Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit#: ELC2018-00063
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/17/2019
7 r c A l<':17 g Parcel: 251136000600
Jurisdiction: Tigard
Site address: 16620 SW 85TH AVE
Project: Clean Water Services Subdivision: None Lot: None
Project Description: Sodium Hypochlorite&Caustic Improvements-(3)200 amp service and(33)branch circuits.
Contractor: BENTON ELECTRIC INC Owner: CLEAN WATER SERVICES
34037 EXCOR ROAD SW 2550 SW HILLSBORO HWY
ALBANY, OR 97321 HILLSBORO, OR 97123
PHONE: 541-967-1244 PHONE:
FAX: 541-967-8257
FEES
Quantity Description Date Amount
3 ea Services or Feeders-200 02/08/2018 $302.10
Specifics: amps or less
33 crt Branch Circuits w/Purchase 02/08/2018 $244.86
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 02/08/2018 $65.64
Electrical
Type of Const:
Occupancy Grp:
Total $612.60
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 ' work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification ent Those r les ares forth in OAR
952-001-0010 through OAR 001-0090. You obtain a copy f the rules o irect questions to OUNC by calling 503 19 or 1.800.33 . 44.
Issued By: Permittee Signature: - .a�
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 Application FOR OFFICE USE ONLY
City of Tigard .
Received lir c,„ -JA'..(...71-. t
Permit i6r-oeo3
1111 • 13125 SW Hall Blvd.,Tigard,OR 97223
I Phone: 511S.711I 2439 Fax: 503.598.1960 • Pi 41, ',,1,V
Date/B • /a 'Ulf V
• III?, Related Permit#:
Plan Revie • ..-2
Inspection Line: 503.t 39.4175 AN z z .,1Date/By: - /
Ready Date/B uris: 0 See Page 2 for
I I 6 A k I') Internet: www.tigard-or.gov , ;,., • e. eth... 7, _,,, /At Supplemental Information
4-'V ,' i'.' 'r li,,' :t t' o4ffMad'''''mw:r"
TYPE-OF wol'- ' ' - - PLAN REVIEW
n,.., Tittr"1-1,r‘fvorf--,,,,,:. •
0 New construction 1:El Addition/alteatMoVliabLiiiesii 1 l'i., `%..)i 4 Please check all that apply(submit a sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling il Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
O Addition of new motor load of system.
Job#: I Job site address:1.65/IrSW 85th A venue 100HP or more.
City/State/ZIP:Tigard,OR 97224 /66 AO 0 Six or more residential units. occupancy.
O Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:Sn. ium 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: CL-Ce-Al tC//7-7--t72- S0 t-t-''S FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
Durham AWWTP Sodium Hypochlorite&Caustic Improvements (with above sq.ft.)
Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER El TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 3 100.70 302.10 2
201 amps to 400 amps 133.56 2
Address:
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANTI 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Benton Electric Inc. above service or feeder fee, 33
7.42 244.86
2
each branch circuit
Contact name:Nancy B.Fee for branch circuits without
service or feeder fee,first
Address:34037 Excor Road SW branch circuit 56.18 2
City/State/ZIP:Albany,OR 97321-9464 Each addl branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(541)967-1244 I Fax: :(541)967-8257 Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:nancy@bentonelectric.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Benton Electric Inc. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:34037 Excor Road SW panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:Albany,OR 97321-9464 Additional inspection(1 hr min) 66.25/hr
Phone:(541)967-1244 I Fax:(541)967-8257 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:nancy@bentonelectric.com Inspections for which no fee is
90.00/hr
CCB Lic.: 4213 Electrical Lic.: 22-84C Suprv.Lic.: 2067S specifically listed(1/2 hr min)
ELECTRICAL PERMIT PEES
Suprv.Electrician signature,required:j.j,t)/4911/ QA, ' # Subtotal: 546.96
Print name: Gerald 0.Sheffield Date: 1 22-18 0 Plan Review Required(25%of permit fee): 136.74
State surcharge(12%of permit fee): 65.64
TOTAL PERMIT FEE: 749.34
Authorized signs : This permit application expires if a permit is not obtained within 180
Print name: ' itit Date(-1 7-/c3 days after it has been accepted as complete.
* Number of inspections allowed per permit
1:\Building\Permits TLC_PmitApp ELR_ERE.doc Rev 06,17/2015 440-4615T(11/05/COM/WEB
A
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16620 SW 85TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2018-00063
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor