Permit n CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2012 -00252
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/10/2012
Parcel: 2S112AA00300
Jurisdiction: Tigard
Site address: 14200 SW 72ND AVE
Project: Gerber Blades Subdivision: MILLMONT PARK Lot: 49
Project Description: (1) sign lighting.
Contractor: VANCOUVER SIGN COMPANY INC Owner: GERBER LEGENDARY BLADES
2600 NE ANDRESEN RD #50 14200 SW 72ND AVE
VANCOUVER, WA 98661 PORTLAND, OR 97223
PHONE: 360 - 693 -4773 PHONE:
FAX: 360- 693 -2747
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/10/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 05/10/2012 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
•
Total $75.98
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. ATTE : Oreg. • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 thro • gh OAR 9 -• 11 -1090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19: • r 1.800. • 2. - .4.
Issued y: ` /L ,,e, r, Permittee Signature: / d
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 503.839.4175 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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard � 1VED Rec eived Permit No.: A .. () J.
° 13125 SW Hall Blvd., Ti azd, OR 2 DateB : �` �1
Tigard, Plan Review •
C : Phone: 503.639.4171 Fax: 503.598.19� Date/B : Other Permit:
T I c n It D Inspection Line:' 503.639.4175 IVI 201 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard or.gov /. Notified/Method: Supplemental Information
TYPE OF
OF 'IMAM PLAN REVIEW
I A� v DIVISION Please check all t apply (submit 2 sets of plans w /items checked below):
❑ New construction ,1 Addition/altera o replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
❑ 1- and 2- family dwelling Er Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: /2/ 200 5 L,3 '7 Z AID A V E I Six or more residential Recreational
❑ Six or more residential units. ❑R vehicle parks.
City / StatelLIP: T; 0.0.r O 1 z �
❑ Health -care facilities. ❑ Supply voltage for more than
0
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: lief 6ef' glt es ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee- I Total I •
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: as n 2. A AQ O 3 00 ' A 5i OS 33 Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
A Limited energy, multi - family 67 84 2
(1) i �( I IA WI . 1 n.6 /P./ 'CC P.Pi� -t art ( l. I Yl G( S.N i3 n residential (with above sq. ft.) _
i J Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ja TENANT 201 amps to 400 amps 133.56 2
Name: Ge C b,, Q 6 c.E..S 401 amps to 600 amps 200.34 2
l� 601 amps to 1,000 amps 301.04 2
Address: 1 200 s W ?ZA/D A Over 1,000 amps or volts 552.26 2
City / State/ZIP: j ` 0 Temporary services or feeders installation, alteration, and/or
T qa R ci f ZZ Li relocation
Phone: ( ) � Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel _
A. Fee for branch circuits with
IZI APPLICANT I ® CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: V0.Yl.! OtA u ex, C csy1 B. Fee for branch circuits
Contact name: J without service or feeder fee, 56.18 2
R e,r �. 5t() CM first branch circuit
Address: Z (CO A/F- A arse n a fS,, Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: 0 44.444 0 e,c- tA.)A '7g6 G 1 Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( 3600 ) 6 11772 Fax:: ( 360 19q3 Z797 Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting (/) 67.84 2
Signal circuit(s) or limited-
Business name: Did .l'tGA IA.ueif S ig17 energy panel, alteration, or
t� extension. Describe: Page 2 2
Address: 2 (ono NE Ayija erri Rd,* SO
City / State/ZIP: � YI,G n t /u _ - /A3 i $G, I , 1 Each additional inspection over allowable in an of the above
Per inspection 66.25
Phone: (36O) bq 3 4177 Z Fax: ( 360) 69'3 X7117 Investigation per hour (I hr min) 66.25
CCB Lic.: e R ci s I Electrical Lic.: 37_ L/ GL.$I Su . Lic.:
524 _ 51 industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 5 a Subtotal:
Print name: 84/ Date: •.3 //"' � // z Plan review (25% of permit fee):
�� /^^^ State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:, f7 5 '_g
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
. • Number of inspections allowed per permii. .
I:\ Building \PcrrnitsELC- PcrmitApp.doc 10/01/09 , 440 4615TOI /05/COM/WED _