Permit _ 1 " OF TIGARD ELECTRICAL PERMIT
IN
k " v PERMIT #: ELC2007-00054
COMMUNITY DEVELOPMENT
'' DATE ISSUED: 3/19/2007
Tt s 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DD-00200
SITE ADDRESS: 11560 SW 67TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT : 004 JURISDICTION: TIG
PROJECT: GREEN OFFICE BLDG. VESTIBULE
Project Description: 1 branch circuit.
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: SIGNAL /PANEL:
MANF HMI 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:
JOE GREEN INVESTMENT CO BEAR ELECTRIC
PO BOX 1 P.O. BOX 389
DONALD, OR 97020 DONALD, OR 97020
Phone: 503 - 970 -2927 Contact #: PRI 503 - 678 -1355
FAX 503 - 678 -1108
FEES
Description Date Amount Reg #: ELE 24 -107C
[TAX] 8% State Surcharge 3/19/2007 $3.75 LIC 20919
[ELPRMT] ELC Permit 3/19/2007 $46.85 SUP 4902S
Total $50.60 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 suspended for
more th- • :: : - s. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR • 2- 001 -0010 ough 0' ' • '2- 001 -0100. You may obtain copies of these rules or direct questions to OU 03.246.6699 or 1.800.332.2344.
Issu By: • / �41 Permittee S ignature: Z _ _
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: � . - i / _ ■ / ^ // DATE:
LICENSE NO: , i' ,
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.
" Application : (a. } \i 171) FOR OFFICE USE ONLY
III City of Tigard Received �?, permit No.
131 25 SW H all Blvd., Tigard, OR 97223 I ANI l`. / D ( Date/B A a / 36 ti „i01.--00.0 A
g d J Plan Revi- Phone: Other Permit:
In ection Line: 503.639.4175 GI i 1� iLl Date/B .
T I G A R D p I; Y Ut (1 t11Vl C tn1' Date Ready/By: )aria: ®See Page 2 for
Internet: www.tigard - or.gov L{lll�� Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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 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 ", "1 -3 ",
Job no.: Job site address: // 5 .SW.C7/1'Gp Six or or more. R occupancy. Recreational a
�� - / ID Six or more residential units. ❑Recreational vehicle parks.
City / State/ZIP: / l 64-gn o h 9'q 2,0 ❑ Health -care facilities. ❑ Supply voltage for more than
/ Hazardous locations.
• �i�CClJ 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 6g t;nope v r/ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Fee
Qty. 1 1 Total
& Q / / p / New single -
V for (/ ,PI Ave_ " 1 l eel A Includes attached residential garage. or multi- family dwelling unit.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
� L I Limited energy, multi - family
(1 ) f I Alit ci C-v i f / / t , el e /A 4/ / /444 residential (with above sq. ft.) 75.00 2
I
€ C �•.-- (') 'v, I( Mo(/n T [(91 Services or feeders installation, alteration, and/or relocation
LLJ 200 amps or less 80.30 2
gig PROPERTY OWNER I TENANT 201 amps to 400 amps 106.85 2
'nt/el MeA . 401 amps to 600 amps 160.60 2
Name: rot T
601 amps to 1,000 amps 240.60 2
Address: (4p b,„ I Over 1,000 amps or volts 454.65 2
City/State/ZIP: 7 jj t d OX 9 70 4.0 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 170 29 L7 I Fax: ( r e 3) 6In 6 266 200 amps or less 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 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A Fee for branch circuits with
APPLICANT 1 ' ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: T tfZ t ti A,t.ct+-( f'1 ' f V t B. Fee for branch circuits
� _��� without service or feeder fee
Contact name: n 'T(lil / 46.85 /// 2
( first branch circuit ZZ ffee 0 10
Address: Pc 6.O k at/ Each add') branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: pnnq 1J op_ q1 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (5.3 )1 $R IA q Z Fax: : (So 3 ).'73 703 Reconnect only 66.85 2
E -mail: In ft n t fe a rG( t tt' re LD W1964194 i h e!,1" Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: n - Signal circuit(s) or limited-
/? &_�- Z &i4 /G energy panel, alteration, or
Address: ZD 9 S $"- ,13v C r i/e A d N, extension. Describe: Page 2 2
City / State/ZIP: Po 1Q J vA. glow Each additional inspection over allowable In any of the above
/
Phone: v (503 1 -- Fax: t50 3) 67 Y � LJ / /Do Inve inspection ) � 7 0 35 - Investitigattion ion 62.50
per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 -----
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: qt. `j am
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): �
T 3,, 7�
C Authorized signature: / TOTAL PERMIT FEE: .5 ) . w This permit application expires if a permit is not obtained within 180
Print name: Date: y days after it has been accepted as complete.
' Number of inspections allowed per permit
I:\ Building \Pennits\ELC- PermitApp.doc 05/23 /06 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: •
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL. WORK ONLY:
Fee for each commercial $75.00 •
system
(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
•
I:\ Building ''ainits\ELC- PermiWpp.doc 03/23/06
C;`
CITY OF TIGARD
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
RECEIVED
MAR 2 2 2007
Electrical Signature Form
CITY OF TIGARD
P LANNING /ENGINEERING
IMPORTANT PERMIT NOTICE
BEAR ELECTRIC
P.O. BOX 389
DONALD, OR 97020
Permit #: ELC2007 -00054
Date Issued: 3/19/2007
Parcel: 1 S136DD -00200
Site Address: 11560 SW 67TH AVE
Subdivision: WEST PORTLAND HEIGHTS
Lot: 004
Jurisdiction: TIG
Zoning: MUE
Project Name: GREEN OFFICE BLDG. VESTIBULE
Description: 1 branch circuit.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
JOE GREEN INVESTMENT CO BEAR ELECTRIC
PO BOX 1 P.O. BOX 389
DONALD, OR 97020 DONALD, OR 97020
Phone #: 503 - 970 -2927 Phone #: 503 - 678 -1355
Reg #: ELE 24 -107C
LIC 20919.
SUP 4902S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X -� /�� ��tte,,e. j c2. �v� S� S��
Signatur f Sup isi E lect a Name (printed) SUP LIC #