Permit W ELECTRICAL PERMIT
„ CITY OF TIGARD
� 'µ� ' ` q COMMUNITY DEVELOPMENT Permit #: ELC201000204
Date Issued: 04/29/2010
T F GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102AA00600
Jurisdiction: Tigard
Site address: 12045 SW HALL BLVD
Subdivision: Lot: 0
Project: 7 -11
Project Description: Sign lighting for relocated freestanding sign.
Owner: FEES
ALPROP CO Quantity Description Date Amount
6149 SW SHATTUCK RD
PORTLAND, OR 97221 1 ea Sign or Outline Lighting 04/29/2010 $67.84
PHONE: 503 452 -2115 1 ea 12% State Surcharge - 04/29/2010 $8.14
Electrical
Contractor:
ES & A SIGN & AWNING
5856 NE COLUMBIA BLVD STE 200
PORTLAND, OR 97218
PHONE: 503 - 542 -2100
FAX: 503 - 542 -2105
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permit is ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' 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. TTENTION: Oregon la re• Tres you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 1 -0010 through OAR 95 r r 1-010+. 'ou may obtain a copy of the rules or direct questions to OU • ...y 503.246.6699 or 1.800.332.2344. r
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Issu By: _ Permitte " S 'lgn ature: 1 1 1 _ _ ∎ Ilir C-5-
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.
Electrical Permit ation k ''' ., h
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q .. �, City of Ti gard � C 4/ / 9 /0 ( Permit No.: ek_ ye, - 2 ?O
e q 13125 SW Hall Blvd., Tigard. OR , 7.¢ s CE! c Date /By: 9r ' Plan C Other Permit: d /J ev 040
P j , Phone: 503.639.4171 Fax: 503.598.19 Date /By: ALC/ / "a �� eC7
1 A ti D! Inspection Line: 503.639.4175 A P Date Ready/By: Juris: 0 See Page 2 for
s Internet: www.tigard-or.gov 1 Q ( 010 Notified/Method: Supplemental Information
TYPE Ofti)�(�tHlie r- v U PLAN REVIEW .
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❑ New construction ❑ Additmn/ate tion/r D Please check all that apply (submit 2 sets of plans w /items checked below):
L' /` 1Y r t,� t - ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ® Other: sign Wi t ` Y - l:nJI> 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 ", "I 2'Y'l - ",
Job no.: 10819 Job site address: 12045 SW Hall Blvd 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 7 -11 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW Pacific Hwy 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
" DESCRIPTION OF WORK ( with above sq. ft.) 67.84 2
' Limited energy, multi - family
67.84
Re- locate (1) illumniated pole sign residential (with above sq. ft.)
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
Name: Mark Schick 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 6149 SW Shattuck Rd Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: Portland, OR 97221 relocation
Phone: (503) 452.2115 Fax: (503)452.2139 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not '
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 0 CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: ES &A Sign & Awning Co. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Katy Fong branch circuit
Each add'I branch circuit 7.42 2
Address: 5856 NE Columbia Blvd, Ste 200 Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State/ZIP: Portland, OR 97218 dwelling. service and /or feeder
Phone: (503) 542.2100 Fax: : (503) 542.2105 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign or outline lighting 1 67.84 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: SAME AS ABOVE panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed ('/ hr min)
CCB Lic.: 163470 Electrical Lic.: 20 543CLS Suprv. Lic.: 717SIC ELECTRICAL PERMIT FEES
Subtotal: 67.84
Suprv. Electrician signature, required: r
Plan review (25% of permit fee):
Print name: Wayne Pehrson Date: 04/26/10 State surcharge (12% of permit fee): 8.14
1 TOTAL PERMIT FEE: 75.98
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Katy Fong Date: 04/27/10 • Number of inspections allowed per permit.
1:\ Building \ Permits \E LC-Permit App.doc 11)01/00 440- 4615T(11/05/ COM /WEB