Permit (17) q CITY OF TIGARD ELECTRICAL PERMIT
m -; COMMUNITY DEVELOPMENT Permit #: ELC2010 -00056
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/03/2010
Parcel: 1S136DD05300
Jurisdiction: TIGARD
Site address: 11850 SW 67TH AVE, STE# 100
Subdivision: TIGARD TRIANGLE COMMONS Lot: 13
Project: Broad River
Project Description: Install sign /outline lighting.
Owner: FEES
PNWP LLC #2 & Quantity Description Date Amount
PNWP LLC, 6600 SW 105TH AVE #175
BEAVERTON, OR 97008 1 ea Sign or Outline Lighting 02/03/2010 $67.84
PHONE: 503-626-3500 1 ea 12% State Surcharge - 02/03/2010 $8.14
Electrical
Contractor:
ES & A SIGN & AWNING
5856 NE COLUMBIA BLVD STE 200
PORTLAND, OR 97218
PHONE: 503 - 542 -2100
FAX: 503- 542 -2105
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $75.98
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 wit
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 OAR 952 - 001-- 01 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Ng ea I't a, Permittee Signature:
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 —n _ API) Date:
LICENSE NO. `C(
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.
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Electrical Permit Application - I Fl)R (11. FIC F USE ONLY
City f Tigard Received
` g �Q n I Dnte 6 ' I Permit No.: A 6 . . •O(j(_
: . , • 0 13125 SW Hall Blvd., Tigard, OR 97223 Review vv�D
, Phone: 503.639.4171 Fax: 503.598.1960 ea O ` paterPlan Bv: Other Permit ` I t Q .00012_
• r i C A 1 . I ) I Inspection Line: 503.639.4175 Date Ready /By: nial ® See Page 2 for
- - - -- Interact: www.tigard or.gov Notified/Method: Suppkmental information
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❑ 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 r..4 Other: 31 t^ where the available fault current
or ❑ Floating buildings.
t �'/�,TS'u.,a '� a r>w >• ti c z � [ ; �:.erx � t ._.� aKwt ,. exceeds 10,000 amps at 150 vol ❑Marinas and boatyards.
a s c+ t 1 u ; ; rs r i t t a r y,M1 volts n5 A , +.. s i' `4 „ ..,. 3..; � ,-,...r_, rti' :I.n r 3r A',.. . ' , Y ::,i . + i re 4"!:i less to d, or exceeds 14 I- and 2- family dwelling NI Commercial/industrial ❑ Accessory building a g` oun .(NXI ❑ Commercial -use agricultural
El for all other irtstallntions. buildinlrs.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
Y " s n : fir ii0 z x v ., H err r , a y y - y ? , p c .j a _ ❑ Emergency system larger separately derived system.
f Y4 „V j+t Y'+' <(t ! t - '111 \ I / i y 4ys ft.Yi�: r .A t k ..` ..3t 3ic'nti,�.
s',.,_..,.�. r. ... ... �ck..d.��{a:t c,$mt • }.th -.a >s�5 ..... ate., ❑Addition of new motor load of ❑ "A" "E" "I -2" "I -3"
Job no.: t 0 S 32_ Job site address: t I g$p 1 to-141" A.VP- 100HP or more, occupancy.
❑ Six or more'residential units. ❑ Recreational vehicle parks.
City / State/ZIP: Tt J o g_ c,'-7 22 ❑ lleahhcare facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: /pad vtar ❑ Senrce or feeder 600 amps or more
Cross street/directions to job site: -7 t4. * � ' ` ' ' ' " ' + `. e " t T • h
/ Cu CLu . r, Description >n .: , x . t t . }. + .. - t 5 ; �
Qty. Fa. Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited en residential
a �z 67.84 2
� d , 1 y3t I } ( ` 4 + I t r s . � t with above sq. ft.)
Limited energy, multi - family 67.84 2
residential (with above sq. R.) _
I Services or feeders installation, alterations, and/or relocation
r ryfi 4 200 amps or less 100.70
., £ . .,., Ii' '..Y,,t a .;!L-::, L- : :, .- ..:'. , ..' . ,. .. �. .. .A: 20 amps to 400 amps 133.56 2
Nance: V C.1r 401 amps to 600 amps 200.34 2
Address: l �7 v2 601 amps to 1,000 amps 30 I.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: '; AJ C. g.. c1 3 Temporary services or feeders installation, alteration, and/or
• relocation
Phone: (Str6) l.{s2 , (9ct15 Fax: ( ) 200 amps or less i 59.36 1
Owner installation: This installation is being made on property that l own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. ';'.',T ; :;‘:',‘':;.1 . . , .!:::1: , •:; - ;:";;',„,;',',V, -
..Y .t..t - i' z.. .. . • % . '
+,. 'A1. f b .,. .t., i w ` : .i j
r... `a �t a t L
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above service or feeder fee, 7.42 2
each branch circuit
Business name: ES t A Si X f,& e, . B. Fee for branch circuits
s without service or feeder fee.
Contact name: , first branch circuit 56.18 2
Address: 58 5(0 0 ■ Cry \0,1h, 1 c.- Ltvj S e 20th Each add'I branch circuit _ 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: i a ( .. - 4 D o c\ 3 Each manufactured or modular
2
dwelling, service and/or feeder 67'84 2
Phone: ( )54 . 'ZIQ(.j Fax: : (Sb3 )592 .2ICT Reconnect only 67.84 2
E -mail: C a _ -Fpn 1 -e 0151 . Caw\ Pump or irrigation circle 67.84 2
w , h _ % ^ c r '���,ii' - .,ja +k J AIt I., C, g i, r -t. l A t m .. Sign or outline lighting I 67.84 2
. f t...i •i ,t. Jam.:.. 5 4. ✓-?,Y:rn /a .T. ? Yl,. ...ii.u�,..?<� , i. ...,.., .v ii, ...,...o.
Business name: Signal circuit(s) or limited -
iv energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in an • of the above
Per inspection 66.25
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 66.25
CCB Lic.: VILA Electrical, Lic : Zb - 53.41 5 Suprv. Lic.: 117510 Industrial plant per hour 78.18
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Suprv, Electrician signature, required: I Subtotal: ( $
Print name: e Pe r , - II ` ( Date: t qi, 10 Plan review (25% of permit fee):
State surcharge (12% of pennit fee): 0 • I9
Authorized signature: TOTAL PERMIT FEE: Z$ c
This permit application expires if a permit is not obtained within 180
�� 1 Date: () tilt O days after it has been accepted as complete.
0 i ' Number of inspections allowed per pennit.
I:' Buildin0Pennits 'E1- C- PermitApp. 10.01-09 440-46151111.05'COM WEB