Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00404
T 1 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2010
Parcel: 1 S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY D
Subdivision: Lot: 0
Project: EDWARD JONES
Project Description: Sign lighting.
Owner: FEES
PACIFIC CROSSROADS PROPERTIES, I Quantity Description Date Amount
BY WYSE INVESTMENT SERVICES CO, 1501
SW TAYLOR ST STE #100 1 ea Sign or Outline Lighting 08/04/2010 $67.84
PHONE: 1 ea 12 % State Surcharge - 08/04/2010 $8.14
Electrical
Contractor:
ES & A SIGN & AWNING
89975 PRAIRIE RD
EUGENE, OR 97402
PHONE: 541 - 485 -5546
FAX: 541- 485 -5813
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 0 • - 952- 001 -0100. You ua obtain a copy of •• -s or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344,
Issued - ��>/� Permittee Signature: t / ,
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.
Electrical Permit Application ��. FOR OFFICE USE ONLY
���� �� Received City of Tigard e
� Rec iv t. t P ermit No.:
13125 SW Hall Blvd., Tigard, 22 , . 1 Plan Review .14. 4 —00 C Phone: 503.639.4171 Fax: 50
I N ' `
L ' J 9g,(97i0 � �;`� Dat Other Permit:
T I G A R D Inspection Line: 503.639 P SG v �; a' a Date Ready /By: See Page 2 for
Internet: www.tigard- or.gov . e y'- ".�, _, Notified/Method: �� , Supplemental Information
TYPE OF WORKt'. + ; PLAN REVIEW
v� °' cement
❑ New construction 0 Addition/alteratio Please check all that apply (submit 2 sets of plans w /items checked below):
tt �pl�
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ErOthei:
5 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 IX 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 - ", "1 - ",
Job no.: 10 o Job site address:( I'j 5 5 U PD 4tc_ or more. occupancy.
❑ Six ix o or r more residential units. ❑ R ecreatio
nal vehicle parks.
City /State /ZIP: V 2 { ?223 ❑ Health -care facilities. ❑ Supply voltage for more than
t ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: krw -D Project name: MAM.,a4 Obi4.4eS ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
1 Qty. 1 Fee. 1 Total l
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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
/ � I L Limited energy, multi - family 75.00 2
�tw .Nlrt
( lJS1 l(- l( 4114 a _. Warm. Si 4.N1 residential (with above sq. ft.) -
Services or feeders installation, alteration, and/or relocation
om 1I4 4wwi 200 amps or less 100.70 2
❑ PROPERTY OWNER ( 21 TENANT 201 amps to 400 amps 133.56 2
Name: f ., 401 amps to 600 amps 200.34 2
Qi/(A-,J) Grbt4ES tiqvi3TAt&I.JTS 601 amps to 1,000 amps 301.04 2
Address: ((,o 9 (,a) Pkr..t.A( It cw i iu—D Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZiP: 'ha r ,. - ,r) i O( L =5
ss.� ��Ca relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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: s`s' Date: A. Fee for branch circuits with
X APPLICANT 1 , CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: E✓ St A Sl(ol*6 A D Auji,1/41 LNG do . B. Fee for branch circuits without
service or feeder fee, first
Contact name: eAlidti - Rw��LC.,i branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: f5 ( 7 s Rim e /�
City /State /ZIP: i ( D IL. c ) . Miscellaneous (service or feeder not included)
Each dwel ling, se ing se d/ f 67.84 2
dwelling, a and/or r feeder modular
Phone: (94( )) yt G�5 _ 541, Fax: : (9 I ) 510'3 Reconnect only 67.84 2
� ,'eie- �wu esrt . 's . caw,
Pump r irrigation
tl i ne ti g L in g ( 67.84 �� W 2
E-mail: �-f G
Sign or outline lighting 67.84 � 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Eta ¢ k L , 1 ` �D panel, alteration, or extension. Page 2 2
Y T 40 L la 6 Each additional inspection over allowable in any of the above
Address: i i'?+� �a t ♦ . ,± i ]) Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: � Investigation (1 hr min) 66.25/hr
�.6fi7�� I C �2 .. 7 T0� Industrial plant (1 hr min) 78.18 / hr
Phone: (61 ) 4e6'.. 54 Fax: (94( ) 465.6 Inspections for which no fee is 90.00 / hr
specifically listed (h hr min)
CCB Lic.: 1,3'410 I Electrical Lic.:20 -9fa Suprv. Lic.: G ELECTRICAL PERMIT FEES
VLf
Suprv. Electrician signature, required: > 41 6 4 0141 ' 1, Iii Subtotal: 01.
Plan review (25% of permit fee):
Print name:4 r /6 Date: .. 2_7 .. I C State surcharge (12% of permit fee): 8,14
TOTAL PERMIT FEE: ? Is .q g
Authorized signature: This permit application expires if a permit is not obtained within 180
ch j,� D Date: 7 days after it has been accepted as complete.
Print name:
4� ,�/p I n'e_i' s e4/. r d�it ( 4/ 201,0 Numbe of inspections allowed per permit.
I: \Building \Permits \ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB