Permit ELECTRICAL PERMIT
; CITY O F TIGARD
PERMIT #: ELC2008 -00132
COMMUNITY DEVELOPMENT DATE ISSUED: 3/7/2008
TIGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S101BB -00301
SITE ADDRESS: 11834 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: TIGARD ROAD GARDENS LOT : 001 JURISDICTION: TIG
PROJECT: JACKSONS
Project Description: Installation of (1) 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:
JOHN JACKSON YOUNG ELECTRIC SIGN CO
3450 E COMMERCIAL COURT 416 E 41ST B
MERIDIAN, ID 83642 BOISE, ID 83714
Phone: Contact #: PRI 208 - 345 -2982
FAX 208 - 345 -3064
FEES
Description Date Amount Reg #: ELE 37 -51CLS
IELPRMT] ELC Permit 3/7/2008 $53.40 LIC 69308
['TAXI 12% State 3/7/2008 $6.41 SUP 710SIG
Total $59.81 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 rule . - •rth in • • ' 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246 •699 or 1 .800. •
Issued : y: ` �'� �� �� _ � Permittee Signatu
•
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.
540 240 IF- o oo Lis - Ay e
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard
Received Q ff G� � O 7 lli Received `J Afros, _ r t. Permit No.: G g Q /3,p, ° 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' ° , ' - • Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
TIGARD Inspection Line: 503.639 Date ReadyBy: Juriss El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: %% /(o. Supplemental Information
TYPE OF 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 ❑ 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 N,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 ", "I -2 ", "1 -3 ",
Job no.: Job site address: Q c IOOHP or more. occupancy.
�' v J �Qri� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP ❑ Health -care facilities. ❑ Supply voltage for more than
< < �Q� t ¶ Project ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: name: J S ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: " Description 1 Qty. 1 Fee. 1 Total 1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 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 75.00 2
4 \ LtIVn-J:nartea' f� XI'kq residential (with above sq. ft.)
v Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: `0 ) J, ok+ 401 amps to 600 amps 160.60 2
J J "lam" 601 amps to 1,000 amps 240.60 2
Address: 3 -1 sr, C d oirnebt „ / G+ . Over 1,000 amps or volts 454.65 2
City/State /ZIP: k i t rL �! D 36 � Temporary services or feeders installation, alteration, and /or
relocation
Phone: (a od ) ?8� . 6 906 1 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, m and , ` 701. 401 amps to 599 amps 133.75 2
Owner signature: d l e,G Lai(r,GI f Date: 3/0 Y Branch circuits — new, alteration, or extension, ler panel
7 A. Fee for branch circuits with
APPLICANT 2" PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: *Ion E, j G s ilK Co B. Fee for branch circuits
2 � without service or feeder fee, 46.85 2
Contact name: e !� �/n 6/ first branch circuit
Address: L i l c o s Li/ S,I- Si-. • Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Nst, j i, 7 14 Each manufactured or modular 90.90 2
6 dwelling, service and/or feeder
Phone: (206 ) 344 s. 4: ),1 gok I Fax: : (PD $) P/S 3o • f Reconnect only 66.85 2
E -mail: atbvpmg lip) y14. GOI 7 Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting $ ' 53.40 6 qc. 2
Business name: �oUM^ E tg CJi'l SJ� Co energy panel, e r t i o n,ed-
JJ energy panel, alteration, or
Address: & p, e i 3+ 3 extension. Describe: Page 2 2
City/State /ZIP: So) sz, t 0 337 iv Each additional inspection over allowable in any of the above
! Per inspection 62.50 .
Phone: Q() 3 C4 s n o z 9 b Fax: 0 0 I ) 3' 4 30 ( it Investigation per hour (1 hr min) 62.50
b/ 3o p 27 /ets
CCB Lic.: - 0 Electrical Lic.: � Suprv. Lic.: 1 / (T. Industrial plant per hour 73.75
ctrl ELECTRICAL PERMIT' FEES
Suprvf a tan signature, required: � /o ` ! ��� Subtotal: ✓ . t-0 Print name: Date: 3/5/01 Plan review (25% of permit fee):
J erry �c�m.cs State surcharge (12% of permit fee): I •
Authorized signature: „ /� _ � TOTAL PERMIT FEE: 5q • 9
�� � This permit application expires if a permit is not obtained within 18
Print name: � h 'lg .ei f Date: % . - 3 - q days after it has been accepted as complete.
•/ �� ' yl * Number of inspections allowed per permit.
I:\Building\Permits\ELC - PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB