Permit 'a CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2009 00621
;TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/18/2009
Parcel: 2S102BD03200
Jurisdiction: Tigard
Site address: 13075 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Denture Design
Project Description: Sign outline lighting for (1) sign.
Owner: FEES
SANCHEZ, J GUADALUPE & Quantity Description Date Amount
ZAVALA, BLANCA E, 13075 SW PACIFIC HWY
TIGARD, OR 97223 1 ea Sign or Outline Lighting 11/18/2009 $67.84
PHONE: 1 ea 12% State Surcharge - 11/18/2009 $8.14
Electrical
Contractor:
PHONE:
FAX:
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 - nter. Those rules are set forth in OAR
952- 001 -0010 through AR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2.69• or 1f00.332.2 44.
c 11 kW) Issued By: ekf(�' A K3 Permittee Signature: r 4
". ," 4
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.
iee'Yical Permit Application r p _ ,, ` ' � OR n I I
I C u 0N1 1, �
City of Tigard NOV 17 2009 Date/Be: 1 j Permit No.: E C20O11; • O
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review „, Phone: 503.639.4171 Fax: 503.598.19 �°IT 1 OF TIGARD Date/B : Other Permit:
Inspection Lin 503.639.4175 Date Ready /By: 10 See Page 2 for
,, _ - - - Internet: www.ti ard -or. ov pp
='1 I ft Il i g g BU ILDING DIVISION No tified/Method: Supplemental Information
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TYPE OF WORK PLAN REVIEW
[71,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 load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
so-25-
100HP or more. occupancy.
Job no.: Job site address:
.6k) L(Lj / G N1.0(1 ❑ Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: 1 l ci cki ...� 0 f1 c •1 '1 ❑Health -care facilities. 0 Supply voltage for more than
I !7� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: b re , ; r\ ❑ 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: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
• Ea. add'l 500 sq. ft. or portion 33.92 I
fax map /parcel no.: Limited energy, residential
• DESCRIPTION OF WORK • (with above sq. 11) • 67.84 2
..\
1 \ Limited energy, multi - family 67.84 2
l.1 (� R �� ��G, n 0 a- X t 5'! i r1 residential (with above sq. ft.)
l Services or feeders installation, alteration, and/or relocation
O Amp C. t C'OJ ,* 200 amps or less 100.70 2
0. PROPER YY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 51 0 M ''e, C- 9 /�' ""-� � 401 amps to 600 amps 200.34 2
�J / 601 amps to 1,000 amps 301.04 2
Address: i 6 0 0 0 EL m ob. ; Over 1,000 amps or volts 552.26 2
City /State /ZIP: 1 i 644 •`�J ,(f) 0 Atr19- 2 Temporary services or feeders installation, alteration, and/or
l r` I / relocation
r Phone: ay L T his d � 1 ®? I Fax: ( ) 200 amps or less 59.36 1
Owner installation: innstallatioh is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
intended for sale, rent, or exchan:e, acc • ding to • RS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
/ � J ) Branch circuits — new, alteration, or extension, per panel
Owner signatu e: ., Ill � r A!I J� / / // - • e: — / 45 e A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7'42 2
Business name: --. 0. _ ..4 . 5 ..\ \J F- 0._,!7 B. Fee for branch circuits
t without service or feeder fee, 56.18 2
Contact name:
r.r Q. �\ \ ) ��:.tic.L. first branch circuit
Address: S �I�7 �G t � L "� , -t r �� Each branch circuit 7.42 2
�'� Miscellaneous (service or feeder not included)
City /State /ZIP: —CSC ( �:t f- G"` 4 0 (71^7aa,'� Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (Si ( ) "7� I _ . t Zi Fax:: ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
• CONTRACTOR Sign or outline lighting 67.84 (Di .8I J 2
Business name. (s ,� Signal circuit(s) or limited -
LC' [1la (' — c P!' ( . f'_+( Q cu...
V energy panel, alteration, or
Address: (00 - _°N ..i.0 31J� , / \C, M/` 12_ extension. Describe: Page 2 2
City /State /Z1P77 ) q ,,,, r c l Coe c r)c,-)a3 Each additional inspection over allowable in any of the above
` Per inspection 66.25
Phone:, 03 e.D'� _ L (� t 0 I Fax: ( )
Investigation per hour (1 hr min) 66.25
CCB Lic.:1 S� O I Electrical Lic.: I Suprv. Lic. 7� tp..SN'(Ji Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: 1.< v Date: Plan review (25% of permit fee):
t — `�S _.�
2 State surcharge (12% of permit fee):
Authorized sig n . It ►� TOTAL PERMIT FEE: S.ce
t � •ra��
/ This permit application expires if a permit is not obtained within 180
Print name - J Date: i j5-- '
At
ri' days after it has been accepted as complete.
* Number of inspections allowed per permit.
h\ Building \Permits\ELC- PermitApp.doc 10/01/09 4404615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL•WORK ONLY: -
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n G • arage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n V • acuum Systems*
❑ 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
n Boiler Controls
n C • lock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control* . •
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n 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