot: 2
Project Description: Primary Treatment&Hydraulic Capacity Improvements Project. Construct new headworks effluent structure and
new biofilter.
Contractor: OREGON ELECTRIC GROUP Owner: CLEAN WATER SERVICES
1709 SE 3RD AVE 2550 SW HILLSBORO HWY
PORTLAND, OR 97124 HILLSBORO, OR 97123
PHONE: 503-234-9900 PHONE:
FAX: 503-234-1001
FEES
Quantity Description Date Amount
65 crt Branch Circuits wo/Purchase 04/07/2015 $531.06
Specifics: Service or Feeder
1 ea 12%State Surcharge- 04/07/2015 $63.73
Type of Use: COM Electrical
Class of Work: ALT 1 ea Plan Review Electricial 04/07/2015 $132.77
Type of Const:
Occupancy Grp:
Total $727.56
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 r adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma o■tain a copy of thor direct questions to OUNC by calling 503.232.1 r 2.2344.
Issued By: Li_ �,� _ _ , i�� Permittee Signature: —NnK C c�
A
4-
pra.
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.
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Electrical Permit Applicatiote V FOR 0rl•1( 1. I st.0\I.}
ReceiveJ10 ���
iiii City of Tigard �ll �� �wl'�► IJate/B jiW �• 13125 SW Hall Blvd.,Tigard,OR it Plan Re l�. Related Permit#:
Phone: 503.718.2439 Fax: 503.5 i Date/B :
Inspection Line: 503.639.4175 '4 t 1�1 Ready Da runt: I ®See Page 2 for
T1<IAttl) Internet: www_tigard-or.gov r \ 7.1A1 Notified/Method• -L' rM RS " j Supplemental In formation
F+"OF WORK ' , L 11=7 , _ r, : PLAN'REVIEW::• ... . . •
❑New construction AOdition/aiteration/TcSf Tr• Q NO. 1 Pkese cheek all that apply(submit2 eats of plane wfile:ne checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑other: LAIN where die available fault cunent ❑Marinas and boatyards.
CATECO _OF.CONSTP14110N. exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑1-and 2-family dwelling ommuroia/industrial ❑Accessory building lase to ground,or exceeds 14,000 ❑Commercial-tree agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
. JOB SITE INFORMATION:-AND LOCATION ❑Emergency system. larger separately derived
Job#: Job sift address: �/2 ' ' k I ❑Addition of now mote load of sysem•
to f e� /✓v E 100HP or more. CI"A"„"E","l-2","1-r,
❑Six or more residential units. occupancy.
City/State/ZIP. ❑Health-care facilities. 0 ReeteRtionoi vehicle parks.
Suite/bldg./apt#: 1 Project name: ea).S' Hazardous locations. ❑Supply voltage fot more than
--- Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site
Daern:tton i Qty. I Each I Total i _
New residential'Ingle-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.Et or less 168.54 4
Tax map/parccl#: Ea.add',500 sq.ft.or portion 33.92 1
'p e'cfOtttO ! Ol::filVii C '' ' _ Limitod energy,residential
• //�� / { (with above sq.R) 75.00 2
C'nyS¢r-ei q, /1"rtiu/or h S / '• ''rr'f•r 'tr.4 f i-,ve- 9'1, Limited energy,multt-family, •
qq U�p r'0 T /r, r 1",
residential(with above sq.ft.) 75.00 2
Y ..• Renewable Energy ❑ See Page 2
PROPERTY O 'M1 . .;, J C] TENArii7" Services or feeders installation,alteration,and/or relocation
Name: C/1q,.t V.,jer Srrv'`er-1 200 amps or less 100.70 2
Address: 1 6 c 6 O 5+t/ g,c t:- Are- 201 amps to 400 amps 133.56 2
� 401 amps to 600 amps 200.34 2
City/State/ZIP: / 6 f ,p, 04 97 a t-�---- 601 amps to 1,000 amps 301.04 2
Phone:(563) 51/11- g(?5 Fax:( ) Over 1,000 amps or volts 552.26 j 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on properly that 1 own which is not 200 amps or less 59.36 1 i
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. ; 20 amps to 400 amps 125.08 2
Owner signature: Date: Branch circuits i new,alteration,or extension,. ,,,s,., .. _
401 amps 168.54 _ 2
(� Q APPLICAN' ' CONTACT' PIkRSON: ' A,Fee f , o o loo,per panel
C1 __ � • � ��. �_..�W�.�:• A.Fee for branch circuits with
Business name: C 1e,,, Wei t r 5{r,,,"f.-.S above service or feeder fee,
7.42 2
/ each branch circuit
Q
Contact name: e c I !)0 rc h�r S B.Fee for branch circuits without
l Baltic):or feeder fee,first i 5618 5� 1 2
Address: Q Q S W g tJ v G branch circuit
1fl City/State/ZIP: -f--\ / 04 CI 7 a a (1 Each add'l branch circuit 6� 7.42 07s.�.0/2.
I 1, 6 r. , Miscellaneous(service or feeder not included)
O Phone:(r63 ) _ �4 7._ (7 7 Fax: :( ) Each manufactured or modular 67.84 2
1 dwelling,service and/or feeder
Email: j'a.rc 4 - g CI .1 i•/gfrr4t'rt/t ct'S', nisi Reconnect only 67.84 2•
!fl -CO1VTRe�G"f6�t '-;_, . .., . , Pumporirrigationcircle 67.84 2
Business name; ,l'1/ / / C / Sigu or outline lighting 67.84 2
Signal circait(s)or limited-energy
1 Address: 17(L)9 sr,c( xi(A . panel,alteration,or extension. ❑ Sec Page 2 2
City/State!LIP: �e,, },�� Each additional inspection over allowable in any of the above
^- , p 7� ' Additional Inspection(1 hr min) 66,25/hr
investigation hr min) 66,25/14
Phone:(S"3) L Li - 9 I DC? Fax:(S 3) 2-3i /a v / —
Industrial plant(1 hr min) 78.18/hr
o \O t D✓t c.,sv,N-C' R+ L. (-0'2^ Inspections for which no fee is 90.00/hr
klt
CCB I.,ic.:��j3 Electrical Lie.: �"�5 7 Suprv.Lie.: �rF�� tpeeificallylistad� hrmin)-> z ., ET*CiRTCi t t ttjdf'TEES
Suprv.Electrician signature,required; / 4144 ....f----- Subtotal: >f 3 I „et(a
1 Print name: , A • - Date: '-/_7- /5 • ❑Plan Review Required(25%of permit fix). /1,), "17n
State surcharge(12%of permit fee): (3' `73
Authorized signature AL_ 1/4(_,-../ TOTAL PERMIT • ‘1,27_5(e,*Rhin t
This permit application espirea if a permit is not rained within 0
Print name: ) ., r k („j4,,,,104_,.-4.,, Date: '-r--1_ I days after it has been accepted as complete.
— ' Number of inspections allowed per permit.
l.lnocdbiglPermitin.LC ParmbApp_ELR ERBdoe!ter 04/21/2014 4404615T1I t/OS/COM/WED
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16375 SW 85TH AVE, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00146
Jeff Grove
Violation Summary:
Inspector Contractor