Permit q CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2010 00430
T I ei A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/20/2010
Parcel: 2S 101 AC00400
Jurisdiction: Tigard
Site address: 7095 SW GONZAGA ST
Subdivision: NATIONAL SAFETY BUILDING Lot: 0
Project: Willamette Dental
Project Description: (2) branch circuits for sign lighting.
Owner: FEES
NATIONAL SAFETY COMPANY Quantity Description Date Amount
17010 SW WEIR RD
BEAVERTON, OR 97007 2 ea Sign or Outline Lighting 08/20/2010 $135.68
PHONE: 1 ea 12% State Surcharge - 08/20/2010 $16.28
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: OTR Type of Const:
Occupancy Grp:
Total $151.96
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 t ugh ORR452 -00 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: K.....
, CkA/11 Permittee Signature:
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' 411.1111. • , _ A/ 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.
Electrical Permit Application _,TA , j FOR OFFICE USE ONLY
R e ceived
City of Tigard � ' ' 9 �O
g DateB : ((� l y �d vi Permit NogZ� - ''‘O 1 30
a 13125 SW Hall Blvd., Tigard, OR \,97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.19kp, (1 A — DateB Other Pe CA, AIN _lay/ 1
T I G A R D Inspection Line: 503.639.4175 H Date Ready /By: lur s: / ® See Page 2 for
Internet: www.tigard- or.gov 1:'; °z� Notified/Method Supplemental Information
.tee / . . ?4n1,1
TYPE OF WORK ,.` ' K ,, y .�' ' PLAN REVIEW
c'.lk. 8h - re `` a m
Please check all that apply (submit 2 sets of plans w /ites checked below):
❑ New construction ❑ Addition /alter AV/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: L ,'4 S 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 Ig Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E ", °I -2 ", "I -3 ",
ell 100111'
more. occupancy.
Job no.: (I( Job site address: ?A 5 ,444 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ` v (L ❑ Health -care facilities. ❑ Supply voltage for more than
6r{'—� ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Lo L ' (eT re ip ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qtr. 1 Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or les 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
j u ` M
. ( w - � T , /b AND (I) residential (with above sq. ft.)
J ` � Services or feeders installation, alteration, and/or relocation
c oke, � .4. ✓M U0Makti�..IT l 200 amps or less 100.70 2
❑ PROPERTY OWNER I . TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 14 11.4411146TM TW .— 601 amps to 1,000 amps 301.04 2
Address: q J 14 e - IsZ . Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: \Jki, or g lap (or relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Owner signature:
/ h- Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
12 APPLICANT I PSCONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: eS sL tN �,�� � M I �� B. Fee for branch circuits without
b service or feeder fee, first 56.18 2
Contact name: branch circuit
^ �'L�i Each add'I branch circuit 7.42 2
Address: em R" S '( . "- s t o , Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: b , m , (t „_ a e,.�L dwelling, service and/or feeder
(� Reconnect only 67.84 2
Phone: ) - (�( o Fax: : , f `
) �, ��� l,3
Pump or irrigation circle 67.84 2
E - mail: C 'e_ e poweil e esa.slg1's . C.•ofVY Sign or outline lighting 2. 67.84 1W 2
CONTRACTOR Signal circuit(s) or limited - energy
A ` panel, alteration, or extension. Page 2 2
Business name:
E5' A 't(fp w D �N 1,4&..e..s., Each additional inspection over allowable in any of the above
Address: 51 i''r c ?P . Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: 6L � t 0 ,2_ q/� 02. Industrial plant (1 hr min) 78.18 / hr
Phone: et 1 ) `F$y- 6 Fax: 6 f I ) j 5m 3 Inspections for which no fee is 90.00 / hr
specifically listed ('/2 hr min)
CCB Lic.: 16'34 V Electrical Lic.: 20 , 94364SSuprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal: I SS%
Suprv. Electrician signature, required: r Plan review (25% of permit fee):
Print name: el ork-) �— o 5E43a Date:
a.a g - y- /46 ( State surcharge (12%ofpermit fee): � .2.8
�
TOTAL PERMIT FEE: 1 GI .1G (../- Authorized signature/ /• y l � /Lac.. T his permit application expires if a permit is not obtained within 180
�j Hi e r' " ( / Date: V L,�i ocy� dspe Li a has allowed been accepted as complete.
Print nam Number of inspections allowed permit.
1 \ Building \ Permits \ELC- Permit App .doc 07/01/10 440- 4615T(11/05/COM /WEB