Permit '- CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT
Permit #: ELC2010 00211
TIGAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/04/2010
iii ,ieN ,y1i Parcel: 1S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY Y
Subdivision: Lot: 0
Project: Ace Cash Store
Project Description: Sign lighting for new wall sign.
Owner: FEES
PACIFIC CROSSROADS PROPERTIES, I Quantity Description Date Amount
BY WYSE INVESTMENT SERVICES CO, 1501
SW TAYLOR ST STE #100 1 ea Sign or Outline Lighting 05/04/2010 $67.84
1 ea 12% State Surcharge - 05/04/2010 $8.14
PHONE: Electrical
Contractor:
MEYER SIGN CO OF OREGON
15205 SW 74TH AVE
TIGARD, OR 97224
PHONE: 503 - 620 -8200
FAX: 503- 620 -7074
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 OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.80.. 2.2344.
Issued By: '... J — ./-1-... Permittee Signature: VhMENIIII
OWNER INSTALLATION ONLY ill
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.
CaII 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.
a01 v 000 7,)
Electrical Permit Application FOR OFFICE USE ONLY
//
Received . 010 /� /` el._ C pSOItJ •••• �0���
71 . y a Date/By: I Permit No.:
V 13125 SW of Hall Tig Blvd , Tigard OR 97 223
Cit Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: luri �l PI See Page 2 for
Internet: www.tigard - or.gov Notified/Method: /` 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: 5 J (oA►) 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 ", "I -3 ",
J � 100HP or more. occupancy.
Job no.: Job site address: / 7ds' „5-4.) pace_ ` /Y ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: -3 Q OX ❑ Health-care a dol facilities.
El Supply voltage for more than
/ / v� - ❑ Hazrdous locations. 600 volts nominal.
Suite /bldg. /apt. no.: y Project name: a eid..4 S ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Sh/ ,Da,- / i/4 s4,. Description 1 Qty. I Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
°a(� c. ss nal) ,424,72p 1 Ci+. 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 2
L'-.- ) 1.✓a.l4t St 6 C.P [ �+ a... 'h / 5---/-0-1._. residential (with above sq. ft.)
(� Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) 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 1 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 1 El PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: l flr n ' �S � B. Fee for branch circuits without
lLr✓t- ` service or feeder fee, first 56.18 2
Contact name: J 1 4,-6 , � Q branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: /State /ZIP: Each manufactured or modular 67 84 2
Y dwelling, service and/or feeder
Phone: (6)) 36'/ 22 1/ I Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: ign r outline lighting / 67.84 67, Ir.5 2
CONTRACTOR ignal circuit(s) or limited - energy
Business name: 15{Q /45 ..._....014. /� panel, alteration, or extension. Page 2 2
tom. .t1 - C - r Each additional inspection over allowable in any of the above
Address: 3! ( e ff) . n • / S. El_ Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: /� Investigation (I hr min) 66.25/ hr
o5a % 73_2e._ Industrial plant (I hr min) 78.18/ hr
Phone: (5 3) 34 4/. 2 24 / Fax: ( 36 q _ y 315 -- Inspections for which no fee is 90.00/ hr
specifically listed (%I hr min)
CCB Lic.: 690 / S ! I Electrical Lic.: 20 . ,f f Suprv. Lic.: 52 / -3/ L ELECTRICAL PERMIT FEES
Subtotal: 6,1, kf
Suprv. Electrician signature, required:
Plan review (25% of permit fee):
Print name: / /// Vii„ 4 AeD �,. I Date: �/ / a p4 f State surcharge (12 %ofpermit fee): Q. ri
!`T TOTAL PERMIT FEE: 75 qg
Authorized signatur ''`,4 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.
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB