Permit a CITY OF TIGARD ELECTRICAL PERMIT
.111 a COMMUNITY DEVELOPMENT Permit #: ELC2010 00588
T I G A R. O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2010
Parcel: 1S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY B
Subdivision: Lot: 0
Project: Radio Shack
Project Description: Sign lighting.
Owner: FEES
PACIFIC CROSSROADS PROPERTIES, I Quantity Description Date Amount
BY WYSE INVESTMENT SERVICES CO, 1501
SW TAYLOR ST STE #100 1 ea Sign or Outline Lighting 10/22/2010 $67.84
PHONE: 1 ea 12% State Surcharge - 10/22/2010 $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:
it
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. • •• - •••S= copy o ■ _ =s or direct questions to OUNC by calling 503.246.669' or 1.800.33 .2344.
Issued By: !�`i / %� / — I Per mittee Signature: ■ /V '' 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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received Date/B : i , 41/ �i Permit No.: - , — •, # ,
° 13125 SW Hall Blvd., Tigard, 0 Plan Review
111 II . Phone: 503.639.4171 Fax: 503. it ( C )..° p 010 Date/B : Other Permit:
T I G A R D Inspection Line: 503.639 . N 1 ' Date Ready /By: ® See Page 2 for
Internet: www.tigard- or.gov O c � � A aQ Notified/Method: R Supplemental Information
TYPE OF WO rr-- Q ` 1� 1', 1 ` S , ` Q PLAN REVIEW
® New construction Addition/alteratioM Ont Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑Other: to ❑ Service or feeder 400 amps or more ❑ Building over three stories.
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 E'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 -2 ", "I -3 ",
Job no.: Job site address: , , IOOHP or more. occupancy.
f 1 S s t.�) Ptac,t C t L 14- Loy ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
i A f Q ( 1 / Z 7i 3 0 locations. 600 volts nominal.
Suite/bldg. /apt. no.: 8 Project name: Rte.t o 5 h c,...,.., k ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Descdptlon 1 Qty. 1 Fee. 1 Total 1 •
r 1� New residential single- or multi - family dwelling unit.
P6‘
, I T ( ., 4 5 1A_) ,V o.x -f i Q u±,1?, Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. 0. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
Limited energy, multi - family
1 'l t�.Y1/ .'t' 1°,6i. t.l�eti' Sl V residential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or Tess 100.70 2
❑ PROPERTY OWNER I' I '� TENANT 201 amps to 400 amps 133.56 2
Name: R I o 0. G k 401 amps to 600 amps 200.34
601 amps to 1,000 amps 301.04
Address: it 76 S S{.0 P�1 c C 4 t Over 1,000 amps or volts 552.26 2
City / State/ZIP: a� p 7 l Z -(17) Temporary services or feeders installation, alteration, and/or
!> _I relocation
Phone: ( ) U Fax: ( ) 200 amps or Tess 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
g APPLICANT J CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: v0.Y1d.0 L A.0 Pir' 5;34 B. Fee for branch circuits
• p eC ,' without service or feeder fee,
Contact name:
/ic 1 sto r AO first branch circuit 56.18 2
Address: 2600 N& A ey d, e eA 10, n A d , A so Each add'I branch circuit 7.42 2
, Miscellaneous (service or feeder not included) _
City /State/ZIP: v alet L O ,,, V e_ r W` A / p g 6aa ( Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( 360 ) 0 3 11 7 7 3 _ Fax: : (360) 6.9 3 7j7 1{ Reconnect only 67.84 2
E -mail: I'e1dti e t)lAXLS1 . Gdro Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting (t) 67.84 6 2
Signal circuit(s) or limited -
Business name: Ua,l+l,e.O1._vP 5 ;an energy panel, alteration, or
Address: 2600 N/ Ane&rl. S YL Rd_ eS0 extension. Describe: Paget 2
City / State/ZIP: \a vv_Q IA t J e c A q O & / O I Each additional inspection over allowable in any of the above
I ( Per inspection 66.25
Phone: (3 64) to 1 773 Fax: ( ) Investigation per hour to hr min) 66.25
CCB Lic.: 6 3 q S l Electrical Lic.: 37- Li L L Suprv, Lic.:5745-7,4 Industrial plant per hour 78.18 _
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: (,'7 1
Print name: /L _ Date: Plan review (2590 of permit fee): .�
a �tG✓l r / 7l� l �4 v State surcharge (12% of permit fee): f. !4
Authorized signature: /� TOTAL PERMIT FEE: k Qb /
St0 1(1/L This permit application expires if a permit is not obtained within 180
Print name: e A r t i Date: J Q J�1 /Z0) 0 days after it has been accepted as complete.
( • Number of inspections allowed per permit.
1:\ BuildingWermits \1il.C- 1'ermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB