Permit 1
CITY OF TIGARD ELECTRICAL PERMIT
e PERMIT #: ELC2009 -00034
ni COMMUNITY DEVELOPMENT DATE ISSUED: 1/26/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 133RD - 16000
SITE ADDRESS: 12744 SW NORTH DAKOTA ST ZONING: C -P
SUBDIVISION: PP1995 -073 LOT : 001 JURISDICTION: TIG
PROJECT: KEYBANK
Project Description: Replace existing sign.
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: 1
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:
PACIFIC CREST PARTNERS SCHOLLS L YOUNG ELECTRIC SIGN CO
BY FIRST AMERICAN TAX VALUATIO 416 E 41ST B
DEPT: KEY BOISE, ID 83714
WORCESTER, MA 01615
Phone: Contact #: PRI 503 - 612 - 6672
FAX 503 - 612 -0914
FEES
Description Date Amount Reg #: ELE 37 -51CLS
[ELPRMT] ELC Permit 1/26/2009 $53.40 LIC 69308
[TAX] 12% State Surchar 1/26/2009 $6.41 SUP 710SIG
Total $59.81 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applic -ble laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days .f issuance, or if wor. ' suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notifi i• ' enter. Thos . es are set forth in
OAR 952 - 001- Vffif211 0010through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to • % 50 , =9 .r X0.332.2344.
Issued By 1i, j � Permittee Signature: _ i
Nor
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.
E ctri�al Permit Application FOR OFFICE USE ONLY
j� - -eived
City of Tigard Date/By: l• Z I o q • Permit No.: Fs- l C ? 004.000 ALt
:� • 13125 SW Hall Blvd., Tigard, OR 97223 an Review
Phone: 503.639.4171 Fax: 503.598.1960 J ' F 7U ate/By: Other Permit:
T I C. A It D Inspection Line: 503.639.4175 Date Ready/By: twist B See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGADifted/Method: 1 15 Supplemental Information
TYPE OF WORK BUILDING DIVISION PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ._ Addition/alteration/replacement
❑ 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
❑ I- and 2- family dwelling f '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 ",
IOOHP or more. occupancy.
Job no.: Job site address: ^
I .1 ( l J 5w. N • btF � ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: { ❑ Health-care facilities. ❑ Supply voltage for more than
` ■ yr I O ❑ Hazardous locations. 600 volts nominal.
Project ) e r ' ❑ Service or feeder 600 amps or more.
Suite/bldg./apt. no.: Pro ect name: '1 /_
FEE SCHEDULE
Cross street/directions to job site: 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 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
`` � �m1�kl r -,1, a ps-k I( PQ 1 y J 3 n residential (with above sq. ft.)
k
'T'Y1Gi.V \S Q11t �c Vhl . L;>L, t 1,.,, Services or feeders installation, alteration, and/or relocation
f Q. 200 amps or less 80.30 2
❑ PROPERTY O WNE R ._a. TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
/ 601 amps to 1,000 amps 240.60 2
Address: 1 21 Sva , ` ` ) a , \ Over 1,000 amps or volts 454.65 2
City/State /ZIP: T�Qa�� ' O V n t� t Temporary services or feeders installation, alteration, and/or
\ 1� • relocation
Phone: ( ) r I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
,APPLICANT I „R CONTACT PERSON above service or feeder fee, 6.65 2
Business name: c each branch circuit
Ynu r't E\P.c r l J►ay1 c • B. Fee for branch circuits
V.1 ` S J
without scrvi or feeder fee, 46.85 2
Contact name: r /` first t branch branch cirir cui t
Address: e.0 I S T • [l a Av e. , Each add'I branch circuit 6.65 2
n D Miscellaneous (service or feeder not included)
City/State/ZIP: i �Q �, 1 7) 12. 1 Z Each manufactured or modular 90.90 2
) - �i Fax: ( I dwelling, service and/or feeder
Phone:
� tp� I L ILI Reconnect only 66.85 2
E- mail: -� rk" r► e5CC4C•C)Y1 -• Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting I 53.40 .4 C 2
Signal circuit(s) or limited -
Business name: l O �n9 Vey i- ; C v' C energy panel, alteration, or
Address: abiob Ski I /a r iciV extension. Describe: Page 2 2
City/State /ZIP: T im. n k , ' .�; N �; '6 P • q ?0 Each additional inspection over allowable in any of the above
F' p Per inspection 62.50
Phone: a - U(e 7c. I Fax: 6 D3) C0 6-1 iq Investigation per hour (l hr min) 62.50
CCB Lic.: (q e) Electrical Lic.. �. j (G Suprv. Lic.:1 SI V Industrial plant per hour 73.75
U ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 53. 4c•
0/..,..:_.> _ Print name: s--c -K l I L �r Date: / -0 Plan review (25% of permit fee):
/,,,///, State surcharge (12% of permit fee): 4UC9 .
Authorized signature: / / /� S TOTAL PERMIT FEE: S l• D 1
� Date: This permit application expires if a permit is not obtained within 180
Print name:
r "�41 r E� 5 ( aC( - Q 7 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 05/23 /06 440- 4615T(I I /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 .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ 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 03/23/06
r
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELC2009-000311
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/36/2009
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 EJ1
INSPECTION WORKSHEET FOR DATE: 2/25/2009 TIME: 7:00AM PAGE: 20
SITE ADDRESS: 12744 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: pP1995 LOT #: 00 TYPE OF USE:
PROJECT NAME: KEY BANK
DESCRIPTION: R ex isting sign.
OWNER: PACIFIC CREST PARTNERS SCHOLLS L, PHONE #:
CONTRACTOR: YOUWG ELECTRIC SIGN CO PHONE #: 503-612-U1672
Inspection Request Scheduled For: Date: 2125/2009 Pour Time:
Code # Inspection Description Confirm Contact # Message
199 Electrical final
3$1318-01 503-753-1068
Corrections/Comments/Instructions:
N N.1t
PASS LI PARTIAL APPROVAL CANCEL Ej NO ACCESS
fl FAIL fl CALL FOR INSPECTION 11] ADDITIONAL FEES ASSESSED
Inspector: Crd e Date: 214 Phone #: (503) 718- 70-
- •