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Permit CITY OF TIGARD ELECTRICAL PERMIT o •• COMMUNITY DEVELOPMENT Permit #: ELC2010 -00455 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/27/2010 Parcel: 1S136 DB00600 Jurisdiction: Tigard Site address: 11635 SW PACIFIC HWY Subdivision: Lot: 0 Project: Taco Bell Project Description: Sign lighting for replacement menu board. Owner: FEES TYSON FAMILY TRUST & Quantity Description Date Amount LARSON, RAYMOND IVEILEEN FRANCIS, BY TBC #016600, PO BOX 35370 1 ea Sign or Outline Lighting 08/27/2010 $67.84 PHONE: 1 ea 12% State Surcharge - 08/27/2010 $8.14 Electrical Contractor: VANCOUVER SIGN COMPANY INC 2600 NE ANDERSEN RD #50 VANCOUVER, WA 98661 PHONE: 360 -693 -4773 FAX: 360 - 693 -2747 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 a nce wi : •proved 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. ATT TION: Oregon la - =qui -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001- 010 through OAR 952 -0' -0100. Y•u m obtain a copy of the rules or direct questions to OUNC by calling 503.246.6. • • or 1.80•.332.2: • Issu By: r _ L4( 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' 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 ApplicationRECEIVED Foi, OFFICE USE ONLY 7,1 City of Tigard s y Received g tj , Date/B ir' /Q Permit No.: C i C�I, 5 q 13125 SW Hall Blvd.. Tigard, OR 972 A l �� G /• Plan Review : C . Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: T 1 G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: Juris: ® See Page 2 for Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Ar 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 ,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.: Job site address: 4 (+ 10OHP or more. occupancy. 57 S a5 !w� pax. 14 .1 ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: T ;a r 0 ( Cm ZZ ❑Health -care facilities. 0 Supply voltage for more than �, ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: l Q —`,,„ 01 ❑ Service or feeder 600 amps or more. 1 V FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I 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 DESCRIPTION OF WORK (with above sq. ft.) 67.84 2 J Limited energy multi - family C� P l n q e#X t S+l n_ Q t� P. I'l.lA . boo,s L residential (with above sq. f.) 67.84 J `J Services or feeders installation, alteration, and/or relocation 200 amps or Tess 100.70 2 ❑ PROPERTY OWNER I 15f TENANT 201 amps to 400 amps 133.56 2 Name: ;ax.° B ei 1 401 amps to 600 amps 200.34 2 (` 601 amps to 1,000 amps 301.04 2 Address: /1 ( 3 S 6 la ) pax.. t T t G )1 0 y Over 1,000 amps or volts 552.26 2 Temporary City /State/ZIP: T; aA el O A 97 Z Z 3 / relocation services or feeders installation, alteration, and/or Phone: ( ) J Fax: ( ) 200 amps or less 59.36 1 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 ex tension, per panel Owner signature: Date: A. Fee for branch circuits with g APPLICANT 1 lit CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: Val.Yl. C.O t. eA- 6 eyet B. Fee for branch circuits Contact name: without service or feeder fee. R e.i L Storr'Y) first branch circuit 56.18 2 ,Q , � �� G #iS0 Each add, branch circuit _ 7.42 2 Address: Z /00& �' -`-" `r`^rc� Miscellaneous (service or feeder not included) City / State/ZIP: Vaxu.otAve,c 1,6A p © / 6 Each manufactured or modular 67.84 2 ' ` 1 O c0 dwelling, service and/or feeder Phone: ( 360 69i y 77 3 I Fax: : (3 ) ( 13 21 in Reconnect only 67.84 2 E -mail: CP.leLsSd oat, Siq rl.cor con. Pump or irrigation circle 67.84 2 LCONTRACTOR Sign or outline lighting CI) 67.84 (o7. 7 2 r Signal circuit(s) or limited- Business name: U eat, G o IJ. J ei c' st q tl energy panel, alteration. or �1 extension. Describe: Page 2 2 Address: at.00 NE A vizi'6si✓ n Raid # SO City /State/ZIP: Van GO um e r A O s 4 . 4 I Each additional inspection over allowable in any of the above 7 Per inspection 66.25 Phone: ( 340 69 3 2177 3 F ax: ( 34.0 ) 69 3 2.7 L'{ 7 Investigation per hour (1 hr min) 66.25 CCB Lic.: 6 3 q S % I Electrical Lic.: 3 7- y , S Suprv. Lic.: Industrial plant per hour _ 78.18 `�� ELECTRICAL PERMIT FEES Suprv. Electrician signature, r f !� Subtotal: 6 7• FY (to r �. r ' Date: Plan review (25% of permit fee): -e W 0 ,- State surcharge (12% of permit fee): O . /'f Authorized i TOTAL PERMIT FEE: - 75 - . 9g This permit application expires if a permit is not obtained within 180 Print name: R J or' L Date, days after it has been accepted as complete. ' Number of inspections allowed per permit. I:d Building \PermitsTI.0 -PermitApp.doc 10/01/09 440- 4615T( I I /05/COM/WEB