Permit A ---. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00010
J i I DEVELOPMENT SERVICES DATE ISSUED: 1/10/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2 S 112AA -00300
SITE ADDRESS: 14200 SW 72ND AVE
ZONING: I -H
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Electrical industrial equipment relocation of AUTO RIVETER cell.
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 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: 3
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:
GERBER LEGENDARY BLADES BECK ELECTRIC INC
14200 SW 72ND AVE 9318 SE CHURCH ST
PORTLAND, OR 97223 CLACKAMAS, OR 97015
Phone: Phone: 656 - 7396
Reg #: SUP 1326S
LIC 00002629
FEES ELE 3 -5C
Description Date Amount
Required Inspections
[HRELC] Hourly Electrical 1/10/03 $175.23
[HRTAX] Hourly Rate Tax 1/10/03 $12.27 Elect'l Final
•
Total $187.50
This Permit is issued subjed 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 - -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct qu s t• c N .t (503) 246 or
1- 800 -33 344. �,� _ I 1,, ,, A
Issued
y: - �- et.4,4�L / Permit Signature: ' k t } 1/ V v"' �----
OWNER INSTALLATION ONLY ill
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: VsQ i i � /j- • -• DATE:
LICENSE NO: It /5,,V
Call 639 -4175 by 7:OOpm for an inspection the next business day
• 4- Electrical Permit Application •
Datereceived: / ffp Permit no.: EZ4p7v.e40/0
. A 1 ', City of Tigard Project/appl. no.:
pp Expire date:
- CiyofTigard I3f23�WIbal1 Blv�, igar., OR 9722 Date issued: - By:.... Receipt no.; ; •
Phone: (503) 639 -4171
' Fax: (503) 598 -1960 Case file no.: ' . Payment type: " ' :r • •' < •
• Land use approval: -
TYPE OF PERMIT
O I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
1 O New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
1x: ^ r;w'i f �'..nnpp. 7 mn.N axa :5+.;.r�S1io s � ,
-1-'7,:
lfi`E I��Q[(1�[L[�1R •. _ . ,a—p s . .rc1' : t_.. . ? ..
Job address: , x,00 S.w.7a - Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: e l
,,t))
Project name: 1 Description and location of work on premises: AU,'(a � 1V a01( C.e 1,4,1
Estimated date of completion/inspection: _ .. /-0 �.?'^
CONTILICTORAPPLIC1TION . . FEE SCHEDULE
Job no: Fee Max
Business name: Sea' %�p� -1y -i,. Description Qty. (ea.) Total no.
[
New residential - single or mufti-fan* per
Address: q 3 g jG Gk, t i ; dwelling unit. Includes attached garage.
City: C-\ a_c_Kctvvt.CtS 1 State:pie_ 'ZIP: 9 Service included:
Phone: Li ,56.1 3`j is I Fax:(` '/357 E -mail: moo sq. ft. or less 4
CCB no.: '26. Elec. bus. lic. no: 3 -5c, Each additional 500 sq. ft or portion thereof
_ a:J� _� Limited energy, residential 2
City /metro lic. no.: J Limited energy. non- residential 2
/��jt //,:3,75-__T
v ' Each manufactured home or modular dwelling
Signature of supervising ele ( tred) Date Service and/or feeder 2
Sup. elect. name (print): /../.)4L fit ,.) . ,f,47,7 j'Bvi License no: 1 6, - �� Senica or feeders fi installation,
PROPERTY OWNER altera
200 amps or less 2
Name (print): 1),e,} 6.4 (beC 'JOSeph ' 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address Q Box p' 601 amps to 1000 amps 2
City: w ids c . I State: OR !ZIP: G73 (0eq Over 1000 amps or volts • 2
Phone: 435- 5''1321 Fax: 1 E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - . .
which is not intended for sale, lease, rent, or exchange according to alla8otyalteration,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am .s 2
— , _ . . _x - ._
.... :. ...-.. Munch •t •-� - i:�GINE.Is� : :_ � -. : _. _-- � :� -� :.. - _ ,,j,.__ . new,
Name: • or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: [State:. 1 ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee. first branch circuit: 2
Each additional branch circuit
PLAN REVIEW (Please check all that apply): Mlsc . (Service or feeder not included):
O Service over 225 amps - commercial • 0 Health -care reality Each pump or irrigation circle 2 ,
O Service over 320 amps - rating of 1812 0 Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel.
O System over 600 volts nominal more residential units in one structure alteration, or extension' 2
O Building over three stories 0 Feeders. 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lightingplan O Other Per inspection ( 1 1 1
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other AI l[ L i t 7 . 1 . '
•
Not all jurisdictions accept aedit cards, please call jurisdiction for more information. Notice: This permit application Permit fee
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
• caeca card number / 1 within 180 days after it has been State surcharge (8%) .. -- $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
S
Cardholder signature Amount
440-4615 (6/00IC0M)
•
JUL -31-03 08:07 FROM- GERBER LEGENDARY BLADES 5036203670 T -240 P.02/03 F -061
E b2w3-600 , 0
Building Division
1`4'1l'" Applicant Request to Cancel Permit ED
Cit a Tig ard RECTI
JUL 3 i 2003
TO: CITY OF TIGARD, BUILDING OFFICIAL CITY pF TIGARD
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639,4171 Fax: 503.598.1960
FROM: Applicant Name: &4Y'b-/1J) tai f
Mailing Address: Pea R r ( 30 $g BUILDING DIVISION
City /State/Zip: J ov ' r \ t; /t_ 4 d Z q?
Phone No.; 503 "i 03 t 1'E 1
Fax No.: (a3 /21-0 3 b1 o
PLEASE CANCEL PERMIT APPLICATION AND ROUND PERMIT FEES, IF ANY,
FOR THE FOLLOWING:
V O (P P. "N°': E.i...0 X003 - coo l O (F1u:rd la Lre./L -
TypcofPermit: g , s , & tt'AL . . E uP AtJi}C£M
. 1 - . Aae o 7'. ?....
Subdivision: 44 _
Lot No.: IJ /i4
EXPLANATION: 14. le - Pra t t 1 1E-erL7 ‘44-h>41-AN 1.i34-
ti' i : L.. ILO O&? t - ' _ r . ■ . .
144vot.. - Esta c1.:b 5tiT) a cLTj of - r aiik..
Signature: �1- Date: 7/0 a
Print Name: 7 tea _44 . - 114 a l .
rcili OFiii F, usi; ()NIA'
Route to Admin.: Date: B :
Perrait Canceled: Date: B :
Refund Processed: Date: By:
c20 -o3_ //3
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