Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00217
X01'' DEVELOPMENT SERVICES DATE ISSUED: 4/30/01
K.� 11 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S1 10C D -07600
SITE ADDRESS: 15685 SW 116TH AVE
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT : JURISDICTION: KIN
Project Description: Add (1) LED display to existing pole sign
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:
TOBIAS INVESTMENT CO TUBEART SIGNS
300 SE SPOKANE ST 4243 -A SE INTERNATIONAL WAY
PORTLAND, OR 97202 MILWAUKIE, OR 97222
Phone: Phone: 503- 653 -1133
Reg #: LIC 00070956
SUP 366SIG
ELE 37- 554CLS
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
PRM3 CTR 4/30/01 $53.40 2720010000(
5PCT CTR 4/30/01 $4.27 2720010000( EXPIRED
Total $57.67
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 OA • 952- 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 - 6699 or 1 332 - 23
Permit Signature: Issued By: y �
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 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Date received:' 30 -O l Permit no.: Ei-e aDlD/ - CO l
� , 14: 4i City Tigard Ci of Ti and
Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503). 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address:^ 65. ( S 1/677A._ Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: lock: I Subdivision: ,7,tj& 0,/ 7V 6*t 40,iG- eex f6 . i
Project name: _ I Description and location of work on premises: I V 0 (�. 6 . 1b 2)/s / ,�,/
Estimated date of completion/inspection: • - /S /I S j., J
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 5 e Fee Max
Business Hans _ Description Qty. (ea.) Total _ no. insp
New residential - single or multi- family per
Address' a ..1111W t .. .). dwefling unit. Includes attached garage. .
City: OF 1111=011 ► IItt: - iiv in.. Serviceimdhded:
Phone Fax I (Z Fax _ - -91 cif E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 4 :2 - , otil, - Elec. bus. lic. no: y Limited energy, residential 2
Cit etro 1 . no.: s A Limited energy, non- residential 2
004
trs� -, _ / / Each manufactured home or modular dwelling
Signature of supervising electrici..� iced) Date Service and/or feeder 2
Sup. elect. name (print - al 4 O(-"( — License no: 3 - 1 4 Se��or feeders - installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: - . Date: 401 to 600 am .s 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps-commercial ❑ Health- carefacility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 18(2 0 Hazardous location Each sign or outline lighting 0 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension" - 2
O Building over three stories O Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept cre cards, cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number / / within 180 days after it has been State surcharge (8%) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$ EXPIRED
ED
Cardholder signature Amount
440 -4615 (6l00VCOM)
Electrical Permit Fees: Limited Energy Fees: .,
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4- Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ *Burglar Alarm
Limited Energy a. . $Z5.00
Each Manufd Home or Modular Garage Door Opener
Dwelling Service or Feeder $90.90 2
•
Services or Feeders . ; _ Heating Ventilation and Air Conditioning System'
Installation, alteration, or: relocation =: ' ❑ '
200 amps or less - .. _ $80.30 2 ❑ fi . •
201 amps to 400 .amps $106.85 2 Vacuum Systems
401 amps to 600 amps $160.60 2 ❑
601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65 2 -
Reconnect only $66.85 2
Temp Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. 7 Audio and Stereo Systems
Branch Circuits n Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service 0 Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 and Paging Systems
Each sign or outline lighting I $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ 5 3 l `T ! J n Other
8% State Surcharge $ "T r 2-7 Number of Systems
25% Plan Review Fee
See flan Review" section on $ * No licenses are required. Licenses are required for all other installations
-
front of application.
Fees:
Total Balance Due $ S1 • 6
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:'dsts\forrns\elc- fees.doc 10/09/00
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UL
KING CITY
1111411 15300 S.W. 116th Avenue. Xing City Oregon 97224-2693
MINIMINsmall Phone: (503) 639 -4Q32 • FAX (503) 639 -3771
Notice To Contractors Working In K6 i C
>5 ne City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigara staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
.- whether you prefer it to be mailed without any notification. Any incomplete or illegible
application %Nill be returned to King City staff for correction and no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd. Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The 'City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project: Air .�,.-. _- / •
located at: . es / S# t-42
/scars' a- //t, )1 - 5 �� � ''
• - i ,
King City Representative
1 DSTSr-cr sT Doc
EXPIRED