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Permit o CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT .11 COMMUNITY DEVELOPMENT Permit #: ELC2010 00568 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/28/2010 Parcel: 2S102CB01802 Jurisdiction: Tigard Site address: 13407 SW PACIFIC HWY Subdivision: Lot: 0 Project: AutoZone Project Description: (3) sign lighting Owner: FEES BAR -AM, LLC Description Date Amount BY GODFATHER'S PIZZA, 1416 THIRD AVE Sign or Outline Lighting 10/14/2010 $203.52 SEATTLE WA, 98 12% State Surcharge - Electrical 10/14/2010 $24.42 PHONE: 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: OTR Total Number of Systems: Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: N Fire Alarm: N HVAC: N Instrumentation: N Total $227.94 Intercom/Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Required Items and Reports (Conditions) Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Other Desc: 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 coov of the rules or direct questions to OUNC by calling 50 . 6699 or 1.800.332. 4 Issued B ��I _.� Permittee Signature: 4 — P '_ � 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 Received II City of Tigard T C. . J I Permit No4ZC, — o®s6p e 13125 SW Hall Blvd., Tigard, OR 97223 PlanRevie / JI I ,i� • a . Phone: 503.639.4171 Fax: 503.598. OF TIGARD Date/El : : Oth • efnit[ ,o , 0 /0 ' ,0/ as 4 T I G A R D Inspection Line: 503.639.4175 Date Ready/By: INE ID See Page 2 for Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW El 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 'E( Other: Si (DOS' 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 ❑ I- and 2- family dwelling g Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or AND LOCATION ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION A ND ❑ Addition of new motor load of ❑ "A ", "E ", "I - 2 ", "I - 3 ", Job no.: Job site address: 1001 or more. occupancy. 74 0 7 S Qt;. 1 C � l l► ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: 1. ❑ Health-care facilities. 0 Supply voltage for more than � 1 dt 1 C - ❑Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: J Project name: F. -2.4.).1/4.11.. ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qtv. I Fee. 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 Tax map/parcel n0.: Ea. add'I 500 sq. ft. or portion 33.92 1 Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi - family 75.00 2 `� yt n , v� 51-3-14.4 a � residential (with above sq. ft.) J LLJ. Services or feeders installation, alteration, and/or relocation 1 t 1-451N--- 200 amps or less 100.70 2 ❑ PROPERTY OWNER I EFTENANT 201 amps to 400 amps 133.56 2 L 401 amps to 600 amps 200.34 2 Name: Qom. ? - . 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 /o City/State /ZIP: relocation Phone: ( ) 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 IT i e"t PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: cS v 16 4 WA& /41 rt , 5roS — .0m--. B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: 'Q� branch circuit Each add'I branch circuit I I 7.42 12 Address: Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( N ' 6 t.{ - a-a (` Fax: : ( ) Reconnect only 67.84 2 E - mail: � -3T mp or irrigation circle 67.84 2 Si or outline lighting 3 67.84 a03 , 5 .4 , 2 CONTRACTOR ` _ gnat circuit(s) or limited-energy Business namel r � �; 1 L Y V1, � � Q (��� panel, alteration, or extension. Page t 2 .11 c� v 111 �� ���LLLIII J J+ Each additional inspection over allowable in any of the above Address: a• -r-, • Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: --T Investigation (1 hr min) 66.25/ hr V A rA i Industrial plant (1 hr min) 78.18/ hr Phone: (3b3) 3( -aa. I ( I Fax: 613 ) 3 (0 4 -4 31:-S. Inspections for which no fee is specifically listed (%: hr min) 90.00 / hr CCB Lic.: (04D i 4 f Electrical Lic.:ab_ RD U.D Suprv. Lic.: J 1'O b _ S I(o ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: // 1 Subtotal: 9b3 .. v Q Pj /1tei �d© Plan review (25% of permit fee): Print name: ► L sPq y l `� Date: 1 — 13 - lb State surcharge (12% of permit fee): ei , 9 TOTAL PERMIT FEE: a 'a1 . th 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. I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440.4615T(1l/05 /COM/WEB