Permit i+'' ELECTRICAL PERMIT
' 4� CITY OF TIGARD
` ; ° •:'.• COMMUNITY DEVELOPMENT Permit #: ELC2010 -00263
. :AT Date Issued: 06/01/2010
,TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
fix -, ,cF,: Parcel: 2S102AC00500
Jurisdiction: Tigard
Site address: 12490 SW MAIN ST
Subdivision: Lot: 0
Project: Tigard Liquor Store
Project Description: (2) sign lightings.
Owner: FEES
WOODARD, CHARLES L & ARLIE Quantity Description Date Amount
PO BOX 23303
TIGARD, OR 97223 2 ea Sign or Outline Lighting 06/01/2010 $135.68
PHONE: 503-639-1483 1 ea 12% State Surcharge - 06/01/2010 $16.28
Electrical
Contractor:
SIGNCRAFT ELECTRICAL LLC
8900 SW BURNHAM
TIGARD, OR 97223
PHONE: 503- 639 -4910
FAX: 503 - 620 -9568
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $151.96
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 - . • • - . ith 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. AT NTION: Oregon law - • ' es you to follow the rules adopted by the Oregon Utility Notification r enter. hose rules are set forth in OAR
952 -001 '010 through OAR 952- 1 -01 �.'. •u may obtain a copy of the rules or direct questions to OUNC by calling 503.24:.6•=9 or ;'0.33 2344.
e
Issu By: , / O2/1/1 � / Permittee Signature: t(;■ - .-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.
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.
N2o lo oo / a 3 -f- oo • Electrical Permit Applicat EC E I V ED j gci 1) , j t a, k. , ,, ,
1pg 4 City of Tigard Rece g 6 ,/ ' Permit No.: G�O10 /0 — pe,p� 3
13125 SW Hall Blvd., Tigard, OR 97223 MAY 2 7 2 010 Plan Review
- C ' e• Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit
Inspection Line: 503.639.4175 i r - D ate Read /B Juns: El S Page 2 for
rf(i',\Itla' p CITY o TI CAF#® Ready /By: e
1 ' Internet: www.tigard- or.gov Notified/Method: / Supplemental Information
ID! AMtofpor∎it'Atr.,,mipEQIFeL,
TYPE OF WORK PLAN REVIEW
•
yl 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 EJ 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 ", "1- 2 ", "I -3 ",
� ,,1 n — OOHP or more. occupancy.
Job no.: Job site address: `.atkcto S ` 4\ S....� ❑ S ix or more residential units. parks.
� 0 vehicle
City /State /ZIP: A ❑ Health -care facilities. ❑ Supply voltage for more than
c\ O .. , . , , t � e -j'i ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Si feeder 600 a mps or more
T'tola L t yr` z .9,;k0 r Q Service or er FEE SCHEDULE
Cross street/directions to job site: �u _ r v..4, -0...,t> Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
+� Limited energy, multi - family 67.84 2
. A. r ► f• .. . _. % . a L ;"-s. ' - residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
co A n& p Cs` CL) A • 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
oC'� �� 401 amps to 600 amps 200.34 2
Name: ix.!'
601 amps to 1,000 amps 301.04 2
Address N NAck 0 5 4t....3 0., : e‘ .s.:r- Over 1,000 amps or volts 552.26 2
City /State /ZIP ` Ce 1 r rA n Q
1 el c , r. `3a 1 Temporary services or feeders installation, alteration, and /or
F -1 relocation
Phone: (tom 3) (,, 3 9 _ 0,1 g 3 1 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 1 ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name'
1 l C\ L 1
; IO UO C�
B . Fee for branch circuits
\_ 1 without service or feeder fee,
Contact name:
�`V�G� Loo o U ack A first branch circuit 56.18 2
Address: �3- �{c S L Each add'I branch circuit 7.42 2
�s` Ste" Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
�( �Ca r f !�.,.� dwelling, service and/or feeder 67.84 2
Phone: (e� Co 3C _) I ? Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 6 2
. CONTRACTOR Sign or outline lighting 67.84 /,?j,,(tt$ 2
Business name: Signal circuit(s) or limited-
A _ S _, ' i C.. Ad . 4 r / energy panel, alteration, or
Addresse309 S,� ----iirn�t/V� �� .�, �t9GI
f �� - extension. Describe: Page 2 2
City/State /ZIP:` C.:(0. 1 � � Each additional inspection over allowable in any of the above
I ,----a G a / � r/ Per inspection 66.25
Phone:� /„3c C !O 1 Fax: 3) (�J)C '. (SdCJ Investigation per hour (I hr min) 66.25
CCB Lic.: l w({ Electrical Lic.:'7 . ,c I 1 Suprv. Lic.: 7x115 i z Industrial plant per hour 78.18
/'�' /'� CA %1K ELECTRICAL :PERMIT FEES V4( ' t J�� t�
Suprv. Electrici.n signature, required: � Subtotal: / 36 cos
/, Plan review (25% of permit fee): --1S-- Print name: D ` , f _� G ( 0
k =- . 4 ' ; State surcharge (12% of permit fee): a$
Authorized signature: ,1 4, � l TOTAL PERMIT FEE: /57„ 94,
�+ This permit application expires if a permit is not obtained within 180
Print name: , Date' _ - I ` . • I days after it has been accepted as complete.
" Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 10/01/09 440- 46t5T(tl /05 /COM/WEB
•
Electrical Permit Application - City of Tigard
Page 2 = Supplemental Information
LIMITED ENERGY PERMIT FEES:
(RESIDENTIAL WORKONLY — – j
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n 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