Permit CITY OF TIGARD ELECTRICAL PERMIT
g - � COMMUNITY DEVELOPMENT Permit #: ELC2010 -00689
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/13/2011
TL rARII Parcel: 2S101DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Project: ACS Subdivision: FARMERS INSURANCE Lot: 0
Project Description: Sign lighting.
Contractor: JAMES F STEIN Owner: TRIANGLE POINTE LLC
P.O. BOX 410 901 NE GLISAN ST #100
CORBETT, OR 97019 PORTLAND, OR 97232
PHONE: 503 - 750 -8852 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 01/13/2011 $135.68
Specifics:
1 ea 12% State Surcharge - 01/13/2011 $16.28
Electrical
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. AT , • ION: Oreg•• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 1010 t ough OAR 95 • 0* •09 • ou may obt• in a copy of the rules or direct questions to OUNC by calling 50 2.1987 or 1.800.3 .2344. ,
Iss ed By: 4-1—.4./h. _.1. Permittee Signature: di1111111rPff 17 t'
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 the next available inspection date.
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
•
REC E IV i�Reeived
City of Tigard �DaieB :�' Permit No.: L� t O �l�p �� •1111
° 13125 SW Hall Blvd., Tigard, O 97223 Plan Review
III ` Phone: 503.639.4171 Fax: 503.598.1960 NOV 8 Other Permit:
T I (A R D Inspection Line: 503.639.4175 ` p ate /B g ate Ready /By: 10 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: / Supplemental Information
P"I rti r\tr: - r o r2 Al t-e ui
vrr a -,:, o.. •.... .. ...�
TYPE OF WORK A mt lir t„ 1r` -m 1K , PLAN REVIEW
New construction ❑ Addition /alteration/replacei 'e J s 4 Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ B uilding over three stories.
❑ Demolition . ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION d ( � exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
1 , c `Z��U less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling Commercial /industrial ID AccestkEu1 g amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
C( C� li. PRQ �� CI Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
t ynl P± (� ��',S�Q ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: /�,e� Job site address: �^ , 1 livlitl 100HP or more. occupancy.
�� /(/, x G2 � A.._ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 77 ,...„ 1 ". 4 Q�
Ci //ZIP: c ['Health-care facilities. Supply voltage for more than
���� V ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.:4 fisj/ l Project name: ,A-Cs 2��=�e/Y) - ❑ Service or feeder 600 amps or more.
� � FEE SCHEDULE
Cross street/directions to job site: .... ..t . 6 -
..! . 2/ 7 Description I Qty. I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 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 WO RK (with above sq. ft.)
Limited energy, multi- family 75.00 2
`h,6 n / 4/ �� 1C - i ,5 1 c residential (with above sq. ft.)
(iV iY[ t�_ vt�� / Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
s >. / Da/ 401 amps to 600 amps 200.34 2
Name: T I C
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: ( r ) 25 g71 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
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
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: G 7 (,) B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Address: Ct- F17/
�'� ,_ ^ z - y Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
6 Each manufactured or modular
City /State /ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle % 67.84 2
E - mail: Sign or outline lighting 67.84 /35:R 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: S i,V cJ l d4/ panel, alteration, or extension. Page 2 12
Each additional inspection over allowable in any of the above
Address: p 1 _ 1 0 Additional inspection (1 hr min) 66.25/ hr
Investigation
,, g) 0-y_ q 7) ( er Industrial plant mm (1 l hr m ) 66.25/ hr
in) 78.18/ hr
Phone: (,,,50) &lb 2 Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (V: hr min)
CCB Lie.: 7 Electrical Lic.:�..2 • S Suprv. Lic.: �3h .516 ELECTRICAL 'PERMIT FEE; _ _
II
Suprv. Electrici'ai i i1 ture, required: 1 I I t I I I o Subtotal: /3574
Plan review (25 /o of permit fee):
•
Print name: ,ii F- 5 � � Date: 11. � t /O State surcharge (12% of permit fee): 7• CO. d-8
I ` G/ TOTAL PERMIT FE • i S 1, G) G
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.
C\Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I 1/05 /COM/WEB i
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00 .
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System* .
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system .
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting* . .
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
ih k. C\Building\Permits\ELC- PermitApp.doc 07/01/10