Permit (75) CITY OF TIGARD ELECTRICAL PERMIT
h ,, COMMUNITY DEVELOPMENT 7 ,? Permit#: ELC2017-00899
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 2 Date Issued: 12/05/2017
7 Parcel: 2S110AA01000
Jurisdiction: Tigard
Site address: 14220 SW PACIFIC HWY
Project: Gardner's Choice Subdivision: None Lot: None
Project Description: Convert 240v to 120v,safe off wires,move junction boxes. 12/8/2017: REPRINT permit to add(1)branch circuit
for water heater.
Contractor: BEAR ELECTRIC Owner: GCI PROPERTIES LLC
PO BOX 389 GCI INVESTMENTS LLC
DONALD, OR 97020 10430 SW VIEW TERR
TIGARD, OR 97224
PHONE: 503-678-1355 PHONE:
FAX: 503-678-1108
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 12/05/2017 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/05/2017 $7.63
Type of Use: COM Electrical
Class of Work: ALT 1 crt Branch Circuits w/Purchase 12/08/2017 $7.42
Service or Feeder
Type of Const: 0 ea 12%State Surcharge- 12/08/2017 $0.89
Occupancy Grp: Electrical
Total $79.54
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throug R 01-0 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �G'�
Permittee Signature: (V(,/ "/7 / ��/e4-77 Le'\
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 503.639.4175 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.
1
Electrical Permit Application ' Folz;I C10E USE O{ LlIN '
1 Received
Cityo Tigard /
f �, , A" Date/By: /2 O 7 .'.IIS'" Permit#: Edi i 7— ?--
13125 SW Hall Blvd.,Tigard,OR 97223 A , Plan Review
Phone: 503.718.2439 Fax: 503.598.1960- `l�I Date/By: Related Permit#:
Inspection Line: 503.639.4175 R DateB f7J See Pa e 2 for
TIGARf3 g g { y' /2/e/7 "s' $
Internet: www.ti and or ov t� d/Method._./ !'> Il.� Supplemental information
0 New construction "Additiorl/alteratlon/re r : en t , ` Please check all that apply(submit a sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories,
❑Demolition ❑Other: a where the available fault current 0 Marinas and boatyards.
Wil e s_ i ..4,.. 'i Ws 6 z' 0 4,0 74..,.f.',2 exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ I-and 2-familydwellingCommercial/industrial less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 ❑Accessory building
amps for all other installations. buildings.
0 Multi family 0 Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or
W° ,„ "` # .far ; 1 py + 6 „,aq ;' ❑Emergency system. larger separately derived
.
L4 2 i7 i I i t'l/ ❑100H oo of oew molar load of system.
Job#: Job site address: 100HP or more. ❑"A""E `t-2""l-3",
City/State/ZIP: -II'1Project name:t C ("2 (, '1 �' M ❑Six or more residential units. ' up on
t` ❑Heatth•care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#;
0 Hazardous locations. 0 Supply voltage for more than
600 volts nominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site: �.'' i
Description IQtr. I 'Each L Total •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
; Ea.add'l 500 .ft.or portion 3 . 1
„_ sq io 3 92
. , , `s I1 .4 6 %t6 Gig)
° tt�ttyx I ,_ 41. Limited energy,residential `
A -o palm t e E L C 2-011'- () Gf acid Hi On i, (with above sq.ft.) 75.00 2
f Limited energy,multi-family 7500 2
tV" t of VJ ,r- )% residential(with
RenewableEne ❑ SeePage2rgy q )
Bove s .
s :. u " 6 1'4'; - f;,4 . :,fa Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps _ 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: DaTe: 401 amps to 599 amps 168.54 2
.fait8 Branch Circuits-new,alteration,or extension,per pane
i
'' m
A.Fee for branch circuits with
Business name: €,A' -51€ r c, 1 flG above service or feeder fee, 7.42 2
/t each branch circuit
'
Contact name: tiSSO. W( (11 ( .V15 B.Fee for branch circuits without
Address: po X 3sq service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Dona Donald O Cr? 0 2 0 Each add'l branch circuit 1 7.42 1.<-1'"X<-1'"X2
c
Miscellaneous(service or feeder not included)
Phone:
(50-i )(01.3- (-3 S j Fax::(503) (n'}5'- I 1 0? Each manufactured or modular
67.84 2
Pe, vn, + • e — t e.c- �t„ dwelling,service and/or feeder
Email W Reconnect onl67.84 2
` iti ' - ' v.g. Tk ' a. SEt?s.-!.ttlk Pump or irrigation circle 67.84 2
Business name: 13 - E. lee I C/ 1a� Sign or outline lighting 67.84 2
Address: Po 80,v 3 -. Signal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Don et i / ci q-702. Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) _ 66.25/hr _
Phone:(s�j ) (t)-7"- / '5 � Fax:(503 ) kg?-flak Investigation(1 hr min) 90.00/hr
Email:Pe.-m l+S ' 5p..�'r -�(e�C. C rQ i Industrial plant(1 hr min) 78.181 hr
1 Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.:2s.1./07 Suprv.Lic.: '1s s• tfifcait hstedI/:hr min
o
Suprv.Electrician signature,required: ),�_ Subtotal: 1•L!
Print name: €f j I/{0 (? t Date:1401111
❑Plan Review Required(25%of permit fee):
` ' Y` ' State surcharge.(12%of permit fee): .` ci
Authorized Signa ,
TOTAL PERMIT FEE: I.3 t
This permit application expires if a permit is not obtained within 180
Print name' p �, f 01 Date: 12107/./7 days after it has been accepted as complete.
r``�*t u a Number of inspections allowed per permit.
1:1Building\Permits\ELC_P itApp ELR_ERE:doc Rev 06/17/2015 440-4615T(1I/05/COM/WEB