Permit CITY OF TIGARD ELECTRICAL PERMIT
.11 " COMMUNITY DEVELOPMENT
Permit #: ELC2010 -00333 •
Date Issued: 07/08/2010
Y,TiGARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S.101BB01400
Jurisdiction: TIGARD
Site address: 12110 SW GARDEN' BLDG# 4
Subdivision: PARK 217 Lot: 0
Project: Randstad
Project Description: Sign lighting
Owner: FEES
WALTON CWOR PARK BC 8 LLC Quantity Description Date Amount
BY TTA/EPROPERTYTAX DEPT 325, PO BOX
4900 1 ea Sign or Outline Lighting 07/08/2010 $67.84
1 ea 12% State Surcharge - 07/08/2010 $8.14
PHONE: Electrical
Contractor:
RAMSAY SIGNS INC
9160 SE 74TH AVE
PORTLAND, OR 97206
PHONE: 503 - 777 -4555
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 Center. Those rules are set forth in OAR
952- 001 -0010 through OAR : 952- 001 -0100. You ma obtain a co . - or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By. Permittee Signature: J
®5
OWNER INSTALLATION ONLY
The installatiomis being:7rrnade on'Property 1 own is not intended for sale, lease or rent.
OWNER'S`SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Cali 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.
' a " I it f " l ik I ilIt t IR �nnu r t m : d` i J M1 i t, , 9 . .
Electrical Permit Application ti Received
ll � ri ti � ' ' "' �, FowcIFFIcElusE ciN - L � �^ ,,, b r '�
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, � " r 5 City of Tigard Date /B rl' Penult No.: L to— . •
111
4 Phone: 503.639.4171 ° 13125 SW Hall Bl "vd., Tigard, OR 97223 Plan Review
Fax: 503.598:1960 ■ ' �\ Date/B Other Permit
y -
T G DS Inspection ection Line: 503.639.4175 li Date /By: lulls: l0 See Page 2 for
4 hW'rtaiai"+'*�Mr Internet: www hgard or gov 0... t ', t ifed/Method: Supplemental Information
° f - f E $ € $' �N l xet ' ,a` : ':L7 PLAN REVIEW ` .!
:�� s °i TYPE OFD WORK � , . _ E - �: ,Y. ., t;
.,t„ . �.,,,F �F r.s ..# ., ..xa,.. [� . , �� '. ,tt �.F, ❑ Se rv ice or feeder 400 amps a ,.. s.i
�Iew construction ❑ Addition/alteration/rePl � t t �0 - Please c all that apply (submit 2 sets,of plans whtems checkeeow)
d bl:
O or more ❑ Building over three stones.
El Demolition ❑Ogler: V where the available fault current ❑ Marinas and boatyards.
s t C t AT EGORY OF CONSTRUCTION s , ; ''' '' ..... less to round, or exceeds 14,000 ❑ Comm
a ,a t: $ exceeds 10,000 amp at 150 volts or ❑ Floating buildings.
g erc -use agr
❑ 1- and 2- family dwelling 0.Commercial /industrial ❑ Accessory building amps '. for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
a - ❑Emergency system. larger separately derived system.
JOB SITE I NFO RM ATION AND LOCATION
IA ,�,� �� .� �.- �, r ,� g �.. ,� ,,� „; ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3
121 I O r ...
Job no.: Job site address: ` ]00HP or more. occupancy.
b Q.� 1.0.0 -e ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIPS
El Health-care facilities. ❑ Supply, voltage for more than
1 1 S 10 1 Re,� ❑ Service or f ns 600 volts nominal
Suite/bldg. /apt. no.: Project name: RAt,Ds rA-D ❑ Hazardous eeedeerie r 600 amps or more.
`; 1..a,. , .t . 3:' FEErSC_HEDULE x L '` P
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: I 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
_ , '')r,.. , n- DESCRIPTION r OF WORK: <. `'., �; (with above sq. ft) 67.84 2
Limited-energy, multi- family 67.84 2
1 V1/4l�.1 . i,a _ D J 1 - "*. residential (with above sq. ft.)
�C 1 N13, Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
* PROPERTYgWNER r a , ` 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
20I amps:to 400 amps 125.08 2
Owner installation: This' installation is being made on property that I own which is not
' ` intended for sale, Iease,•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
0 . K �.y above service or feeder fee, 7.42 2 ,
❑ t APPLICANT ' 3 4 CONTACT PERSON r
.., s ., . a� each branch circuit
/y� p / B. Fee for branch circuits without
Business name:
„ ' .) Zx y 5 0(V service or feeder fee, first
Contact name: branch circuit 56.18 2
' Each add'l branch circuit 7.42' 2
Address: Miscellaneous (service or feeder not included)
City/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: Signor outline lighting 67.84 � � 0 2
• 'CNTRACTOR ` i r.. s .
_ _.,., O = - -!� �. .:.� ,� ,. . -. � ' �': Signahoircuit(s) or limited- energy
Business name: �• M _� panel, alteration, or extension. Page 2 2
Al1MSd4� ►,s C Each additional inspection over allowable in any of the above
Address: Q1kp - • 1 TN Ave ,. Additional inspection (1 tir min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP:; p zart . t.A. , I U ne.ls ({ I Zd (o Industrial plant (1 hr ruin) 78.18/ hr
Phone:' �y ' k' ' 4 SS S Fax: (S63) • df� y Inspections for which no fee is
T 90.00) hr
specifically listed CA hr trtin)
CC13 Lic.:' Electrical Lic.: la`C(,5 Suprv. Lic.: ' „ ; � . „ ,PERMIT FEES " ,
� 1; Subtotal: 67 ��
. , Suprv. :Electrician signature, req , /t'
uired:
4... je.....1, Q Plan review (25% of.permitfee).
State surcharge (12% of permit fee t
Print riaine ? ht.. Ti Se G {Z ate: 7 2 /!C g ( P ) : -
TOTAL PERMIT FEE: 1511.-
Authorized nature: This permit application expiresif a permit is not obtained within 180
g - -
days after it has been accepted as
Print ` nariie. - Date: • * Number of inspections allowed per permit.
1:\ Building \Pennits\ELC -PennitApp.doc 10/01/09 440- 4615T(1 l /05 /COM /WEB