Permit ,i 1‘,- CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2010 -00180
,.,, Date Issued: 04/19/2010
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
,2t7_z;.i.`.; Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9502 SW WASHINGTON SQUARE RD J03
Subdivision: Lot: 0
Project: AT & T
Project Description: 1 Sign Lighting
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 1 ea Sign or Outline Lighting 04/19/2010 $67.84
1 ea 12% State Surcharge - 04/19/2010 $8.14
PHONE: Electrical
Contractor:
MEYER SIGN CO OF OREGON INC
15205 SW 74TH AVE
TIGARD, OR 97224
PHONE: 503 - 620 -8200
FAX:
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 OA 9 2- 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: t7 2 /l Permittee Signature: r'
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 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 Application 1, , t— ^ } i FOR OFFICE USE ONLY
Received ��`
71 Cit of Tigard r Da te /By: Permit No.: i' c _ 0
- �-U t t. t)O l Bo
° 13125 SW Hall Blvd., Tigard, OR 97223 APR 1 O I O Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 " � '' 1r' T l c� F to Ready /By: luris: El See Page 2 for
TIGARD � ` �� + � '' T "�" ` fi Method: Supplemental Information
Internet: www.tigard- or.gov ,_
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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: S 1t^'+ 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 y4. Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ",
I00HP or more. occupancy.
Q l Was t
Job no.: Job site address: I sl0Q SO Wa'.i4S11.0-6,51 ❑ R ecr ea tional vehicle parks.
❑Six or more re units. P
City /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
�� /� r. ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: /.../T,' 7' ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: S U� rat ban.1ir.-6 le-1. 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 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. 11.) 67.84 2
Limited energy, multi - family 67.84 2
L� 0.4.) l , A , ( s ` E " - PT ` residential (with above sq. ft.) ,
LlJ �-i �T Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: tlenaC'w y f e , (.o LL L 601 amps to I,000amps 301.04 2
Address: 9,-gs' S LJ (� \ "�l - J t ' __ 4- ` St . gat. Over 1,000 amps or volts 552.26 2
/ J ', . Temporary services or feeders installation, alteration, and /or
City /State /ZIP: 1o>, - � t relocation
Phone: ( / 3 SQ _ 8'8 d 4/ Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, ter panel
Owner signature: Date: A. Fee for branch circuits with
0-,%1 LICANT 1 G- -CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: s� B. Fee for branch circuits without
� service or feeder fee, first
branch circuit 56.18 2
Contact name: X i /� '/ `L , ,
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Reconnect only 67.84 2
Phone: (�3) - 3 6 — 2 Z / / I Fes' : ( ) Pump or irrigation circle 67.84 2
E - mail: or outline lighting f 67.84 41, 2
CONTRACTOR Signal circuit(s) or limited energy
panel, alteration, or extension. Page 2 2
Business name:
y-\ O..4 F.. S I , co Each additional inspection over allowable in any of the above
Address: 15 6 . — ',6" i -- 7 9/41,„ /gse__e_ Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /Z1P:Ttia,J � � Industrial plant (1 hr min) 78.18/ hr
Phone: 36 L i_ Z Z l Fax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed (/2 hr min)
CCB Lic.: G y0 7‹./ I Electrical Lic.: -2 C ( s Suprv. Lic.: 5z /_S/G ELECTRICAL PERMIT FEES
Subtotal: i,7 Sj
Suprv. Electrician signature, requir 6.1_( ,! / Plan review (25% of permit fee):
Print nameln i /e )a�4o14iS Date: /73/! State surcharge (12% of permit fee): i , /`!
TOTAL PERMIT FEE: tis-, YC
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB