Permit a CITY OF TIGARD ELECTRICAL PERMIT
.1111 ° COMMUNITY DEVELOPMENT Permit #: ELC2010 00550
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2010
Parcel: 1 S 136AD06505
Jurisdiction: Tigard
Site address: 10998 SW 68TH PKWY
Subdivision: WAY LEE Lot: 3
Project: Union Bank
Project Description: Sign lighting.
Owner: FEES
UNION BANK Quantity Description Date Amount
10998 SW 68TH
TIGARD, WA 97223 1 ea Sign or Outline Lighting 10/07/2010 $67.84
PHONE: 1 ea 12% State Surcharge - 10/07/2010 $8.14
Electrical
Contractor:
MEYER SIGN CO OF OREGON
15205 SW 74TH AVE
TIGARD, OR 97224
PHONE: 503 - 620 -8200
FAX: 503 - 620 -7074
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 OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.33 4.
Issued By: Permittee Signature: A-, n Q
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.
r ilk e--- A) 7.010- oc)
Electrical Permit Application RECE 1 FOR OFFICE USE ONLY
City of Tigard 0 5 �O� �e c eived
el P erm it N o. :
1 1111
° 13125 SW Hall Blvd., Tigard, OR 97223 Q C T ateB : LC a01 - cx
C Phone: 503.639.4171 Fax: 503.598.1960 Fig; Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TSG - ) • 'Re y: ® SeePage2for
Internet: www.tigard- or.gov t 1 r' ,rsI I J ,, hod: 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: 61 (O N.) where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tess 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. A
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: Q c - \ / 100HP or more. occupancy.
t L _I 1 8 S ("- ) ( D 41% Pr kLs1 ( ❑ Six or more residential units. ❑ Recreational vehicle parks.
Clty/State /ZIP' 1 J ❑ Health -care facilities. ❑ Supp voltage for more than
l g, ,1. ow.._ ❑ Hazardous locations.
Suite/bldg. /apt. no.: lvJ Project name: f tl y (51 o0. 0 Service or feeder 600 amps or more.
� FEE SCHEDULE
Cross street/directions to job site: -f r4 • c lv 1 t , A.) (0C Description 1 Qty. 1 Pee. 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
OA 11 i ...) \ .1,M S t " " residential (with above sq. ft.)
o Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ["TENANT 201 amps to 400 amps 133.56 2
k 401 amps to 600 amps 200.34 2
Name: 'L i ; 6v 4 a n k ) 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 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 extension, per panel
Owner signature: Date: A. Fee for branch circuits with
[}APPLICANT 1 9 PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name B. Fee for branch circuits without
Q A1191Y t�' 1.� service or feeder fee, first
Contact name: Q U branch circuit 56.18 2
.r. a rt to Uw-.S Each add'I branch circuit 7.42 2
Address: a Miscellaneous (service or feeder not included)
Each City/State /ZIP: dwelling, service and/or fe eder 67.84 2
Reconnect only 67.84 2
Phone: (SD3) 3 - Da" I Fax: : ( S 3 364- <43 t S
Pump or irrigation circle 67.84 2
E - mail: Vogn r outline lighting 1 67.84 ('1 Si 2
CONTRACTOR circuit(s) or limited- energy
Business name: Sir, anel, alteration, or extension. _ Page 2 2
Co l Each additional inspection over allowable in any of the above
Address: 1 5",?.65 &c.,) . -7t ( 73 /{.. J1 ' , Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: p
, 0 G I c) d i 7�a"3 Industrial plant (1 hr min) 78.18/ hr
Phone: (S 3) N - a 1 1 1 I Fax: (), ‘d - 3 fl S Inspections for which no fee is 90.00 / hr
specifically listed (%3 hr min) _
CCB Lic.: Wy 014.k. Electrical Lic.: 6._ • it Cis, Suprv. Lic.: Sig, - SI ( ELECTRICAL PERMIT FEES
l Ifif Subtotal: 6,1 $q
Suprv. Electrician signature, req i ed��. 4 1 ,,,,„, / ---
Plan review (25% of permit fee):
Print name j y‘..O l c l o Date: / O _ 7 _ /n, State surcharge (12% of permit fee): g .14
TOTAL PERMIT FEE: 9 ... 9$
Authorized signature: This permit application expires if a 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- PernitApp.doc 07/01 /10 440- 4e15T(1I/05 /COM/WEB