Permit At. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00083
4, ".!511.' � DEVELOPMENT SERVICES DATE ISSUED: 2/20/03
� 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S 112M-00300
SITE ADDRESS: 14200 SW 72ND AVE
SUBDIVISION: ZONING: I -H
BLOCK: LOT : JURISDICTION: TIG
Project Description: E Lie�rR IQ Ac_ emu■ p M t )37 p c.r}ef MEx1T o p --
1Ng MA-Kiw16 Hite/1
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 3
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >.= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
GERBER LEGENDARY BLADES BECK ELECTRIC INC
14200 SW 72ND AVE 9318 SE CHURCH ST
PORTLAND, OR 97223 CLACKAMAS, OR 97015
Phone: Phone: 656 - 7396
Reg #: SUP 1326S
LIC 00002629
FEES ELE 3 - 5C
Description Date Amount Required Inspections
[HRELC] Hourly Electrical 2/20/03 $175.23
[HRTAX] Hourly Rate Tax 2/20/03 $12.27 Elect'I Final
Total $187.50
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 mor= r- n :1 • : . ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth ' OAR 952 - 001 - ••10 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -8r -0- 332 -2344.
Issu- • By: ' _ >) ,' , O / 1 i0 i Permit Signature: k',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'N: - O DATE:
LICENSE NO: /454,
Call 639 -4175 by 7:OOpm for an inspection the next business day
Electrical Permit Application .a,� h a
_. Date received: , AO Q3 Permit no.: 5-Om8-
'"'� *t'�!fh • City of Tigard
�;.:; y ar
g Project/appl. no.: Expire date:
City of Tigard Address`. 13125 SW Hall $Ivd, Tigard, OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171.
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
' ;.;e TYPE OE;.PERNIIT
0 1 & 2 family dwelling or accessory O Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
'U ' . -.• a r .,,s,.. �+ wltT� n 1' ny' +r V 4.r��
, i =ti r �d�J[tiC ll�iQ1(tfi�rol�l "•: .. t4K.� kyN;M� ,.^lF,.
Job address: { • • 0 4 W , •1 • �' Q , µ .e... Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: 1 Description and location of work on premises: i ■ r . ow
Estimated date of completion/inspection: 3- 0 3 MG“ e • ,
lee, ,ea ,, ;•,,CONTRACTOR:A.L'PLICATIOi� ,.. ..,.::. ,.:r' .4 -,�: F EE SCHEDULE
Job no: _ Fee Max
Business name: 13c c i. ( —l �L, Description Qty. (ea.) Total no. imp
'I New residential - single or multi- family per
Address: J i -'L -_,I . c-kLL . dwelling wit. Includes attached garage.
City: C a < KrtvvtctS I State:(,& I ZIP: =t`) (,1 Service included:
Phone: y , 7 �,` j(,, 1 Fax:Ip9 q ' E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: ;J.U,,{ j
Elec. bus. lic. no: `j(� q' p
Limited energy, residential 2
City /metro lic. no.: /A
. J5 Limited energy, non- residential 2
hi7 Each manufactured home or modular dwelling
Signature of supervising elec ( tred) Date Service and/or feeder 2
Sup. elect. name (print): (. .. j •, 47.- /r� 1 License no: / 31 rt. f._-, Senes orfeeders— installation,
altera or rel
PROPERTY OIVNER 200 amps or less 2
Name (print): J () k ' 201 amps to 400 amps 2
Mailing address: FO - 3 401 amps to 600 amps 2
..� d 601 amps to 1000 amps 2
City: / J J7 �. 'State: ®K I ZIP: Q 73 ( y Over 1000 amps or volts 2
Phone: b ?5 -pin 'Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation , alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
--- ' :1 : - z- ENGINE r 1 - . _ " r ,, Branch cir suits - new, alteration,
Name: • or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 'State: • 'ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee first branch circuit: 2
Each additional branch circuit:
PLAN REVIEIV (Please' check all that apply); • Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of t&2 0 Hazardous location Each sign or outline lighting - 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection 1 1 1 1
Submit _ sets of plans with any of the above. Investigation fee
i
The above are not applicable to temporary construction service. Other i L n i. 7' AI rp t M1 •S � Not all jurisdictions accept cre cards. please cal jurisdiction for more infommtioa. Noti This Permit fee TT
� permit application
Cl Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card member. / / within 180 days after it has been State surcharge (8%) .... $
Expires accepted as complete. TOTAL $
Name of c, dholder as shown on credit card
$
Cardbolder signature Amount 440.4615 (6/00/COM)
•
Electrical Permit Fees: Limited Energy Fees:
J _
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete -F_ee- Schedule _Bel4 -. _- - - - -- - ----- Restrtcted_ Energy_Fee..u�,_---------- - - - - -- — $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 Ei Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ri Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 Vacuum Systems amps to 400 amps $106.85 2 •
401 amps to 600 amps $160.60 2 Other
601 amps to 1000 amps $240.60 2 El
Over 1000 amps or volts $454.65 2
2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918- 260 -260)
201 amps to 400 amps $100.30 2 Check Type of Work Involved:
401 amps to 600 amps $133.75 2 yp
Over 600 amps to 1000 volts,
see "b" above. Audio and Stereo Systems
Branch Circuits El Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits Clock Systems
with purchase of service or Ei
feeder fee.
Each branch circuit $6.65 2 0 Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 HVAC
Each additional branch circuit $6.65
Miscellaneous El Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 El Intercom and Paging Systems , .
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy Landscape Irrigation Control* panel, alteration or extension $75.00
Minor Labels (10) - $125.00 ❑
Medical
Each additional inspection over
the allowable in any of the abc:: Nurse Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 0 Outdoor Landscape Lighting
Fees: El Protective Signaling
Enter total of above fees $ 0 Other
8% State Surcharge $ Number of Systems
•
25% Plan Review Fee
* No licenses are required. Licenses are required for all other installations
See 'Plan Review" section on $
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
Trust Account # 8% State Surcharge $
Total Balance Due $
i:'dsts\formsklc- fees.doc 10/09/00
CITY-OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Ren AM PM BUP
Location Lt .00 / 02 ✓4 11e- Suite MEC
Contact Person 0 Ph ( ) 5-5 - E-31 PLM
Contractor h ) SWR pp
BUILDING Tenant/Owner ELC -408 03
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final L
�4) L .) " c �)
PASS PART FAIL / �, - l �
PLUMBING �A2 1 my\ Q 11 & t\1
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS A c la v(, (.\\ s ti rs � 6
MECH IC RT FAIL V(.\\c‘ 1 r
Ros )' 1�J 1 /
Rough -In
Gas Line
Smoke Dampers
• - PART FAIL
EL RICAL
Service
Rough -In
UG/Slab
Low Voltage
F' • larm
M . Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line c�
ADA
Date -�> 0 3 I n s
Approach/Sidewalk iP
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL