Permit •
�� CITY OF TIGARD ELECTRICAL PERMIT
II ' COMMUNITY DEVELOPMENT Permit #: ELC2010 -00423 •
Tigard OR 97223 503.639.4171
13125 SW H all Blvd., Ti Date Issued: 08/18/2010
T,1GARl3 9
Parcel: 1S135DC00400
Jurisdiction: Tigard
Site address: 11795 SW GREENBURG 'RD
Subdivision: Lot: 0
Project: Dr. Gebeau Dental
Project Description: (2) branch circuits for roof -top A/C and GFI outlet
Owner:
FEES
GREENBURG LLC Quantity Description Date Amount
BY STEVEN & MELISSSA BLACK, PO BOX 1891
LAKE OSWEGO, OR 97035 2 crt Branch Circuits 08/18/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/18/2010 $7.63
Contractor:
Electrical
WEST SIDE ELECTRIC CO INC
1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 231 -1548
FAX: 503 - 736 -0677
Type of Use: COM
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 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
Issued By: Permittee Signature: �A7 // i v Ll r�f9J�d/v
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 an inspection that business day.
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.
Aug 12 2010 5:26PM West Side Electric 503 - 738 -0656 p.2
.11 J,
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Electrical Permit AnDlicati0 . - J � ' 1
City of Tigard BUG 1 3 2010 .. f, = P ermit No.
. L ` LCa 2 Q /0 - ,0D 4 g •
- ,. _I 13125 SW Hall Blvd, Tigard, OR Plan Review,
Phone: 503.639.4171 Fax: 503.59 ,p¢0 r , r-- n i4 (fin DateB : Other Fermi / rCa2 /0 .-- 0 /
I i. l Inspec ion Line: 503.639.4175 i l Y kit 1 t Date Ready /By: El See Page 2 for
, Internet: wwN•.tigard- or.gov r.1, oil fiNC'; INtstotd Notibe set Supplemental Information
f}E-' -' £` ,• .., .. _ t .sr g.,a u:, -', t t i sea- •�.a ••,w v� }a , tt'9k.
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}� k, t t.v = =�"+t' mot C.fi.... r_ , z r21 �'
lruvc� 'r+M � NYf 'belt �'S�4ih:G • I, I - - _ . -.... . -... � .:: M1''L.:r>'X'�.:Y? 'F. ' .'7FLE
❑ New construction E/.t Addition/alteration/replacement Please check all that apply (submit 1 sets of plans wftems checked below ):
❑Servi or feeder 400 amps or more 0 Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
Bg , .A , .1 ii' 1 R. .741,;' . r .: ° r,"7<*e Fkl x 'ir ;te ' a i . , a/weeds 10,000 amps at 150 volts or'
d. ' /C11.k "�,a' , (• t " _ ..x. - ;. ;`;�t. I, . ....t3 ;t ..id:,,l1.0.r .. + ❑F{Oatingbtcldings.
El 1 - and 2-famil dwelling F 0 building l m B sogralloteerinstalla installations. 0b t,satkpritxktttral
1- g lid i ry S ampe for e11 other ittrteltatioms. bw7dinga.
❑ Multi- family 0 Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or
„7 .: .2.•.. ¢ te r'` . . x ��'' ' ''r Stu..- tl,,k ,4 : t .. i O Eme ncy eysr o. larger separately derived system.
.,� + + ;., -- s - t ' . t ,. '' 5k 4:i 3t°t . 47, *4.. ;;atli ;- 0 Addit of new motor load of
�!;, sit. • �.<..,: „_ _.��•: t . ,... , -.,_ � " O .. A .. , - e • , .. 1 . 2 .... 1.3 _
Job no.: 3 'tea t.' y i Job site addres • 1/ 79S fw G/ 1ttJUr9 , e 100HPormoat, occupancy.
❑ Six or more residential units. 0 Recreational vehicle paha.
City/State/ZIP: 7;' 47ea/ A ' . 72 L3 0 Health - care facilities. o Supply voltage for more than
�/� el Hazardous locations 600 volts nominal.
Project name
, r. ' a t� /F'i27.7n 0 Service or feeder 600 amps or more
Suite/bldg. /apt, no.:
t J,A 7
'L 10:. N .Vrs G°i1t 'j"`pn
•t`' - S fit.. J • .w. W �' :t i t a7 A -}�':n :�4 . r J ' ..p :.
Cross street/directions to job site: ,., , rm, Tatal -
New residential single- or multi - family dwelling unit
includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 168.54 4
Ea. add'1 sq. ft. or portion 33.92 1
Tax map/parcel no.: i
k d � _ : 5iE.07 l 4 W..:..... sr4.4 ° to ' ._ N11.'. y a ' xt 0 tl :�.:'� Li (ced , residential
above sq. ft) fatal 75.00 2
i . '. ,?.4,: --. ', , - • « i ..rr::. , J •�7 b.. _t I . ..:... _ ' ... P� ! "'. f..., , , 'F 1An1+; ,,_ i: M',�'.
Limited energy, multi-family
ROW 4). r' C G F..1 L
residential (with above SQ. ft) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
gy1'7 nr�r r tM} rt. ^rte ''- i7 iIr 4 " 201 a
.t'. ;/ }�• *
ttte�t t +'c'• :v .�iyJ,'',- ti:�_», 't'FVi.:t:.f 1: ��,. t1:'�YS�i, 'u^; ,;n`..v`i ls to 400 m 133.56 2
Name: 601 arttps tarps 200.34 2
601 amps to 1,000 amps 301.04 2
Address; Over 1.000 amps or volts 552.26 2
CiiylState/Z1P Temporary services or feeders installation, alteration, and/or
relocation
Fax: ( ) 200 amps or less 59.36 1
Phone: ( ) 201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on property that I own which is not :
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 1 amps to 599 amps i 168.54 2
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
2�:t � ! ,.i� x �.t. •:r above service or fader fee,
,":..s.1.4.
s. =°' tit l 4 �5.�td'i > � "l u:.».,...., - r. a,.. ^ '?'`; . ,tit,' _ : 14 w . H is..i3k,i,�
each branch circuit 7.42 2
Business name B. Fee for branch circuits wirhow
service or feeder fee, first
branch circuit / 56.18 S'6 It 2
Contact name: Earls add' 1 branch circuit / 7.42 7 � 2 ,
Address: Miscellaneow (service or feeder not included)
Each manufactured or modules 67.84 2
City/State/Z1P: dweilintt, service and/or feeder
Phone:( ) Pax::( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E matt; Signor outline lighting 67.84 2
. I.s .,.n:s` S i -,:r . '.' _: !�:�.' y + `"'v« . L S<.u' -i,. ,a`(h* s'�+/U .Aa _ : a: A
., .t.. r•�b- .�.. �:•a:•w. ._ ... � �- _..> �±:k Signal dreuit(s)or limited- energy
Business anel. alteration, or extension. Page 2 2
usiness name:
West Side Electric ec t r i c Co. Co Inc. Inc . Each additional inspection over allowable in any of the abov
Address: 1834 SE 8th Ave. Additional inspection (1 hr min) 66.25/ hr
investigation (1 hr rein) 66.25/ la
City/State /ZIP: Portland /OR/97214 Industrial plant (1 hr min) 78.18/ he
"Del(503) 231 -1548 Fax' (503) 736 -0677 Inspections for which no fee is
90.00/ hr
/ frcall listed ' %hr min)
0 CCBLie.: 13306 Electrical Lie. 26 -135C S uprv.Lie.: 4654 -5 r .. ., -•. a+i: • -, b;.i is ,. :; ; i:�,,.'.
Suprv. Electrician signature, required: . � /ire 1 /�
Subtotal: (43
/. __ . � Platt review ( -' 5%a of permit fee):
Print name: Randall F Roberts Date: f Q State surcharge (12% of permit fee): c
TOTAL PERMIT FEE: 7 / L
Authorized signature: This permit application expires if a permit is not obtained within 180 i ...,..-- -
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per perntit 3
1 1litdegl?errmts\ELC Pemuvtpp.6sc 07,01110 440.4615T(1lt05iCOMM'E l / / '
t 3