Permit •
`; CITY OF TIGARD ELECTRICAL PERMIT
r l 4
- - Is COMMUNITY DEVELOPMENT Permit #: ELC2009 -00665
T f G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 12/16/2009
Parcel: 2S103DD00800
Jurisdiction: Tigard
Site address: 13815 SW PACIFIC HWY 110
Subdivision: Lot: 0
Project: Yum Yum Pizza
Project Description: Install (1) sign outline lighting.
Owner: FEES
D W SIVERS CO Quantity Description Date Amount
4730 SW MACADAM AVE #101
PORTLAND, OR 97239 1 ea Sign or Outline Lighting 12/16/2009 867.84
PHONE: 503 - 223 2680 1 ea 12% State Surcharge - 12/16/2009 88.14
Electrical
Contractor:
GRESHAM NEON & SIGNS
21551 SE STARK
GRESHAM, OR 97030
PHONE: 503 - 417 -4774
FAX: 503 - 253 -9407
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 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 c WA,3 py of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: C -rl ( `1 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' C Q A Date:
LICENSE NO.
Cali 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.
Electrical Permit Application tom - 0 4 . 09 FOR OFFICE USE ONLY
R eceived
City of Tigard Permit No.: (� J�n /_S
Date /By: `v `w , 1
13125 SW Ball BIvd., 'Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready /By: luris ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: -t-'q Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 1=1 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 ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of
Job no.: Job site address: 1 5 t' c 141 IOOHP or more. occupancy. Cini ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: _ r �� �^ ❑ H ealth -care facilities. ❑ Supply voltage for more than
`J ` ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: ( Project name: ❑ Service or feeder 600 amps or more.
.1 J FEE SCHEDULE
Cross street/directions to job site: C f%t A r L� Lc_ ,f Description 1 Qty. 1 Fee. 1 Total 1
J 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
fax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. fi.) 67.84 2
Limited energy, multi - family
'`j ti ell �-vk - residential (with above sq. ft.) 67.84 2
It Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
*PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: et / /� /� 401 amps to 600 amps 200.34 2
` �' �� /`�'` 601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( c .4 9 _ 2 ' , ^ 7/4 g o Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that 1 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
❑ APPLICANT ( CONTACT PERSON above service or feeder fee,
® � pit.
each branch circuit 7.42 2
Business name: is CZ t..0 T b ISt� B. Fee for branch circuits
l without service or feeder fee.
Contact name: 56.18 2
j AAA n h � first branch circuit
Address: 1 q(• / ,, v s Each add'I branch circuit 7.42 2
'� 1 C �J'G Miscellaneous (service or feeder not included)
... ,.. s. .„ e
City /Slate /LIP: 1 6 ei 7 - 6- Each manufactured or modular
( dwelling, service and /or feeder 67.84 2
Phone: ( ) s _ V( �o. F ax:: ( ) Reconnect only 67.84 2
E- mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:
Signal circuit(s) or limited -
i tfX.wt. 411,..„01 H$ energy panel, alteration, or
Address: ( "s i_ / r t ' cif...! extension. Describe: Page 2 2
City /State /ZIP: 61" , G .7- 0 _ Each additional inspection over allowable in an' of the above
/ Per inspection 66.25
Phone: ( (a, yi t7 r 4, 1 , 1f Fax: ( ) Investigation per hour (1 hr min) 66.25
CCB Lic: 7, rer llectrical Lic.: ( .7 s( Suprv. Lic.: GLS 7 industrial plant per hour 78.18
t 1 t ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Jail. / Q6 Date: � � Plan review (25% of permit fee):
Print name: q_e7 S tate surcharge (112 /o of permit fee):
Authorized sign.ture40 v TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
l \Building \Permits \ELC PermitApp doe 10/01/09 440- 4615T(I I /05 /COM/WEB