Permit CITY OF TIGARD ELECTRICAL PERMIT
. COMMUNITY DEVELOPMENT Permit #: ELC2011 -00681
TICJARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/06/2011
Parcel: 2S112AA00300
Jurisdiction: Tigard
Site address: 14200 SW 72ND AVE
Project: Gerber - Fiskars Subdivision: Lot:
Project Description: (1) branch circuit .
Contractor: BECK ELECTRIC INC Owner: GERBER LEGENDARY BLADES
15600 SE FOR MOR CT #B 14200 SW 72ND AVE
CLACKAMAS, OR 97015 PORTLAND, OR 97223
PHONE: 503 - 656 -7396 PHONE:
FAX: 503 - 656 -4397
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/06/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/06/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 - -= • - 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. A NTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notific- ion Center. Those rules are set forth in OAR
952 -00 0010 through OAR 95 601 O. You may obtain a copy of the rules or direct questions to OUNC by 13.232.1987 or 1 800..32.2544.
Issu • . By: / �� A^O Permittee Signa . e: _ , / ' / , �
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' f 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.
Dec 02 11 09:30a Beck Electric (503) 656 4397 p.2
Electrical Permit Application FOR OFFICE USE ONLY
RECEIVED Received Permit No.:
City of Tigard oate i� II L l/ 6/0/0g/ - " 13125 SW Hall Blvd., Tigard, OR 97223 Plan Rev
Phone: 503.713.2439 Fax: 503.598.19600F C 2 2011 Datei3y: Other Permit
Inspection Line: 503 639.4175 Date Rcady/3y: Jima: Ef See Page 2for
TIGARD Internet: www.tigard -orgov
CITY OF TIGARD Notified/Method: Supplementallrformatiun
TYPE OF %,DING DIVISION PLAN REVIEW
111 New construction y°`• Addition /alteration replacement Please check all hat apply (submit 2 sets of plans wiitens checked below).
❑ Service or feeder 470 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,5410 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2 dwelling 1,Commereial /industrial ❑ Accessory building amps for all other installations. but'
dings
❑ Multi - family ❑ Mauer builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KV.A or
❑ Emergency system. larger separately derived sys:cn,
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E `1 -2",
I OO
` � � HP or more occupancy,
no.: .
Job no. .lob site address: �W -- 1 2r- Recreational vehicle arks.
_ ❑ Six or more residential units. ❑ P
CityiState,'ZIP: --I 'UY AI a-rt.:‘ 0 ' .�Z� El Health-care facilities.
0 Suppinhsommmmal more than
600 v
v ❑ Nazerdous locations.
Suite /bldg. /apt no.: Project name: G-1 e 1.10 e5- 165l -LS ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qt I Fee. I Total I *
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision:
Lot no.: 1 sq. ft. or less 168.54 4
Ea. add'] 500 sq. ft. or portion 33.92 ; I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75. 2
Limited energy, multi - family
75.00
�/�
t }� D - Pr 1 residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 205.34 2
Name: 601 amps to 1,070 amps 301.04 2
Address: Oser 1,000 amps or volts 552.25 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone I I I Fa ( ) 200 amps or less 59.36 I
2C1 amps to 400 amps :25.08 2
Owner installation: This installation is being made on property that I own which is not qGl amps to 599 amps 168 54 2
intended for sale, lease. rent, or exchange, according to ORS 447. 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits ■eth
D APPLICANT ❑ CONTACT PERSON above service or feeder fee; 7 42 2
each branch circu:t
Business Warne: B. Fee for branch circuits without
service or feeder fee, first • I 56 18 51/0•
2
Contact name: branch circuit q
Each add'l branch circuit 7.42 I 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84
City/StateiZIP: dwelling, service and /or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67 - 84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR . Signal circuits) or limited- energy I }I
panel. alteration. or extension. Page 2 2
Business name: k_:. `ec `y t ` 4 - Each additional inspection over allowable in any of the above
Address: `St, 3, k �. moM c...--r- Additional inspection (I hr min) 66.25/ hr
(� Q Investigation (I hr min) 66.25.thr ;
City /Slate/ZIP: G\a LAC e4tw1 GS O y_ - r1 15 Industrial plant (1 hr min) 78.18 / hr
Phone: (5) 6S14=,'yi i,, 7 // / lax: {`,U3 1D
) 5�1.
�i � 5, Inspections for which no fee is 90 hr
specifically listed (IA hr mir.)
CCB Lic.:a1 9 Electrical Lie.: -5c_ Suprv, SLI S ELECTRICAL PERMIT FEES
Suprv. Electrician signature. required:
CL
Subtotal. 51p. I
Plan review (25% of permit fee)
Print name: ll '"� Da �?� Z t State surcharge(12 %ofpermit t p ,1t --I - t
C4, a.
I
TOTAL PERMIT FEE 1„2. t 2_
Authorized signature: g This permit application expires if a permit is not obtained within ISO
�t.0 ✓Les
days after lowed per neon il,
has been accepted as complete.
G
Print name: , y 1 t S Date: Z� Z� 1I • Nu:nbcr of i nspectionsal
I • .Building.Penuns.ELC PermitA',p clot O7e01,10 440-4515