Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -10050
DEVELOPMENT SERVICES DATE ISSUED: 3/15/2006
¢� I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S113AD - 01700
SITE ADDRESS: 16920 SW 72ND AVE ZONING: C -
SUBDIVISION: ROSEWOOD ACRE TRACTS LOT : 030 JURISDICTION: TIG
Project Description: sign lighting
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BRIDGEPORT LAND LLC MEYER SIGN CO OF OREGON
3939 NW ST HELENS RD 15205 SW 74TH AVE
PORTLAND, OR 97210 TIGARD, OR 97223
Phone: 503 - 224 -2676 Contact #: PRI 503- 620 -8200
FAX 503 - 620 -7074
FEES
Description Date Amount Reg #: ELE 20 - 190CLS
[TAX] 8% State Surcharge 4/4/2006 $4.27 LIC 64014
[ELPRMT] ELC Permit 4/4/2006 $53.40
Total $57.67 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344. ,, /J
Issued By: 7� �L � Permittee Signature: ,h e= ��2�TL�C
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'N: 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.
I
a e. t-
• 1 11• • I. 1 -];C t10II , , . FOR OFFICE: USE ONLY ,
E1ecfi>r gal i► R ece i ved I f / Electrical r!, ro
I s Date/By� 5/Ob r .% Permit NoyJ- oG I 0 �0�
5 tJ t Planning A p l rova( Sign ��//' I I
City of Tigard Date /By: Permit No.: 3 t J & /a2/3
13125 SW Hall Blvd. Plan Review Other
MAR 1 5 2006
Tigard, Oregon 97223 Date/By: Permit No.:
���
Phone: 503 - 639- 417,u,g i :(5ieri Q t 1 / , „� Post - Review Land Use
�I Date /By: Case No.:
Internet: www.ci.ti S �Jli , Contact See Page 2 for
Cs2r
24 -hour Inspectioil�� �lre, ,�t: W3 - SI` . -� - " J Name/Method: G ® Supplemental Information.
., j' . PLANREYIENY (Pleasetcheck;all that'aPPIYP < $ 1 • .
'' ,� _ _� TYPEOF.�W,ORK,,„ :.� �,� : <. �. -�.., �_.:: ...,, . .
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement 0 Other: El Service over 320 amps- rating of ❑ Building over 10,000 square feet,
r t'W -CATEGORY OF €CONSTRUCTION.;:„ , n, ...,:, t, 1 &•2 family dwellings four or more residential units to
❑ 1 & 2- Family dwelling 0, Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan t sets ❑ Other: the above.
_ _... , Sub s of plans with any of
`:.' `,. ; • 4. JOB, SITE =INFORMATION, and,LOCATION< 1 ..:,.,, —
The above are not applicable to temporary construction service
Job site address: /,9 ZD �w 7 £ '` - e ' ''
.�.:w , �GrF FEE* SCHEDUL ��`�� g ks� t
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Description Qty Fee (ea.) Total
Project Name: }1/ SLUG S New residential - single or multi - family per it
Cross street/Directions to job site: 7z- P e. dwelling unit. Includes attached garage.
N Service included:
( p&.QAI u-514-9j-7 ex Asus) f i /7 d i i 1000 sq. ft. or less 145.15 4
t L p Each additional 500 sq. ft. or portion thereof 33.40 I
Y Limited energy, residential 75.00 2
Subdivision: Lot #. Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
r s ? s; service and/or feeder 90.90 2
F 8g , ;, r ,DESCRIPTION;:OF:WQRK a,, _� �? ” Services or feeders - installation,
` f `/ (l) ay 1 -t°6-41eL alteration or relocation:
nn w c� � � 200 amps or less 80.30 2
Q i/ ,Q u o (V'd » _1 "'3 ' 201 amps to 400 amps 106.85 2
-Q-62/1/c N� 401 amps to 600 amps 160.60 2
ti a 601 amps to 1000 amps 240.60 2
[ROPERTY OWNER f ' ® T _ . >+ Over 1000 amps or volts 454.65 2
Name: ge Li. V,/ , / O�'t C -• Reconnect only 66.85 2
Address: '93? j w - , k - (eZ °S t c Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: /4-(_ •) q 77_05--- 200 amps or Tess 66.85 1
201 amps to 400 amps 100.30 2
Phone: .903- Z.41- 1 Z Z Z— Fax 401 to 600 amps 133.75 2
:0 APPLICANT µ- .t:; :? E CONTACT,PERSON ,;;,': Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of 2
Address: service or feeder fee, each branch circuit 6.65
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
�C9NTRACTORN�= , .. _ ,-':,: . 53.40 -S S 2
_,. r, Each sign or outline lighting
Job No: Signal circuit(s) or a limited energy panel, 2
n �� alteration, or extension Page 2
Business Name: utei S �..� Description:
Address: )5 2-0s -v 74 C —
Each additional inspection over the allowable in any of the al:u•,e:
City/State/Zip: fr(( L� 0 V (� 2- • 7" 1 2-1 V Per inspection per hour (min. 1 hour) 62.50
Phone: /p 2D --g''O Fax: 6 zo' -7PJ 7. f Investigation fee:
� __Other:
/
CCB Lic. #: L 40 / �t Lic. #: zo ( 2D z_ S r :;Electrtcal;Perinit Fee � ' » ":
Supervising electrician 0 it - 7 D Subtotal $ T 3. ,-I-0 signature required: Print Name: /L Plan Review (25% of Permit Fee) $
P� 1 :• , / Lic. #: Si.G ,�, State Surcharge (8% of Permit Fee) $ 4‘ z7
:, T O TAL PERMIT FEE $ S 7. 6.7
t!d f /
Authorized ( � 2 Notice: This perm application expires if a pct LI:: :.: not obtained within
Signature: �' — �♦`• Date: z —/6 -Dt, 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building industry Service Board.
1' Aktk -g-P WI
(Please print name) 7 S 6/
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03 (�
Electrical Permit Application - City of Tigard ,
Page 2 - Supplemental Information
Y, r
•
LIMITED ENERGY PERMIT FEES: •
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
Heating, Ventilation and Air Conditioning System
1 1 Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
I Fire Alarm Installation
I I HVAC
I I Instrumentation
n Intercom and Paging Systems
I Landscape Irrigation Control
I Medical
n Nurse Calls
Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations •
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD .
BUILDING DIVISION �- PERMIT #:aC 2 . 10050
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 �-, ,'I(I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 16g2t S W 1 7 A V . CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: Si c6 N $ PHONE #:
Inspection Request Scheduled For: Date:* 30104 Pour Time:
Code : Inspec ion IP - - ' • ion Confirm # Contact # Message
Corr -. 'ons 'omments -. - .
6,
∎A ASS n PARTIAL APPROVAL ` CANCEL n NO ACCESS
1 FAIL CALL FOR INSPECTION — ADDITIONAL FEES ASSESSED
Inspector: ' 5 X NCX31--
� Date: 3 06 Phone #: (503) 718- til tits
CITY OF TIGAR®
BUILDING DIVISION .
PERMIT #:� j _ / 0 s -- 0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: �
Phone: (503) 639 -4171 . 1� q i(L '
:!
Inspection Requests (24 Hrs.): (503) 639 -4175 4':..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: /- le 9 . 0 7 cZ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 - ), / - o (2 Pour Time:
Code # Inspection Description Confirm # Contact # Message
/ C 6 - ea
M A._.--e
Corrections /Comments / Instructions: •
` i
n PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
y FAIL ffi■CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: G O N5 L Date: 1 Zq i ®o Phone #: (503) 718-
CITY OF TIGARD - EZ,c
BUILDING DIVISION PERMIT #: 2.6)0C / O OS0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
_ii
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: , 6 5 2. 0 7 Z ' i- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: S \ C s PHONE #:
Inspection Request Scheduled For: Date: 3- 2 O - 0 c0 Pour Time:
Code # Inspectio Desc 'ption Confirm # Contact # Message
1 6 - ) - 0 06
Corrections /Comments/ Instructions:
101 1NIZAliZot 1i(10.
45 w ok\i(maa6gip >i01
(i) s v t p o V? 6o-W smuitrg i TA c_ kilo. - 3 0 ANO 3 A n 30
t,pvc.o\l . 41 - 1(i ‘c.- 5,(wOP m = i00 3
P Gc .5 aQ G N• P■4-■ VISIL 1N6 ..
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7C7 1
n PASS I I PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
11 FAIL CALL FOR INSPECTION... ❑ ADDITIONAL FEES ASSESSED
\ Hector: �.7�� (J Date: 3 Phone #: (503) 718- .2t4_