Permit ' „CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00061
DEVELOPMENT SERVICES DATE ISSUED: 2/11/03
"i II
— — 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 - 4171
PARCEL: 2 S 112AA -00300
SITE ADDRESS: 14200 SW 72ND AVE
ZONING: I -H
SUBDIVISION:
BLOCK: ��Q - - LOT: JURISDICTION: TIG
Project Description: -- 44\ vi t -'u C p p ,
RESI 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: SIGNALIPANEL:
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: 1 PER HOUR:
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
[ELPRMT] ELC Permit 2/11/03 $175.23
[TAX] 8% State Tax 2/11/03 $12.27 Elect, 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 more than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 800 - 332 -2344.
Issued B _ 2�iL�/�/� 0 i lia . _Permit Signature: - A r / /�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: DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
iEiectrical Permit Application a _ :.
Date received: ig� Permit no
r r� � 3 -UOO&
;,,.� Imo City of Tiga �-) [ _ Project/appl. no.: Expire date:
City of Tigard Address: 13125 $W !' +t i _ 3 Date issued: By: a' Receiptno.:
Phone: (503) 639 -4171:
Fax: (503) 598 -1960 FEB 1 1 2003 Case file no.: Payment type:
Land use approval: CITY OF TIGAfD
Tin OF,PER111IT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial .
„.'s'; "9.1 gai 11 1' ' ' '
c�, ,'' r, rbf a Z ,►r `
:� a 7 � ,. ._ . .. 1 r.a7 ;• a s
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•
Job address: /41.2, 0 0 r w, ' 4.i4 ,,. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: II lock: subdivision: •
Project name: I Description and location of work on premises: 4/n/r/Qflf 4 Vet, , d' ~ Zed -..----
Estimated date of completion/inspection: 03 6 'f / ,i _; .. --- N l , ■ 0
CONTRtCLORA PLIC [ION ; .
. 's"v:;�:x •F ., . ,.4....,"'.,. .. ::... '. xy x . : :, r FEE " SCHEDULE
Job no: Fee Max
Business name: j (,d' L��� �--} 1 i t Description Qty. (ea.) Total no. insp
New residential -single or multi- family per
Address: ?)► Jc. ( (Y (�
dwelling tmit. Includes attached garage.
City: C-\0.<" Kc IACt � I State:C' I ZIP: c l')Ct ) S Service included
Phone: 1,-, ] 3c/it, I Fax:h /o , /-3 7 I E -mail: woo sq. ft. or less 4
CCB no.: .J 6,,,,,: c) I Elec. bus. lic. no: J ----1:)(1.., Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City/metro lic. no.:
.� J
Y J Limited energy, non- residential 2
littej /04t Each manufactured home or modular dwelling
Signature of supervising elec ( ired) Date Service and/or feeder 2
Sup. elect. name (print): 1./241.-/177_ T. ,.',..,,17.,./ jinn License no: /32f -c-, Services or feeders - installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): S.eD h t ( r b e r 201 amps to 400 amps 2
Mailing address: / 1 Box a 3 601 amps to 00 amps 2
A
601 amps to 1000 amps 2
City: A f e # S 4.. 1 State: o it I ZIP: 9 /74, 11 Over 1000 amps or volts 2
Phone: 675- 5y38 Fax: 1 E -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 iletlon, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or Tess 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
- .___ •.-t .' _ .- I:NGIIVE. r -- - r- :=- ;,:.:1---_� :' `,"-- - -.. Branch circuits - new, alteration,
or extension per panel:
Name: • A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 'State: - I 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 REVIEW (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
❑ Service over 320 amps - rating of 1 &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 ❑ Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
❑ Egress/lightingplan 0 Other. Per inspection 1 1 1 1
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other(&er J ,,,, p i �� v! 57 '�/
Not ail jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee '/ 77. a 3
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8%) .... $ /. .n. 7
Expires accepted as complete. TOTAL $ 1 f( 7. D 0
Name of ctrdholder as shown on credit card •
$
Cardholder signature Amount 440 -4615 (6l00/COM)
Electrical Permit Fees: Limited Energy Fees:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Cmmp a ee-SCIIeduleBetoW_ _. -- Restricted EnergKFee.... __ ______ ____ - -- _$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 5145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof 533.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular Door Opener
Dwelling Service or Feeder 590.90 2
Services or Feeders El Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less 580.30 2 Vacuum Systems
• 201 amps to 400 amps 5106.85 2
401 amps to 600 amps 5160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 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 5133.75 2 yp
Over 600 amps to 1000 volts,
see "b" above. t l Audio and Stereo Systems
Branch Circuits 0 Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits ED with purchase of service or Clock Systems
feeder fee.
Each branch circuit 56.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service E Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 HVAC
Each additional branch circuit 56.65 •
Miscellaneous ❑ Instrumentation.
(Service or feeder not included) ,
Each pump or inigation circle 553.40 ❑ Intercom and Paging Systems
Each sign or outline lighting 553.40 .
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 sbc• ❑
Per inspection
$62.50 Nurse Calls
Per hour $62.50 ❑
In Plant $73.75 Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling -
• Enter total of above fees $ ❑ 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\fomu\elc- fees.doc 10/09/00