Permit (7) CITY OF TIGARD ELECTRICAL PERMIT
31 4 $ - COMMUNITY DEVELOPM Permit #: ELC2009 -00449
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/03/2009
Parcel: 2S110AA00900
Jurisdiction: Tigard
Site address: 14050 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Nationwide Insurance
Project Description: Install sign lighting.
Owner. FEES
ELLINGSON REV INTERVIVOS TRUST Quantity Description Date Amount
BY JOSEPH M /JEAN E ELLINGSON TRS, 420 W
LASSEN AVE 1 ea Sign or Outline Lighting 09/03/2009 $53.40
PHONE: 1 ea 12% State Surcharge - 09/03/2009 $6.41
Electrical
Contractor:
HIGHLIGHT SIGN CORP
P.O. BOX 23667
TIGARD, OR 97223
PHONE: 503 -620 -8205
FAX: 503 -624 -3725
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.81
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 through OAR 952 - 001 -0100. 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: X Permittee Signature: t 7�� c�7
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 603.639.4176 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.
. ..- •
Electrical Permit Application FOR 1)1.1.1( E 11. ()NIA'
City of Tigard 13y
IVED Received
-
Date/B .. Permit No.; £2?. 0/ AP .... . d i A F
.7 ._ ,,,,,, SW Hall Blvd., Tigard. Plan Rcvie
' -1 Phone; 503.639.4171 Pax: 503.598.1960 nrin Date/By: Other Permit:
.,
r ,..,,,, 0 Inspection Line: 503.639.4175 S Ep 0 1 V Date Ready/By: lore: 12I See Page 7 for
Internet: www.tigard Notified/Method: ii Supplemental Information
: X 77 1 : ,ii .,0 7 47REtg,g 3 Z ic i• L `.r.: ' i. ' a7FR:';'0 177: "t' ' ' '' ' ''' ' ' ' 'f'''?. "''' '' ' '' ' ' ' 14.Ple ' 'l /,,4/riilit;'''''''''''' '' IV '' '.414111iM26/1):6*'4°7:41•W'.4V.di';
0 New construction 0 Addiblat t i 1 1 — mellt Please check all . • t apply (submit 2 sets of plans w/items checked below):
0 Service & -- . r 400 amps or more 1:IBuilding over three stories.
0 Demolition 121 Other: Sign where the a . able fault current D Marinas and boatyards.
Igkii.re; , ,,, , ,Rr e .V7:11 47 ,FVSi, 7 9r 7 7; 7 Vite:FM:ffig l .%'W. , ,7F',
less exceeds r 10,0 8 amps at 150 voila Or 0 Floating buildings.
gowl. or exceeds 14.000 0 Commercial-use agricultural
0 I - and 2 dwelling El Commercial/industrial 0 Accessory building amps for all . her installations. buildings.
0 Multi-family 0 Master builder 0 Other 0 Fire pump. 0 Installation of 75 KVA or
.,t y ' 8 g/f/ Y ":Zi- , ,;•?;'',/i..6,1 . 1 ,;7,7 7 ,., i.,g,T/ i—ii3 Emergency s stem, larger separately derived system
,0• A;' ;Akknt,'21 74 i/jr;,:■W,.; U Addition of vi moo t load of 0 "A", '•E". "1-2", "13",
OW �r m. e. occupancy.
Job no.: Job site address: 14050 sw Pacific Hwy. 0 Six or more idential units. 0 Recreational vehicle parks.
City/State/ZIP; tigard or 97223 0 lieelth • citifies. 0 Supply voltage for more than
.
0 Hazardous ... tions. 600 volts nominal.
Suite/bldg./apt no.; 100 Project name: NATIONWIDE INSURANCE El Service or - • - 600 amps or mom
f,7;:.;41 :k7,70.71,7.7
Cross street/directions to job site: th.cripav, Q. it.. . Toad *
. New residen ... I single or multi-family dwelling unit.
Includes atta hed garage.
Subdivision: Lot no.: 1,000 sq. It. o less 145.15 4
- — Ea. addi 500 .. ft or portion 33-40 1
Tax map/parcel no.: . .,. ,...... Limited en 1, , residential
„ 75.00
Ve.; PH' ..• 7 F ,: 7 ,
0;1 (with alsove ,i . ft) 1111
.' ;:;,- V, • / ,. • ,',•:q..1-d- "i• •'-- 14-,...,i,ALidili.ip:i.•/,-,,•4,.:•..:',,-...E.th•r,r,,•••2:•'•••••'''..'-:'-'1f.Y:'::::0,•:•'4.:•'','-',,' V:"1.7!:•",'
Limited eneri, , multi-fernily 75.00 . 2
INSTALL 1 EA. RACEWAY SIGN residendal with above SQ. ft.)
- Services or f eders installation, alteration, and/or relocation
200 amps or 1-s 80.30 2
' T 1?) si5l p, •/,...7;;F/1 / 31. 7, 201 amps to , a' amps 106.85 2
./.4 ;,' ' ,o," MV,,,ILL.: z io t i : 151.7,y,...L'arkl;:m.,:zaa;. , :i2/1j7b,'611),IL , L, 2 1/ -°;'.• . ., Pi:'..
401 amps to , 10 arngi 160.60 2
Name; 601 amps to ,000 amps 240.60 . 2
Address: Over 1,000 : r s or volts 454.65 2
Temporary , rvlees or feeders installation, alteration, and/or
- City/State/ZIP: relocation •
Phone: ( ) Fax: ( ) 200 amps or - s 66.85_ 2
•
Owner installation: This installation is being made on property that I own which is not 201 amps to a D amps 1 2
5 •
intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701. - 401 amps to .99 amps
Branch cite its- now alteration or extension. • r , net
Owner signature: Date; A. Fcc for b ch circuits with
.,: 1 )1.4:i.d' Ic.Orr65FT03.1271:MOR:70gan15V,t777.W_I=',f1.:Ti3):'!2K:111;g4 abovc *ce Or feeder fee, 6.65
Business name: B. Fee fort ch circuits
- _ w ithout ., ice or feeder fee.
Contact name: first bran.' circuit 46.85
Each addl • •, oh circuit 6.65 2
Address:
Miseellati . . service or feeder not included
City/Smte/ZIP: Each menu tured or modular . 90.90 III
dwellin: se ice and/or feeder
Phone: ( ) Fax: : ( ) • Reconnect • y M 66.85 1131
E-mail: Pump or • , I. 'on circle 53.40
1 i :'' Si °r ' sue " el 5340
. nal c
Business name: HIGHLIGHT SIGN CORP. .
Signal ($) or limited
energy pan. , alteration, or
extension. I cribe: Page 2
Address; POBOX 23667 . •
. •
City/State/ZIP: TIGAIRD OR 97223 • •
• ii Each addi , onal inspection over allowable in an of the above
Per inspect n 62.50 IIII
Phone: (503) 620 8205 1 Fax; (503) 624.3725 7— - , Invcstigati. per hour (I hr min) M 62.50 . al
_ .
CCB Lit: 104599
Electrical Lie.; S105 17 r Suprv. ic.: 37695 Industrial • ant per hour En 73-75 MI
y$0,7a
Suprv. Electrician signature, required: lejilrartalgi / _... _
Subtotal: 116.-Wr .
..
man revievy (25% of permit fee):
Print name: MICHAEL CLEARY Date: 1 0 ibo ' '
- • tate surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE;
_ ____ This pc .. t application expire: If a permit is not obta5.
Print name: Date: days after it has been accepted as complete.
E Number .f inspections allowed per permit.
lAlluilainSTcrrnitskELC-PcrmilApp.doe 05/13/06 440.4615T(Iiios/COM/wRa
ZO/TO 39Vd NOIS 11-19I1HOIH .
SZLE1'Z9E0g ZZ:ET 600Z/T0/60