Permit i , - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00226
t � ° : COMMUNITY DEVELOPMENT
.,F DATE ISSUED: 4/13/2007
Ggp 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102AC - 01100
SITE ADDRESS: 12566 SW MAIN ST ZONING: CBD
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: KARATE
Project Description: Sign lighting.
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: 1
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: 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:
ROGER PAUL SORG TRUST - - SIGNCRAFT LLC
24 AQUINAS 9033 SW BURNHAM
LAKE OSWEGO, OR 97035 TIGARD, OR 97223
Phone: Contact #: PRI 503 - 639 - 4910
FAX 503 - 639 -4999
FEES
Description Date Amount Reg #: ELE 34- 674CLS
[ELPRMT] ELC Permit 4/13/2007 $53.40 LIC 155420
[TAX] 8% State Surcharge 4/13/2007 $4.27 SUP 75S1G
Total $57.67 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: Permittee Signature: /
_cr)cios.L.6,__.._._ 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 A lica „ FOI " USE ONLY a � ' +i 4 ' r. .
CAVED ////,, :( L'�r� /i. , _ �lr't�tN "AI.54r� rti fM"YYd :�'.Y2�i9'iU'` .., , i3«w. 1c;` ,. cr..ya y
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9 * w 1:)' �f Tigard Date Plan Rev Receive. /i / / �f j Permit Not /e f -• cwt,,,,,,
° 13125 SW Hall Blvd., Tigard, OR 972972R4) 1, a iew
k� 6 Phone: 503.639.4171 Fax: 503.598.1 L Date/By: Other Permit. .,: . I � QUO 7 }—
ca ' 1 7 !' Inspection Line: 503.639.4175 Date Ready /By: Juris: 0 See Page 2 for
tTIGARE) CITY OF TIGARD
w I nternet: www.tigard or.gov � ING DIU Notified/Method: Supplemental Information
TYPE O WORK
. PLAN .REVIEW
❑ 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 I Other:S t ee A) %1Stt,k ' T �p 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 ❑ "A ", "E ", "1 - ", "1 - ",
�_/ L `• 100HP or more. occupancy.
Job no.: Job site address:
Ia SLR 'S r.t-7 / (7
['six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: -rug A 2 f� e7 [[�� F/J � ^� 2 1:1 Health-care
locations.
Health -care facilities. ❑ Supply voltage for more than
/ - / -� 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ete .. ei cf e_ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: /4 c p4..Gn f. Ai Description . 1 Qtr• 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: .7,..S / (7a 4e —0 1 1 06 Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
/ DESCRIPTION' OF WORK (with above sq. ft.) 75.00 2
^ � - � Limited energy, multi - family
�LYI64c:t it S.`" a me k op r i v residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
is f ec - t r I c A L- S e rL) l G 200 amps or less 80.30 2
' ❑ PROPERTY OWNER . ❑ TENANT 201 amps to 400 amps 106.85 2
Name: /.1 /- 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Rh/ al.ek; Over 1,000 amps or volts 454.65 2
City/State /ZIP: n w /5 Temporary services or feeders installation, alteration, and/or
,..___O relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
_ 'la APPLICANT ' . ❑ .CONTACT. PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Lc\y ��,I� G - f L (ou B. Fee for branch circuits
J without service or feeder fee,
Contact name: � 46.85 2
�0\i_ - c E c.00 first branch circuit
Address: 3 ' 3 er \N� � � Each add'I branch circuit 6.65 2
w� Miscellaneous (service or feeder not included)
City/State /ZIP' L.0A....,\ b 2 O'17 -3 Each manufactured or modular
U v dwelling, service and/or feeder 90.90 2
Phone: 0a) 639 - I q l 0 Fax: : 6.-03 6,2ci --zi q g 9 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
_ _ C _ ON T RA CTOR - �_ -� Sign or outline lighting / 53.40 b3, 2
Signal circuit(s) or limited -
Business name: ( 6- at ( energy panel, alteration, or
`' extension. Describe: Page 2 2
Address: - - A.-An
City/State /ZIP t -------- Each additional inspection over allowable in any of the above
- ` — Per inspection 62.50
Phone: ( )- �� I Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: WA/ 51 G Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT. FEES
Suprv. Electrician signature, required: Subtotal: CI?2,
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): Li.
Authorized signature: TOTAL PERMIT FEE: 5 Co, 7
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.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 - - 440- 4615T(t I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT. FEES:
RESIDENTIAL WORK ONLY: '
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ B urglar Alarm
n G • arage Door Opener*
n H eating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
- COMMERCIAI WORK;ONLY: "
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06
04/16/2007 16:41 5036209568 SIGNCRAFT ELECTRICAL PAGE 01
CITY OF TIGARD
4 v J l til �r
COMMUNITY DEVELOPMENT
3.19Ar 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Electrical Signature Form
IMPORTANT PERMIT NOTICE
SIGNCRAFT LLC
9033 SW BURNHAM
TIGARD, OR 97223
Permit #: ELC2007 - 00226
Date Issued: 4/13/2007
Parcel: 2S 102AC -01100
Site Address: 12566 SW MAIN ST
Subdivision:
Lot:
Jurisdiction: TIG
Zoning: CBD
Project Name: KARATE
Description: Sign lighting.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
ROGER PAUL SORG TRUST SIGNCRAFT LLC
24 AQUINAS 9033 SW BURNHAM
LAKE OSWEGO, OR 97035
•
TIGARD, OR 97223
Phone #: Phone #: 503- 639 -4910
Reg #: ELE 34- 674CLS
LIC 155420
SUP 75SIG
AN INK SIGNATURE IS REQUIRED ON THIS FORM
x � c 1 `1 2 - 1 1 c 6 •
Signature o Supe ising Electrician Name (printed) SUP LIC #
CITY OF TIGARD
BUILDING DIVISION - - PERMIT #: ELC2007 -00226
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1'3/2007
Phone: (503) 639 -4171 ",, ��, I;'
Inspection Requests (24 Hrs.): (503) 639 -4175 r 'R'i'j!
INSPECTION WORKSHEET FOR DATE: 5/1 /2007 TIME: 7:00AM PAGE: 47
SITE ADDRESS: 12566 SW MAIN ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: KARATE
DESCRIPTION: Sign lighting,
OWNER: SORG TRUST, ROGER PAUL PHONE #:
CONTRACTOR: SIGNCRAFT LLC PHONE #: 503 - 4910
Inspection Request Scheduled For: Date: 5/1/2007 Pour Time:
Code # Inspection Description - '"Corifirm = #� Contact # Message
140 Sign installation 047394 -01 `, -, 503.639 -4910 N
Corrections/Comments/Instructions:
1► PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1 1 FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: (Y' N 18 E Date: 61 I (01 Phone #: (503) 718- 1)114..