Permit CITY O F TI CARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00064
r Aili . DEVELOPMENT SERVICES DATE ISSUED: 2/8/2005
I_
°'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S 103AC -09400
SITE ADDRESS: 11460 SW FONNER ST
SUBDIVISION: GERTZ PARTITION ZONING: R
BLOCK: LOT : 003 JURISDICTION: TIG
Project Description: Temp power.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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:
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:
GERTZ CONSTRUCTION DEXHEIMER ELECTRIC INC
19200 SW46TH 10639 SE PRIDE FULLER ROAD
TUALATIN, OR 97062 PORTLAND, OR 97222
Phone: 503- 638 -3390 Phone: 786 -0886
Reg #: SUP 2514 -S
LIC 43935
FEES ELE 26 -321C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/8/2005 $66.85
[TAX] 8% State Surcharge 2/8/2005 $5.33
Total $72.18
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 By:12 Permit Signature:
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: r9 " OS
LICENSE NO: 5 / S
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application r ,�x r ,{ F. n ` ' FO OFFICE US ONL 1 i �� s ° ,
e x s ? r� -. >: ' ice ,. s
City of Tigard Received Permit No.- , -) / Xp i y
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone. 503.639.4171 Fax: 503 598.1960 4*aitGt'iI'' D ate/B Other Permit:
Inspection Line: 503.639.4175� : Date Ready/By. Juns H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
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�f>:_ a��li ��< �, �. ��sr��.;.. ��"`= ��c�� �, �. xs: �x�. ��<< ���: � :.,,; , �� � ? �rµ:< x :S�En�.�r»s��� < <:, =..:�.� �B:` �`,`-` --��, . < < . � 'h-. � ._;, . , r, �` t L.'�� : ' ;= ;
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l Hazardous location
r ^# x 5} {g ,, _; F " = ve r , T ; , .„ M ; Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft ,
� °�� bra -�,� �. � , . y fi
- " , 4M" t' ph `Ireasil aiiV8isii:s 2; t TlOk� = ° x ° m t A ' ` It te of 1 -and 2- family dwellings 4 or more new residential
5b1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑ Other:
Building over three stories ❑Feeders, 400 amps or more
,` 44s * iys }o- z« # f Fn - n _ y Master builder _ µ a ,., Y � , v ❑Occupant load over 99 persons ❑ Manufactured structures or
1 J S11 ONIO A' I`I7 Y C9 T ON�� '{=' " � f- # RV park
-- : 11 ❑ Egress /lighting plan
Job no.: Job site address: f ❑Health -care facility ['Other t /� ` i / ✓iv el Submit 2 sets of plans with any of the above.
City /State /ZIP: The above are not applicable to temporary construction service
Suite/bldg. /apt. no . Project name: Yt v <CH.EAJL 'TMr , ..
Description Qty Fee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145 15 4
Subdivision: Lot no.: Ea add'I 500 sq ft or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75 00 2
4, ro : ,-= , �: : mss w.W, ; .,i,' °
Limited energy, non - residential 75.00 2
te;; � a �,. "�� _ , wit >.�, i,,r_ -rot.,A �I=F • `''�i:.zn '�.'�'ie`.
7: r ., ':,�::ii -, D$ ®. ?O F g: "� i
.,.:� �;i�� � ..'�.�,x °.;cur � °, °��: ,��- ::�;.is > -. N .. � .:.���t a' "s� � „ ���'`�f;:�fr�a� §' „ �a%0 Each manufactured or modular
dwelling, service and /or feeder 90 90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
MP:M- ir:W,”. ti w _ V _ > x , .:s 1 i<; ° r �",,. ; :fli4r, .°; � ., ko&V ; 3 201 amps to 400 amps 106 85 2
rd g ,,� - � <� �- ate; ,,;�• °,,, P mP
:, . 11 win gOP I T ;; OW - ; `::.7 y LI =TES" VT °7 ,; : ?
� � ; � a a �fi ;w mss, x ,s v ,-` �a:...- - 401 amps to 600 amps 160 60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454 65 2
Reconnect only 66 85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less j 66 85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
y _ Y '4::,e L' " ° *" „'T, ' . ax PX••_ tr
te r "i iii *.F A. Fee f
.�� �_ ° ";� �_� '� t °� t�, � or branch circuits with
` " `t ,'" ` ' -, .— I AN , »" A` ;,� ,. ki -P,Ar ACQly`T C'[ ,, I2SO , !; ,s . a 4 A
'���...� ".. �,�- x� -���, t:- .s,Y� ,. +a.` h ^'iii ^ �.. �� , �..;.« a..». ar;�um°•a,- ���:a�,,.�aa�e,*;� ;�+:
service or feeder fee, each 6.65 2
Business name: branch circuit
B Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46 85 2
Address: Each add'I branch circuit 6.65 2
City /State /ZIP. Miscellaneous (service or feeder not included)
Phone: ( ) Fax : ( ) Pump or irrigation circle 53 40 2
Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited -
s 'i`�'.'� - l;a , T`'^ a.' "s z;# -i [,F,�c;�: xaa; x 'st.. r;kf; -^-' ». T.4 ,, i .� • ,o,.•;.<k^a;„
a z :s ti =` ': ` -a en panel, alteration, or
extension. Descnbe• Page 2 2
mow, �, .�_'� - at -' °- - zr gY
aA' GOI RACTO ° ,.a ,: __ 1 _„ , a°
:s:I,&_„ -,» �f;,,, - ��. 'a'�y'�",ra», ,.. .''M "< e 3. �.�.., r� '��.+a+�.s�I��- _='s�`<. _ : «^»°:� "_: sc
Business name: �� xl - lZcif m Or Et. %h1c.
Each additional inspection over allowable in any of the above
Address: /0G G ' y 6',- c - Per inspection 62 50
City /State /ZIP: 67Gr4 . o ' 9F Z Z Investigation per hour (1 hr min) 62 50
Phone: (503) 9C, ^CjI A'(,, f Fax: (b'03) 7 4710 Industrial plant per hour 73 75
I ni W Ka:W l 'EIi1G_ II`T" I' ...... , , ..
CCB Lic.• 1/3 7-33 Electrical Lic.: 2 c_ Suprv. Lie.. ,,,Z5/4J Subtotal
Suprv. Electrician signature, required Z..4 A- tl Plan review (25% of permit fee)
: Date: Z State surcharge (8% of permit fee)
��4 v i 0 G . ' /- i �t 5 - G -J ^
Print name TOTAL PERMIT FEE / J e y
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tn- County Building Industry Service Board
** Number of inspections per peniut allowed.
I \Buildmg\Pemvts\ELC- PermiApp doc 12/03 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard , ,\
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
:.:w:,�xvcrzscau .arra.. .Pss =P':'- -a wi-«, n
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
•
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\Bwldmg\Permns\ELC- PernutApp doc 04/03