Permit ELECTRICAL PERMIT
CITY OF TIGARD PERMIT #: ELC2005 -00154
W I DEVELOPMENT SERVICES DATE ISSUED: 3/15/2005
---`" 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 102AA -00490
SITE ADDRESS: 12085 SW HALL BLVD 120 ZONING: CBD
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: (2) sign lighting.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 2
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ROSENBAUM, LOIS ET AL SECURITY SIGNS INC
C/O 900 SW 5TH AVE #2300 436 SE 12TH AVE
PORTLAND, OR 97204 PORTLAND, OR 97214
Phone: Phone: 503 - 232 -4172
FEES Reg #: LIC 122809
ELE 26- 560CLS
Description Date Amount
[ELPRMT] ELC Permit 3/15/2005 $106.80
[TAX] 8% State Surcharge 3/15/2005 $8.54 REQUIRED ITEMS AND REPORTS
Total $115.34
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OA: 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -6699 or 1 -804- 32 -2344
Issued By: I� - - , , Permittee Signature: �� / . 0
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'N: 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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c...� of Tig . t , • 1 = C E I V Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171
'VIP 2 ��5 Date issued: Bya�jy,� Receiptno.:
Fax: (503) 598 -1960 }��i\ a Case file no.: Payment type:
Land use approval: CITY OF TIGARD
BUIi DINIG D}VISIO
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❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition /alteration/replacement ,Other: 5VJ. J ❑ Partial
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Job address: (7 Cj $ l *A-c,L 3 LLA) Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: 1Z,p 0 "rAel3cg. ' Description and location of work on premises C ._)), ( r..r \NA-( t 'Si [Ad, LS _
Estimated date of completion/inspection:
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Business name: 1k�� f 4 — i .._ c c l e_..-111,A S Description Qty. (ea )
Address: ��t!� S� 1 "2:M �� New residential - single or multi- family per
dwelling unit. Includes attached garage. •
City : Olz. . A I State:(' ZIP: "yej t4 Service included:
Phone:23Z, y t -7 Z I Fax:230186 /1E-mail: - _ 1 _ D (0 1000 sq. ft. or less 4
CCB no.: i n ' Elec. bus. lic. no: Z6sbo c...1- 5 Each additional 500 sq. ft. or portion thereof
�- Limited energy, residential 2
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City /metro lic. no.: Limited energy, non- residential
2
— — . 15 , S Each manufactured home or modular dwelling
Signature of supervising electrician (requirsil' Date Set and/or feeder 2
Sup elect. name (print): A(G Le r s — License no: $�S Services or feders – Installation,
Y m p Stw >s : r , - r . alteration or relocation:
VP.I,srr. �± 4=41 , f ;P ! R OP ERT Y O) ,,al i , z 't ` E � „5 ' 200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: 'State: 'ZIP: Over 1000 amps or volts 2
Phone: I Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps
.q i ra ]n7�p. '� a +�" ry l � r u� tu ry�r) fi r1 d',° ''T � ,{„ r xa en, 2
li t., „x �l,l(„7 es:L 0 ENGINEERy ii�{� � 1r. �4 ,' , � y. is Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2
?,,i4�i�, i n `*PL cllec1 allJhatdappl }) *C`; ' . * M' c (Service orfeedernot
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting Z 53 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan 0 Other: Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 1 O (o. 570
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ S 5'f
Expires accepted as complete. TOTAL $ 1 5.
Name of cardholder as shown on credit card ` 3
Cardholder signature $ Amount '24/•
440 -4615 (6/00 /COM)
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Electrical Permit Fees: Limited Energy Fees: -
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved: •
Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40. 1 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular El Garage Door Opener'
Dwelling Service or Feeder - $90.90 2
Services or Feeders .. . El Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less _ $80.30 2 ❑ Vacuum Systems"
201 amps to 400 amps $106.85 2 _ .'
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
-Over 1000 amps or volts - , _ $fl54.65 2
' Reconnect•only •' '• . $66:85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or Tess $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:" '
Over 600 amps to 1000 volts, n
see "b" above. Audio and Stereo Systems •,
Branch Circuits ' \ ' : ..
New, alteration or extension per panel I 1 Boiler C on tr ols
a) The fee for branch circuits .
with purchase of service or ❑ Clock Systems •
feeder fee.
• Each branch circuit $6.65 2 - ' . . Data Telecommunication Installation -
b) The fee for branch circuits
without purchase of service . . :❑ Fire Alami Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control*
Minor Labels (10) $125.00 •
Each additional inspection over n Medical
the allowable in any of the above n Nurse Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: n Protective Signaling
Enter total of above fees $ in Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee • •
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
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i:\dsts \forms \elc- fees.doc 10/09/00
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200 r001EA
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/15/2005
Phone: (503) 639 -4171 A / 0 41 1 )
Inspection Requests (24 Hrs.): (503) 639 -4175 __
INSPECTION WORKSHEET FOR DATE: 6/21/2005 TIME: 7:11AM PAGE: 46
SITE ADDRESS: 12085 SW HALL BLVD 120 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ROUND TABLE
DESCRIPTION: (2) sign lighting.
OWNER: ROSENBAUM, LOIS ET AL, PHONE #:
CONTRACTOR: SECURITY SIGNS INC PHONE #: 503 -232 -4172
Inspection Request Scheduled For: Date: 6/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final • 009763 -01 603- 232 -4172 N
Corrections /Comments /Instructions:
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ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED •
Inspector: #,Q_Alj Date: 6 - 2/-0C Phone #: (503) 718-