Permit CITY OF T I GAR D ELECTRICAL PERMIT
PERMIT #: ELC2004 -00049
DEVELOPMENT SERVICES DATE ISSUED: 2/3/04
+L „ ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2 S 112AA - 00300
SITE ADDRESS: 14200 SW 72ND AVE
SUBDIVISION: ZONING. I -
BLOCK: LOT : JURISDICTION: TIG
Project Description: (2) branch circuits in conference room.
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: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 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 13265
LIC 00002629
FEES ELE 3 -5C
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 2/3/04 $4.28
[ELPRMT] ELC Permit 2/3/04 $53.50 Rough -in
Elect'I Final
Total $57.78
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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forts • . • - • e s -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC 246 -6699 or
:00- 332 -2344.
ter'
sued By: ►i!),�� � n04, Permit Signature: jgp
i
OWNER INSTALLATION ON
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:
LICENSE NO: 50 5
Call 639 - 4175 by 7:OOpm for an inspection the next business day
` • E lectrical Pe Application . •
Datereceived: , argm Permit no.: •L ,,,, •-4(001
r.ref.1 0 1 , i 6.
_ail, ; •I 1 1 City of Tigard Project/appl. no.. a date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: ,FM Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OE PERMIT
0 1 & 2 family dwelling or accessory A Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: / 51,0 '7Z =C_ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name:: 1 Description and location of work on premises: cR Gk5 cm, men c_ 1 .7044
Estimated date of compietion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDULE .
Job no: Fee Max
Business name: ix'C L c r c,
Description Qty. (ea.) Total no. insp
New residential - single or multi- family per
Address: cj >� C L(2LVc k dwellinganll Includes attached garage.
City: [�I Cc C j.. r vi G.S I State: O L I ZIP: C i((T Service mcluded
Phone: (o5(0- i 3 i ( I Fax: (o$/ 7 I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: ) <G c j I Elec. bus. lic. no: 3-5C._ Limited energy, residential 2
City/metro lic. no.: c 55 Limited energy, non- residential 2
C a. — 3 --cY'l Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): ,,. 11 4-zy- License no: S ly S Services orfeeders - installation,
Su
p �L lQ ,c(15 15 alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): e -j i I (,i(jQ__ 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temp services or feeders -
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
i x. . ..: --: _ Branch circuits - new, alterateon,
• or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 'State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: / 2
Phone: Fax: E-mail: Each additional branch circuit: /
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps -rating of 1&2 O Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 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:
0 Egress/lightingplan 0 Other Per inspection I I I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards. please call jurisdiction for more information. Notice: This permit application Permit fee $ ..,9 U
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
• Credit card mumbo; / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. T $ - 1 . 7
Name of cardholder as shown on credit card
$
Cardholder signature Amount 4444615 (6/00/COM)
Electrical Permit Fees: Limited-Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular 1=1 Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other •
Over 1000 amps or volts $454.65 __ 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918-260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved: -
Over 600 amps to 1000 volts, r �
see "b" above. I I Audio and Stereo Systems
Branch Circuits ❑
New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit / $46.85
Each additional branch circuit 1 $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the aI!rv:able in any of the aba�.
Per inspection $62.50 Li Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting*
Fees: ❑ Protective Signaling
Enter total of above fees $ 53.5D ❑ Other
8% State Surcharge $ 4' 273 Number of Systems
25% Plan Review Fee
See flan Revi ew" section on $ * No licenses are required. Licenses are required for all other installations
Review"
front of application. •
Fees:
Total Balance Due $ .-'' i1 S<
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i :'dsts\fonns\elc- fees.doc 10/09/00
•
CITY OF TIGARD 24 -Hour . .
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION =Business Line: (503) 639 -4171 MST
�/ , / BUP
Received Y.3 3 e � � Date Requested AM PM BUP
Location J4/ 2- n ! Z !2 Suite // MEC
Contact Person Ph ( v 65 ' — 23 6LM
Contractor ,/3'1 -1.-C- Ph ( ) SWR l /
_ BUILDING Tenant/Owner L 4/ - 0d 0'Y 9
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
•
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service •
Sanitary Sewer -
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service _
Rou h CL,(,
G/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
cpA PART FAIL
SITE Please call for reinspection RE: / 0 Unable to inspect — no access
Fire Supply Line
ADA �
Approach/Sidewalk Date Inspect . / .. `• _ / _ - Ext
Other:
Final DO NOT R MOVE this inspection record rom th ob site.
PASS PART FAIL