Permit (43) h CITY OF TIGARD ELECTRICAL PERMIT
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PERMIT #: ELC2008 -00040
COMMUNITY DEVELOPMENT DATE ISSUED: 1/22/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 136DD -04100
SITE ADDRESS: 11850 SW 67TH AVE ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT : 007 JURISDICTION: TIG
PROJECT: AMERICAN FAMILY INSURANCE
Project Description: branch circuit for exterior sign
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: 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:
PACIFIC NW PROPERTIES CAPITOL ELECTRIC CO INC
6600 SW 105TH AVE 11401 NE MARX ST
BEAVERTON, OR 97008 PORTLAND, OR 97220 -1041
Phone: Contact #: PRI .503 255 - 9488
FAX 503 - 257 -7121
FEES
Description Date Amount Reg #: ELE 26 -496C
IELPRMTI ELC Permit 1/22/2008 $46.85 LIC 48748
ITAX] 12% State Surchar 1/22/2008 $5.62 SUN 3132S
Total $52.47 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: (l , -- Permittee Signature: ce . ./ /a- y71)cv1./
OWNER INSTALLATION ONLY /
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each.inspection.
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Electrical Permit Appli atiOn ~' . ` /, ` p' FOR OFFICE USE ONLY
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•� City of Tigard i 1 dam kj l: V P'-r_,r ' " A , Received Date /By: } / ($ Ill $ 671'e no.: '/ O� �/ fog' �y t/�-t l y �
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ��J'� ,/ tCJ
C •• Phone: 503.639.4171 Fax: 503.598.0 1 2008
Date /By: Other Permit.
T l GA RD Inspection Line: 503.639.4175 j� 1 Date Ready /By: Juris: U See Page 2 for
Internet: www.tigard- or.gov, , ) , (� g�
C 11 Y. 0.'s-: y = +.� ` D Notified/Method: Supplemental Information
TYPE O � 1t' ( i, , T / 1 PLAN REVIEW
L I New construction U Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
U 1 - and 2 family dwelling U Commercial /industrial U Accessory building exceeds 10,000 amps at 150 volts or Floating buildings
❑ Multi family ❑ Master Builder ❑ Other less to ground, or exceeds 14,000 Commercial -use agricultural
JOB SITE INFORMATION AND LOCATION amps for all other installations. ❑ buildings
Job no.: 280045 l Job site address: 11850 SW 67th Ave ❑ Fire Pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system.
City /State /ZIP: Tigard, OR ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
100HP or more. ❑ occupancy
Suit,: hide. apt. no.: Project name: A FAM sign ❑ Six or more residential units 111 Recreational vehicle parks.
❑ Health -care facilities ❑ Supply voltage for more than
Cross Street/Directions to job site: ❑ Hazardous locations ❑ 600 volts nominal.
❑ Service or feeder 600 amps or niore
Subdivision: Lot no.: FEE SCHEDULE
Description I Qty. I Fee. I Total I .•
Tax map /parcel no.: New residential - single or multi - family dwelling unit.
DESCRIPTION OF WORK Includes attached garage.
branch circuit for exterior sign 1000 sq. ft. or less $ 145.15 4
Ea. Add'I 500 sq. ft or portion $ 33.40 I
U PROPERTY OWNER 1 U TENANT Limited energy residential
(with above sq. ft.) $ 75.00 2
Name: Pacific NW Properties Limited energy, multi - family
Address: 6600 SW 105th Ave residential (with above sq. ft.) _ $ 75.00 _ 2
Service or feeders installation, alteration, and /or relocation
City /State /ZIP: Beaverton, OR 97008 200 amps or less $ 80.30 2
201 amps to 400 amps $ 106.85 2
Phone: Fax: 401 amps to 600 amps $ 160.60 2
503- 626 -3500 601 amps to 1000 amps $ 240.60 2
Owner installation: This installation is being made on property that 1 own which is not Over 1000 amps or volts $ 454.65 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, alteration, and /or
Owner signature: Date: relocation
200 amps or less $ 66.85 1
U APPLICANT 1 Li CONTACT PERSON 201 amps to 400 amps $ 100.30 2
401 amps to 600 amps $ 133.75 2
Business Name:
Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
r
Contact name:
service or feeder fee, each
Address: branch circuit $ 6.65
B. Fee for branch circuits
C.A
City /State /ZIP: without service or feeder fee, La
9 t branch circuit (((YYY $ 46.85 4 . 5 2
Each additional branch circuit: $ 6.65 2
Phone: Fax:
Miscellaneous (service or feeder not included)
E -mail: Each manufactured or modular
CONTRACTOR dwelling, service and or feeder $ 90.90 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only $ 66.85 2
Pump or irrigation circle *, $ 53.40 2
Sign or outline lighting $ 53.40 2
Contact name:
Signal circuit(s) or limited -
Address: 11401 NE MARX ST. energy panel, alterations, or
extension. Describe: Page 2 2
City /State /ZIP: PORTLAND, OR 97220 -1041 -
Each additional inspection over allowable in any of the above
Phone: 503 - 255 -9488 Fax: 503 - 257 -7121 Per inspection $ 62.50
Investigation per hour (1 hr min) $ 62.50
CCB Lic.: 48748 (Electrical Lic.: 26 -496C ISuprv. Lic.: 3132 -S Industrial plant per hour $ 73.75
c ELECTRICAL PERMIT FEES*
Suprv. Electrician signature, required: D11141,4144--) Mc /
C Subtotal $ 46.85
Print Name: DARRELL MCNEEL Date: 01/17108 Plan review (25% of permit fee)
State surcharge ( 12% of permit fee) $ 5.62
Authorized signature: [/ J A`� _ M° / � ae TOTAL PERMIT FEE $ 52.47
Print Name: DARR C l7EL /V This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections per permit allowed.
CITY OF TIGARD - __ .
BUILDING DIVISION PERMIT #: ELC2008 00040
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: •I/ )2I200 }1
Phone: (503) 639 -4171 45
Inspection Requests (24 Hrs.): (503) 639 -4175 `1I
INSPECTION WORKSHEET FOR DATE: 2/6/2000 TIME: 7:00Alyf PAGE: 27
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: branch circuit for exterior sign
OWNER: PHONE #:
CONTRACTOR: CAPITOL ELECTRIC CO INC PHONE #: 503 -256 -9408
Inspection Request Scheduled For: Date: 2/6/2008 Pour Time:
Code # Inspection Description /Confirm - #_, Contact # Message
199 Electrical final 064607 971 \ Y
Corrections /Comments /Instructions: C 1
CALL L
N \
.
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 3m NO 8 Date: »' " Phone #: (503) 718- 2tf