Permit `� �` -.�: ELECTRICAL PERMIT
Ili `.� CITY OF TIGARD
.1 + /� PERMIT #: ELC2007 -00043
COMMUNITY DEVELOPMENT / l�� i DATE ISSUED: 1/22/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S135BC-00700
SITE ADDRESS: 10795 SW CASCADE AVE ZONING: I -P
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Portland Vineyard Church - (3) branch circuits for sound booth and projector.
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: SIGNAUPANEL:
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: 2 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:
AMB PROPERTY L P BEAR ELECTRIC
BY TRAMELL CROW NW INC P.O. BOX 389
8930 SW GEMINI DR DONALD, OR 97020
BEAVERTON, OR 97008
Phone: Contact #: PRI 503 - 678 - 1355
FAX 503 - 678 -1108
FEES
Description Date Amount Reg #: ELF. 24-107C
[ELPRT] ELC Permit 1/22/2007 $60.15 LIC 20919
M
[TAX] 8% State Surcharge 1/22/2007 $4.81 SUP 49025
Total $64.96 REQUIRED ITEMS AND REPORTS
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
suspend- = • r more- ian 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Thos- rules are set for h in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain cor - • hese rules or direct questions to OUNC at
50 .246.6699 or 1.800.7.3 . .
Iss • ed By: Permittee Si • ature: / ' • ;�41 .
/
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:
V ,
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
01/19/2007 FRI 15:54 FAX 5036781108 Bear Electric. Inc. 2001 /002
4. ` / SAS � - 1 5Aa�( C�v�� - t
Electrical Permit Application
FOR OFFICE USE ONLY . :.. ...., - :.:;..;::,:;: ;:. : .=: ; -;
City of Tigard JAN 1. ) ifix rr Re Da/Br e ive l l 9 �7 Permit No.: f LC �JQ 7 3
13125 SW Hall Blvd., Tigard, Ol Plan Review
Phone: 503.639.4171 Fax 5o3.
71 6®F TIGARD Zce• v•••1 i & DawB : Other Pear&
Inspection Line: 5 111)11 -- c`' Date Ready/By: I H See Page 2 for
Internet: www.ci.tigard.or.us I If Notified/Method: t 6.. Supplemental Information
xm
z t zP - "C a` ss N r r "Sys , ,RI ,n- ra -. {•. .r.,.r vt ,r , -r " e-
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';'11 r ie? ;�. , ', , g ; 1 , ., > - r �y- 3.k. ,.".,t• •g ,j•i 3 . . • r • :
• '� . - n A. r'.. � - Kea " �� � 7e -41�. '�/'wt�� S.ir� r : �.;r _.;.�•. • .: � r °'-�' :. ,
❑ New construction I Addition/alteration /replacement Please check all that apply:
❑ n Demolitio ID Other: OService over 225 amps, comm'l DHazardous location
%_ :u ` Demolition
r , fi r.� yP' . � ;r �+ ,� _ �� :I x. ❑Service over 320 amps - rating ❑ Buildng over 10.000 sq. fr.,
"0 ` ^" -` *Z. ` ate 4 1 - . k tW 4 ' =� r . r a t' •' of 1- and 2-family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building ❑S'stem over 600 volts nominal units in one structure
❑ Multi- family ❑ Master builder ❑ Other: ❑Budding over three stories ❑Feeders, 400 amps or more
y ,e ' c t: ", � . fi , - i : , f- F - m q - o - j k201 - '41'"''''''''1.'t Y ° Occ spn t load over 99 persons ❑Man structures or
w� �� e - - � i< ° . :i1 ' & gP
RN park
Job no.: I Job site address: I l C\ 5 1,J CI Aek V ❑Health -care facility ❑Other:
� A Submit 2 sets of plans with any of the above.
City/State/ZIP: I t Rl�` OK • 19,x3 The above are not applicable to temporary construction service.
-_ Suite/bldg./apt no. -- - - Project name: / / y { . -r . t .- t '
t
�' Description • ' Qty. Fee. I Tout I •
Cross street/directions to job site: (fAZCN � 4:0A - CFr A , il VG New residential single- or multi - family dwelling unit.
rt+� /'t Includes attached garage
1,000 sq. ft. or less 145.15 4
$ubaivisiori - ........ L ot no.: Ba: aid'! 5015 sq ft or p ortion 33 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non -residential 75.00 2
v ? ' �y p r '�, .s • .a te o ' td• ' � z - O - -C+`' " -� � " A rt , . . y 4
• . , ` ° - ;� `" -w : � �{ 5'" :ak , t Each manufactured or modular
i x C'la - 3 ^ CcPLC.S 4-0 svadvA i� -�- A dwelling, service and /or feeder • 90.90 2
``__ __ t Services or feeders installation, alteration, and/or relocation
) DLO eC'C� •`' 200 amps or less 80.30 2
.5 0Aft[7 "e' f .- 2IA,W -', ` £ : � s ! nw,, 201 amps to 400 amps 106.85 2
z.• 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 12
City/State/ZIP: Reconnect only 66.85 I 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 I 1
Owner installation: This installation is being made on property that I own which is not ' 201 amps to 400 amps 100.30 I 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 600 amps 133.75 j 2
Owner signature: Date:
��qq - �„•{, Branch circuits - new, alteration, or extension, per panel
r „t . s a i � a z ' "wo c k i ' A Fee for branch ci with
service or feeder fee, each
Business name: '--1-7- /r 6.65 2
l f ` branch circuit
Contact name: 1 e_ )'1,o a . B . w ee ou branch or feeder A-a_kx d QQ
without service or feeder fee, , 46.85 ti& &5
Address: 5 A _ each branch circuit 2
City/State/ZIP: Each add'l branch circuit _ 2 6.65 \3 .`3p 2
�' Miscellaneous (service or feeder not included)
Phone: (C p'; ) 3 v.& .. 9` ■--g, l Fax :: ( ) Pump or irrigation circle 1 53.40 2
E -mail: _ Sign or outline lighting 53.40 2
` �...; �} �. y.? sk=- 37:` 5•, T-. t7>.`.' y -moo- � -rte �� .�..
Signal circuit(s) or limited -
•� 2 sc�- r z c 74 c `{�s ,�=� -. = �A.: energy alteration,
;�%s�.:.�. � ^tL �':�'f�.'Tr`y�.�c�' ��.0 - ?v�� :-r. �.= L��,� -r� ;.,'i.'`a:� e�' anel panel, or
. Business name: Ghat r C - 1 e ; extension. Describe: • Page 2 2
Address: P 0 r (2, DoL 3 8-1 Each additional inspection over allowable in any of the above
City/ State/ZIP: Per inspection 62.50
�ortc l (-eso --i 01 ', p 2_0 Investigation per hour (1 hr min) 62.50
Phone: ( c o 3) ( , 5 , 7 8 -.- 1 3r-s- Fax: (5'63) Co 7 ir _ / i 0 e Industrial plant per hour "�� 73 -75
CCB Lic.:7_ pc t e Electrical Lic.:2q,4 c, i Suprv. Lic.: 31(,z_. ' Subtotal 0 . 1 S'
Suprv. Electrician signature, requir r /e_e � _ Plan review (25% of permit fee)
Print name: �,� e lox
O ° w.. I < ++ Date A Y %Loi -•Pi s State surcharge (8% of permit fee) /j . '
Authorized signature: TOTAL PERMIT FEE o 4 1
This permit application expires if a permit is not obtained within ISO
Print name: days after It has been accepted as complete
Date: • Fee methodology set by Tri -County Building Industry Service Board
"' Number of inme:tinnc ner nermir allnwed.
02/06/2007 TUE 15:20 FAX 5036781108 Bear Electric,Inc. U001/001
. A - Building Division -
JVIt P. A9,1v Appli cant Request to Cancel Perm "
City of Tigard
F-L3 O 6 001
TO: CITY OF TIGARD, BUILDING OFFICIAL Un or i iu1 a)
13125 SW Hall Blvd., Tigard, OR 97223 ( pi'!r, nri
Phone: 503.639.4171 Fax: 503.598.1960
FROM: Applicant Name: &c,/
V Mailing Address: P.. o . '3b „
0 City/State/Zip: ovI A � Q re ''► b o Z
� Ste' )
0.:A7/,o; 7 17
Phone No.: ro 3 7 1 - 1 3r,r.
Fax No.: 4 I/ O
PLEASE CANCEL PERMIT APPLICATION AND REFUND PERMIT FEES, IF ANY,
FOR THE FOLLOWING:
Permit No.: 414 ZO 0`7 0 O 0 (1 3
Type of Permit: .
Site Address: / x 79 5 E. cS?J htrco cJ..e ,4 (-
Subdivision: Ti S� O '�'`
Lot No.: t I 5 4,,
EXPLANATION: J O hale_ C'. u c_e_. / j1 9 'C o t 11
p ezi,t; f- 1 A , L, ii a�/ t "Le �'��/yt� �¢-I� t� 4.40 /t/.k
f t f)pc4rf
p �
Signature: Cite / e'd- -d r1-7 Date: v
Print Name: r y / i2 p to (o cQ2
FOR ,OFFICE USE ONLY
Route to Admin.: Date: j4 0 By: 1'
Permit Canceled: Date: , /3 /o 7 By: 4W---
Refund Processed: Date: 2/3/ 7 By: •
07-x/3 /aayo7 C 60, /5co Palo — y / 42 /1-
i:\ Building \Fonns\RegCancelPeunit.doc