Permit a CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00465
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2010
Parcel: 2S110DCO2100
Jurisdiction: Tigard
Site address: 15520 SW PACIFIC HWY
Subdivision: Lot: 0
Project: CARL'S JR
Project Description: Sign lighting for (4) signs.
Owner: FEES
JCR RESOURCES LLC & Quantity Description Date Amount
STERLING DEVELOPMENT CORP, 3262
HOLIDAY CT STE 104 4 ea Sign or Outline Lighting 09/01/2010 $271.36
PHONE: 1 ea 12% State Surcharge - 09/01/2010 $32.56
Electrical
Contractor:
ADVANCED ELECTRIC SIGNS INC
1550 DOWN RIVER DR
WOODLAND, WA 98674
PHONE: 360 - 225 -6826
FAX: 360 - 225 -8299
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $303.92
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. Y. " . • • r = • py 0 s or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
diP
Issued B Permittee Signature: _
�j
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.
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 44,4 FOR OFFICE USE ONLY
City of Ti and �, R _
g � d Date/By: $ J3 i /() J7T Permit No.: :LC 2'Z)!t / -0l0 !o5
• 13125 SW Hall Blvd., Tigard, OR 9 .!k Plan Review
I Phone: 503.639.4171 Fax: 503. ° • ° . I ., 'N. 9 D Other Permit:
Inspection Line: 503.639.4175 4
T I G A R D •-\>,'s �� l t� Date Ready /By: 0 See Page 2 for
B: runs:
Internet: www.tigard- or.gov • ' . 0\,`-'\, C. Notified/Method: 7y'& Supplemental Information
.i TYPE OF WORK � :. C,5 .• tit,.,is..�i; 7:1 ; ; ;trik..f 't,PLAN•REVIEW.ii'; „t -:s:,: :.•
❑ New construction ❑ Addition/alterhtio ment Please check all that apply (submit a sets of plans w /items checked below):
fie[• _ 14Vv/'� y ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition
: S i (,/J ' I-Ql) where the available fault current ❑ Marinas and boatyards.
• •.. CATEGORY OF CONSTRUCTION.. . •. . exceeds 10.000 amps at 150 volts or O Floating buildings.
building less to ground, other installations. ons. 0 Commercial -use agricultural
❑ I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory g amps for all other iustallatiom. 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 O "A ", "E ", "I -2 ", "1 -3"
Jot) n0.: Job site address: ` [f 100HP or more. occupancy.
Jo
�57 a 0 SW PAO CLL v'w y ❑ Six or more residential units. ❑ Recreational vehicle parks.
lJ
City /State /ZIP: ,. d ❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: l Af W : r e _ e _ ❑ Service or feeder 600 amps or more.
.. ,:.,;,:y...e.: t '. • ` t ot f - „. FEE SCHEDULE...., ..,. ; : .
Cross street/directions to job site: 99 .�/ 're) I N G Ed- Description 1 Q. I Fee 1 To I •
New residential single- or muld- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
. Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
. DESCRIPTION OF WORK. . `. r.•: :;s!t e : (with above sq. ft.) 75.00 2
.114i41\11 l t Limited energy, multi - family
Al Of Jr 'U t () i °'1 q 51(.11S residential (with above sq. ft.) 75.00 2
`��
r Services or feeders installation, alterad on, and/or relocation
VIGO _
k� EX 1 S 'P6wCt 200 amps or Tess 80.30 2
❑ PROPERTY OWNER s ..�:, ::.:.. I � -. ,: ja. TENANT -:'_• : "• '.'. 201 amps to 400 amps 106.85 2
Name: r S � 401 amps to 600 amps 160.60 2
• ,` 601 amps to 1,000 amps 240.60 2
Address: 155 'AO S\d,, Pl c ki y Over 1,000 amps or volts _ 454.65 2
City/ State/ZIP: �(� {� 6n . Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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.; µ::. :. :i ❑ CONTACT. PERSON " r" above service or feeder fee, 6.65 2
each branch circuit
Business name: RDUANc_fD E1EC.'f tie., 3 5 B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2 -
.lV� first branch circuit
Address: i5So t- t w vo2_ of
Each add'( branch circuit 6.65 2
Miscellaneous (service or feeder not included) _
City/State/ZIP: Each manufactured or modular
ty��� -A N� WA ? y 90.90 2
^ dwelling, service and/or feeder
Phone: (3 '^ �) A e - 6,421C. � I Fax: : (360 a �I� Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
14• . t: -. CONTRACTOR - . . •• .. . Signor outline lighting L) ,.... 5_3.4(r":)7/,, � 6 2
' Signal circuit(s) or limited- - 0 ,71 - ,
Business name: 5sap AS Ape iir. energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State/ZIP: Each additional inspecdon over allowable in any of the above
Per inspection 62.50
Phone: ( ) I Fax: / //) o / 1 / 11 . Investigation per hour (1 br min) 62.50 • CCB Lic.: 1 Lj I Electrical L 37. 1 Suprv. Lic.: 307 14 Industrial plant per hour 73.75 _
• , . ELECTRICAL PERMIT FEES
• Suprv. Electrician signature, required: Subtotal: ?_-) 1, 3c
Print name: 5,6, Sl Date: g/u/
review (25 % of permit fee):
State surcharge (12% of permit fee):
Authorized signature: /g aue, Sikkg TOTAL PERMIT FEE: U 3r q;
Print name: Date: permermit la noed within 180
f2' /io days after it bits been accepted as complete.
• Number of inspections allowed per permit.
I Building \Permits\ELC- PermitApp.doe 05/23/06 440.4615T(Ii/0S/COM/WEB