Permit t.
CITY OF TIGARD ELECTRICAL PERMIT
' .. COMMUNITY DEVELOPMENT Permit #: ELC2010 -00093
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/25/2010
Parcel: 1 S 136CD01000
Jurisdiction: Tigard
Site address: 11745 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Aaron's
Project Description: Install sign /outline lighting for (1) wall mounted sign.
Owner: FEES
MONAGHAN FARMS, INC Quantity Description Date Amount
14120 EAST EVANS AVE
AURORA, CO 80014 1 ea Sign or Outline Lighting 02/25/2010 $67.84
PHONE: 1 ea 12% State Surcharge - 02/25/2010 $8.14
Electrical
Contractor:
SECURITY SIGNS INC
2424 SE HOLGATE BLVD
PORTLAND, OR 97202
PHONE: 503- 546 -7114
FAX: 503- 230 -1861
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 ti AR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by ca ' g 503.246. 99 or 1.800.332.2 4.
Issued By: p �6 - IPA ( � V'VW ` Permittee Signature: 1
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.
Ki V v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2010 -00093
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/25/2010
Parcel: 2S102AA00906
Jurisdiction: Tigard
Site address: 12080 SW MAIN ST
Subdivision: Lot: 0
Project: Rite Aid
Project Description: Low voltage for data cabling.
FEES
Owner:
BSM REALTY LLC Description Date Amount
3176 AMERICAN SADLER DR Restricted Energy Permit 05/25/2010 $67.84
PARK CITY, UT 84060 12% State Surcharge - Electrical 05/25/2010 $8.14
PHONE:
Contractor:
WEST COAST BUSINESS COMMUNICATIONS
INC
11134 NE HALSEY ST
PHONE: 502- 465 -9222
FAX: 503- 257 -0028
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom/Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is ssued su to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance with roved ans. 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 la quire you to follow the rules adopted by the Oregon Utility Notification ; enter. Those rules are set forth in OAR
952 -0 1 -0010 through OAR 952 -0 -0100. ou obtain a copy of the rules or direct questions to OUNC by calling 503.2 -!•.6699 or 1 ;'0.332.2 f 4.
Iss By: Permittee Signature: _14 .
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 Application Di r, RF (JF FOR OFFICE USE ONLY
City of Tigard Received In Permit No.
le 13125 SW Hall Blvd., Tigard, OR 97223
8 520 10 r . 'C.R3
FEB 2 plan Review
Date , 20 ��
111 1114
' C Phone: 503.639.4171 Fax: 503.598.1960 B : Other Permit t . •
Inspection Line: 503.639.4175 1 - 1 l : A RD Date Ready/By: UM ® See Page 2 for
TIGARD � �.: o
Internet: www.tigard- or.gov 1 r `.tD GI,v I Notified/Method: Supplemental Information
Li; i ∎, ■ , (, . 1.3 v
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 ® 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 Toad of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: 52518c Job site address: 11745 SW Pacific Hwy I xHP or more. occupancy.
❑ Si x or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Aaron's Rentz: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Tom 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. ft.) 67.84 2
Limited energy, multi- family 67.84 2
Wall Sign residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
*Mount Only* 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:
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 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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Security Signs B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Melissa Hayden branch circuit
Each add'l branch circuit 7.42 2
Address: 2424 SE Holgate Blvd Miscellaneous (service or feeder not included)
City/State/ZIP: Portland OR 97202 Each manufactured or modular 2
Y Portland, dwelling, service and/or feeder
Phone: (503) 546.7114 Fax: : (503) 230.1861 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Melissa @SecuritySigns.com
Sign or outline lighting 1 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Security Signs panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 2424 SE Holgate Blvd Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Portland, OR 97202 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: 503 546.7114 F ax: (503) 230.1861 Ins for which no fee is
Phone: ( 503) ( ) 90.00/ hr
specifically listed ('h hr min)
CCB Lic.: 122809 Electrical Lic.: 26560CLS Suprv. Lic.: 383SIG ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: Marc Linguist Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 75 . 9
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Melissa Hayd Date: * Number of inspections allowed per permit.
1:\ Building \Permits\EI.C- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB
N i s ; c i�i9 ,aid; 'tiYb��'"a.Pi ir y - xa:,'W, .6 ' 45 Otto" 'xi 7t a
Electrical Permit Application i'`�` ' ; � � <> ^ FOR oFFICE41SE ONLV f ,1d�' �s r .:4Z 0
'%fit. . .. . -, . .*E41 #dl9,Zz.ttC na ri ... tF'"N..dk',t� th 41. i isii'l +'- :it` kl'I Atr
lig CE� t1ED Received
ate City o f Tigar �� 1 1 p l Date/By: r" 1 O Permit No.: EkQ /Q + te 3
13125 SW Hall Blv T igard , OR 972 ` ` ' Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: •
T I G A R D, Inspection Line: 503.639.4175 MAY 2 5 2010 Date Ready /By: luriss Fa See Page 2 for
,
Internet: www.tigard - or.gov Notified/Method: --/ ( ee Supplemental Information
. TYPE OF VVE114Y OF TIGARD PLAN REVIEW
❑ New construction QAddition/alt galANKiISION 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 '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.
0 Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ° ,
Job no.: Job site address: 12 D 50 5. LA 1-y) / .� / u .57- 1 ix or or more residential R occupancy.
❑ Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: - Q , L d / L C' ' z ?� ❑ Haz dour facilities.
❑ Supply voltage for more than
/ / 0 locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: rZ l --- - 4 i p ❑ 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 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
F7A TP C A -.lj L A.)1 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or Tess 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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Y relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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 ❑ CONTACT PERSON . above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact naive: 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: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign* outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy 4
panel, alteration, or extension. Page 2 (j? g 2
Business name: r ,t-.,ec ) 7 - C A —r & u5 „,,, e__5 C_e _ Each additional inspection over allowable in any of the above
Address: ) /) 3, N AJ€_ H h-e--5”, 5 . 7 _ Additional inspection (1 hr min) • 66.25/ hr
� .s_,.t,0 ® !1 9 -7 2 _ _' Investigation (1 hr min) 66.25/ hr
City /State /ZIP:
r� L / -,`� Industrial plant (1 hr min) 78.18/ hr
Phone: ( 5) 2 i/ 6 2 , 7 _-- z _ Fax: (5Z9) 25 (J� e p inspections for which no fee is 90.00/ hr
specifically listed ('h hr min)
CCB Lic.: 17 'y) 5 Electrical Li .: t, cc., /Suprv. Lic.:3707 ELECTRICAL PERMIT FEES / 7r
Suprv. Electrician signature, required:
Subtotal: � Sf�{
Plan review (25% of permit fee):
Print name: `�Q y `c?)Q.DD1& Date: 5/Z611 I D State surcharge (12% of permit fee): t / ./
TOTAL PERMIT FEE: -- 7. 99
Authorized signature: Th i s perm app expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: — 1\ZAC;--/ ' bCZ,O) Date: J/ j/ c7 * Number of inspections allowed per permit.
•
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
i RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
6 COMMERCIAL WORK ONLY;
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
2 Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
Ti Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09