Permit ELECTRICAL PERMIT
Y r. ''. CITY OF TIGARD
PERMIT ISSUE : ELC2008-00041
COMMUNITY DEVELOPMENT
DATE ISSUED: 1/24/2008
TIGA "RD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 110AA -00700
SITE ADDRESS: 14030 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: 76 STATION
Project Description: (2) 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: 2
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:
CASCADE SIGNS + NEON
KINNEE SIGNS INC
2166 WAYSIDE TERR NE
SALEM, OR 97303
Phone: Contact #: PRI 503 - 378 - 0012
FEES
Description Date Amount Reg #: ELE 36 -2CLS
IELPRMT] ELC Permit 1/24/2008 $106.80 LIC 64416
[TAX] 12% State Surchar 1/24/2008 $12.80 SUP 659S1G
Total $119.60 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: t7/ t - — -
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.
. _ _ - f-�-r ;
Electrical Permit ApjiliC �. �� fibif' i. l ■ : FOR OFFiCE•USE ONLY
}�� I 1 r '-' , 'WY /
Cl / (� 35 Permit No.: za
`J g �� , — ., Date/By: G / / 01 - 1 0 0 E{�t.d't 02 0,0,
of Ti and Received
13125 SW Hall Blvd., Tigard, OR 97223 y
g n ; Pl an R evie
Phone: 503.639.4171 Fax: 503.598.1960 i 9 c� =/ LUUl1 ipplt Date/By: Other Permit:
Inspection Line: 503.639.4175 ! /La y► e' Date Ready/By: Juris: / ® See Page 2 for
Internet: www.ci.tigard.or.us CY,'s , - 1 � iii Notified/Method: I Supplemental Information
1 1 1 ,r i s° f rf,.± , ..PLAN REVIEW • ❑ plAITTFICY, " p ii e l ) Please check all that a 1 New construction Aid n/ fir "
alteration/re lacement apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ I and 2 family dwelling [Ptommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑ Building over three stories ['Feeders, 400 amps or more
❑ Other:
['Occupant load over 99 persons EManufactured structures or
JOB SITE INFORMATION AND LOCATION . ['Egress/lighting plan RV park
Job no.: Job site address: 1 P IBC►Fi \A Y ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: . - n GA 12D 0 The above are not applicable to temporary construction service.
l � L� ��--
Suite/bldg./apt. no.: Project name: A- L FEE* SOHEDULE
Description Qty. I Fee. Total *R
i x
Cross street/directions to job site: CO(' Co.4.1( () - 1- f -i f C. \J New residential single- or multi - family dwelling unit.
111 -^ ^ Includes attached garage.
PA _ Crlcd. d S -� - ]] 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
��� � �l 1 - DESCRIPTION OF WORK Each manufactured or modular
C /� ,,�� f its 1,13 et ( S ( �" A- Cats 0 p y o 0 dwelling, service and /or feeder 90.90 2
l �()T \ I l� S Services or feeders installation, alteration, and/or relocation
- 60 -k S ^ t d 200 as or less 80.30 2
❑ PROPERTY "OWNER ❑ TENANT • 201 amps to 400 amps 106.85 2
_ 401 amps to 600 amps 160.60 2
Name: C� S I tM W T� 601 amps to 1,000 amps 240.60 2
Address: 140 1 3r , /� c &I Over 1,000 amps or volts 454.65 2
` 0 V 1' [)
Reconnect only 66.85 2
City /State /ZIP: '1-1`0 (AAA lJ g. Temporary services or feeders installation, alteration, and/or
t
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 600 amps 133.75 2
Owner signature: Branch circuits - new, alteration, or extension, per panel
APPLICANT CONTACT PERSON . A. Fee for branch circuits with
`r branch or feeder fee, each 6.65 2
Business name: tr ki��,
branch circuit
`� B. Fee for branch circuits
Contact name: V al \J nil -R-12-- without service or feeder fee,
each branch circuit 46.85 2
Address: PO eYsx -- 1 - 2411
Each add'1 branch circuit 6.65 2
City/State /ZIP: 6 r W N (Ile_ (Ile_ cn503 Miscellaneous (service or feeder not included)
t
Phone: (So 3) 371. - Q) Z Fax:: (c03) 3 - 0 t Pump or irrigation circle 53.40 2
Sign or outline lighting r 53.47
0 t -2
E - mail: 1 jsa.P cas 2 - - p, A ,•$ . cow- Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
OAS S l� /y [I, _ ^ Q A extension. Describe: Page 2 2
Business name: CJ ► `
Address: PO B6)/� 1114 Each additional inspection over allowable in any of the above
"% Per inspection 62.50
City /State /ZIP: ( S n n i . � t 0 C1-1303 Investigation per hour (1 hr min) 62.50
Phone: ( '(�3) 37 v - ao 1 Z Fax: 503) 3() ins' Industrial plant per hour 73.75
• ELECTRICAL PERMIT FEES*
CCB Lic.: l4 , C.Ni G Electrical Lic.: 3G- 2,0_3 Suprv. Lic.: (,,1,5 -Si (- 1 Subtotal ` r •
Suprv. Electricia s ign atu re , equired: � / / /• O Pl an review (25% of permit fee)
Print name: sA ki 'v a Date: I _) 3 l o7 / �
t---L State surcharge.($9(of permit fee) /Z ,
_ TOTAL PERMIT FEE / / q .. f,
Authorized signature: ( ��� This permit application expires if a permit is not obtained within 180
' 1 �/� days after it has been accepted as complete
U
Print name: S Y- �lNA Date: i 24 3 1, • Fee methodology set by Tri- County Building Industry Service Board
•' Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PernutApp.doc 12/03 440- 4615T(10 /02/COM/WEB
-4
Electrical Permit Application - City of Tigard
Page 2 Supplemental Information
LIMITED ENERGY PERMIT FEES:
ESIDENTIAL WORK
Fee for all residential systems combined ... 575.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COIVIIVIERCIAL ,WORK <QNLY I`, .E. _ 7
Fee for each commercial system $75.00
(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
is\ Building \Permits \ELC- PemritApp.doc 04/03