Permit a CITY OF TIGARD ELECTRICAL PERMIT
NI I:.. COMMUNITY DEVELOPMENT Permit #: ELC2010 -00567
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/14/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9355 SW WASHINGTON SQUARE RD T19
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Verizon Wireless
Project Description: (2) sign lighting
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 2 ea Sign or Outline Lighting 10/14/2010 $135.68
PHONE: 1 ea 12% State Surcharge - 10/14/2010 $16.28
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 $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 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5 6.6699 or 1.800.33. 44.
Issued By: , Permittee Signature: .y / .c.�. .r.��
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 RECEIVED FOR OFFICE USE ONLY
City of Tigard Received O�
`, g DateBy: /D�y�O 4 /4- 4 L. Permit No. (C /O — .56 7
° 13125 SW Hall Blvd., Tigard, OR 97223 0 j 1 t. 't . Plan Rev
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T 1 G A R D Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: 726--- Supplemental Information
BUILDING I)IVISIO'
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: 5 16NS 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "I - ",
_ � 1
100HP or more. occupancy.
Job no.: Job site address: -v Wash sh it 9f7'v � . FC1 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
ty ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: - s ue n I Project name: \e r- Zoy 10 1 Ye_ le_S 5 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:' , W c kg ' L� New 1 Qt v. 1 Fee. I Total I •
New residential single - or multi- family dwelling unit.
(Ylt?a.v h - 75 - - s Includes attached
Includes
Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
A) L ` ii cS y "� f�- v_ Zit _ residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
A S . ci.e. t Q • 200 amps or less 100.70 2
❑ PROPERTY OWNER I El 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: uQ /L► Z6>1 1.0.ir ..O n ...4_ ) 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: ( ) I 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.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
El 1 latoNTACI' PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Y cuf 6 .s ,,_.01/LC—.- B. Fee for branch circuits without r t 1 Yl service or feeder fee, first
56.18 2
Contact name:
J a.4 Le branch circuit
E ach add'I branch circuit 7.42 2
Address: I faS ,V,a/LC.I Si S Miscellaneous (service or feeder not included)
City/State/ZIP: S ate tNZ ct 3 Each manufactured ere and/or or r modular 67.84 2
ty VY► • ' 7 0 o1., dwelling, service and/or feeder
Phone: (93) 3(4 _ as 1 1 I Fax: : (S13) 3l0`/- 43!S— Reconnect only 67.84 2
Pump or irrigation circle 67.84 8 2
E -mail: -.3 p u. L4 5 a@ I'YI n r4 i n - b r 6s . r r7 $4 0, r outline lighting o� 67.84 35 . lee 2
CONTRACTOR u al circuit(s) or limited - energy
panel, alteration, or extension. Page 2 2
Business name:
G r 4 - n VD S . 21,, L Each additional inspection over allowable in any of the above
Address: 3 I b S C 3 rrt.c„.„c..,, S2 -- z Additional inspection (1 hr min) 66.25/ hr
/M q Investigation (I hr min) 66.25/ hr
City /State /ZIP:
5 a , l e ►�. v t "! - 730 2. Industrial plant (1 hr min) 78.18/ hr
Phone: (SD3) -3b'I - a a 1 I 1 Fax: (57 3) -61,4 - y 3 I S~ Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.: 4,44 , 0 Lki. I Electrical Lic.: a0-1 -`r Suprv. Lic.: 52 1 - ( ELECTRICAL PERMIT FEES
/ i' Subtotal: 136 . loll Suprv. Electrician signature, required:
`� Iri i 1/�.W "_ '- Plan review (25% of permit fee):
Print name: a , ' ., I Date: e - - 1 O State surcharge (12% of permit fee): It . °I S
TOTAL PERMIT FEE: is '
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. 1/
Print name: Date: • Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I1/05 /COM/WEB