Permit � � � c �V•� � Q c
w d CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00280
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/08/2009
ZIt"iAI? Parcel: 2S113AB00800
Jurisdiction:
Site address: 16055 SW 74TH AVE
Subdivision: FANNO CREEK ACRE TRACTS Lot: 0
Project: NW Ski & Wakesports
Project Description: Installation of one (2) sign outline /lighting.
Owner: FEES
DUNCAN, JOHN A & JANICE LEE Quantity Description Date Amount
9929 NW UPTON CT
PORTLAND, OR 97229 2 ea Sign or Outline Lighting 06/08/2009 $106.80
PHONE: 1 ea 12% State Surcharge - 06/08/2009 $12.82
Electrical
Contractor:
YOUNG ELECTRIC SIGN
20100 SW 112TH AVE
TUALATIN, OR 97062
PHONE: 503 - 753 -1068
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $119.62
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 1.800.332.2344.
Issued By: Permittee Signature: ejl ttS Q f ` ev r a i (
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.
w CITY OF TIGARD ELECTRICAL PERMIT
`�1; = ` COMMUNITY DEVELOPMENT Permit #: ELC2009-00280
• TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/08/2009
Parcel: 2S113AB00800
Jurisdiction:
Site address: 10655 74
Subdivision: FANNO CREEK ACRE TRACTS Lot: 0
Project: NW Ski & Wakesports
Project Description: Installation of one (2) sign outline /lighting.
Owner: FEES
DUNCAN, JOHN A & JANICE LEE Quantity Description Date Amount
9929 NW UPTON CT
PORTLAND, OR 97229 2 ea Sign or Outline Lighting 06/08/2009 $106.80
PHONE: 1 ea 12% State Surcharge - 06/08/2009 $12.82
Electrical
Contractor:
YOUNG ELECTRIC SIGN
20100 SW 112TH AVE
TUALATIN, OR 97062
PHONE: 503 - 753 -1068
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $119.62
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is sus ended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification a Those r s are set forth in OAR
952- 001 -0010 through OAR 952-001-0100. n You may obtain a copy of the rules or direct questions to OUNC by calling 50 6. or 1. 03,3. 344 , ✓ - �
Issued By: `i�.� .0 Permittee Signature: 4_ //4„ /G '�� `�
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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• i .aa a a r,l- M t' Fi1�50 '1tx J '"�} �, !tt"I.�� t't y ,�'y. .�•
�Cectrieal lPerlylit Application °�' k � t F,° ° I 1749 }h I ,1 _ 2ida +r
'0° ` .$ City of Tigard Received / /1 A Permit No Flo. �(Yn�, c
'. 13125 SW Hall Blvd., Tigard, OR 97223 JU 0 8 2003 Date /Ban y: �GU Flo. n.i 1J0' J
Date/By: Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 D
TI CITY GARD Inspect Line: 503.639.4175 r "S t;F r IGA F ' ate Ready /By: luris: See Page 2 for
Internet: www.tigard- or.gov 01 111 11 1 1 H i'.) L .H tified Method: � C� 0 Supplemental Information
IKE " .'„ , ,.: Tj ` r , ... .,�,. REVI ,, ., ''r ,., ',
❑ 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: where the available fault current ❑ Marinas and boatyards.
z h a ' or a
CA 'DGO CONSTCTION ex ,
eeds 10000 amps at 150 volts o ❑ Floating buildings.
.. ..u: �t.: I A E. _ RU r 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
,r *r „, x r c „ ❑ Emergency system. larger separately derived system.
JOBB SITE INFORMA AND L OCA TI ON g _ ❑ Addition of new motor load of ❑ "A ", "E ", "1- 2 ", "1 -3 ",
Job no.: Job site address: 16055 SW 74th Ave. 100HP or more. occupancy.
❑ Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: Tigard, OR. 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: NW Ski & Wakesports ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCIIEDULE 1 X t
J Description I Qty 1 Fee Total
New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited ever residential
Li gy, id
liglialMiallati,4, ESCRIPT10N OF WORK jr ri (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
Install 2 32sf customer supplied illuminated wall signs residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or Tess 80.30 2
® PROPERTY WNER ; a ® TE ` 201 amps to 400 amps 106.85 2
Name: NW Ski & Wakesports 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 16055 SW 74 Ave. Over 1,000 amps or volts 454.65 2
City/State /ZIP: Tigard, OR. 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)968 -7555 Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
®APPI IGANT E, EI 0// €3 CONTACT PERSON J above service or feeder fee,
., ,. ,...,, 6.65 2
each branch circuit
Business name: Young Electric Sign Co. B. Fee for branch circuits
Contact name: Thad Firkins without service or feeder fee 46.85 2
first branch circuit
Address: 20100 SW 112 Ave Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Tualatin, OR 97062 Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (503) 753 - 1068 Fax: : (503) 612 - 0914 Reconnect only 66.85 2
E -mail: tfirkins @yesco.com Pump or irrigation circle 53.40 2
e j ��.,..�"., � 8 „!CONTRACTOR z " r Sign or outline lighting 2 53.40 106.80 2
Business name: Young Electric Sign Co. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 20100 SW 112 Ave. extension. Describe: Page 2 2
City /State /ZIP: Tualatin, OR 97062 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 753 - 1068 Fax: (503) 612 - 0914
Investigation per hour (1 hr min) 62.50
CCB Lic.: 69308 Electrical Lic.: 37 -51 CLS S rv. Lic.: 647SIG Industrial plant per hour 73.75
,ELECTRICAL PER HT FEES ,
Suprv. Electrician signature, require Subtotal: 106.80
Print name: Eddie Lehigh ate: 6 - - Plan review (25% of permit fee):
/�f State surcharge (12% of permit fee): 12.82
Authorized signature: `--�� ` ` 4 � A �
J TOTAL PERMIT FEE: 1 19.62
This permit application expires if a permit is not obtained within 180
Print name: Thad Firkins Date: 6 -8 -09 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I: \Building \Permits \ELC- PermitApp.doc 05/23/06 440- 4615T(I 1/05/CO51/WEB I q 9 r