Permit q CITY OF TIGARD ELECTRICAL PERMIT
2 .. COMMUNITY DEVELOPMENT Permit #: ELC2010 -00422
T I GIRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/17/2010
Parcel: 2S102BD00100
. Jurisdiction: Tigard
Site address: 9905 SW MCKENZIE ST
Subdivision: Lot: 0
Project: St. Anthony's
Project Description: Sign lighting for monument sign for Tigard Youth Football.
Owner: FEES
ROMAN CATHOLIC ARCHBISHOP OF Quantity Description Date Amount
PORTLAND IN OREGON, 2838 E BURNSIDE
PORTLAND, OR 97214 1 ea Sign or Outline Lighting 08/17/2010 $67.84
PHONE: 1 ea 12% State Surcharge - 08/17/2010 $8.14
Electrical
Contractor:
WILLAMETTE ELECTRIC INC
•
PO BOX 230547
TIGARD, OR 97281
PHONE: 503 - 624 -3631
FAX: 503- 624 -2938
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This per .. ' iss ed..subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be • . e 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
d- -s. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
• .2-001-0010 through OAR : 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 or 1.800.332.2344.
Is • - • - • _ _ , ...411...i•Ce! «•...6L., Permittee Sig ure: m LSD s
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' � - Ju / _-
Date: /74
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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: lb( 7 '10 Permit No.: iL,e 1b -CO .-
1 114 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
a • Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: .503.639.4175 Date Ready/By: Juris: 1 ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ 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 0 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 ", "l - ", "1 - ",
Job site address: .1./e_ l OOHP or more. occupancy.
Job no.:
6,0 � ?90 S 544..) /►� c// my ST - ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: �-/ (r_Gr e, r.5 A 7 7 ? a- - ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 4 j,- Ark T,I 6'4 15. ❑ 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: 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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
/ residential (with above sq. ft.)
/)/ €1....,_i +r1 c.,--1 G, ,^1 Y - J ST, ! ri Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ 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 I
201 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, 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: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting / 67.84 47 / 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Tigard, OR 97281 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 624 - 3631 Fax: (503) 624 - 2938 Inspections for which no fee is 90.00 / hr
specifically listed (Y2 hr min)
CCB Lic.: 75059 Electrical Lic.: 34- 28 Suprv. Lic.: 4226 -S ELECTRICAL PERMIT FEES
Subtotal: & 7 Y
Suprv. Electrician signature, requ
Plan review (25% of permit fee):
State surcharge (12% of permit fee): ,t,„
Print name: David Fife Date: g ( p )�
TOTAL PERMIT FEE: 7 S g
Authorized signature: This permit application expires ifa permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(t I /05 /COM/WEB