Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00325
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/14/2011
Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15500 SW 72ND AVE 200
Project: Chase Homeownership Center Subdivision: PACIFIC CORPORATE CENTER Lot:
Project Description: Sign lighting for (1) sign.
Contractor: MEYER SIGN CO OF OREGON Owner: PACIFIC REALTY ASSOCIATES LP
15205 SW 74TH AVE ATTN: N PIVEN
TIGARD, OR 97224 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 624 -6300
HONE: 503 - 620 -8200
FAX: 503 - 620 -7074
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 06/14/2011 $67.84
Specifics: •
1 ea 12% State Surcharge - 06/14/2011 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 9 - 001 -0090. You ma • • -'• - direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
OP
Issued By• Permittee Signature: ..s.;
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.
4. 6 CO/ 0 10 //- 00 o (a 8
E1, .�tlrica9 'Permit t� t+ lca � � � ° :. � FOR OFFICE USE ONLY
` City of Tigard 291 N 1 2 O � 1 Date/B 1 � ® L1 Permit No : �� a -- , ,
e
q 13125 SW Hall Blvd., Tigard, OR 972' J P l an Review /
Phone: 503.718.2439 Fax: 503.598.1960 DateB : Other Permit. .56
. Inspection Line: 503.639.4175 r� OF TIGARD
T:IGARD' r✓!�'T Date.Ready/By: ® See Page 2for
Internet: www.tigard - or.gov 1-,1 iI1�If lr"RIl',.,4if =G1pt\ t`'
Notified/Method: �` Supplemental Information
TYPE OF WORK 'PLAN REVIEW
,,;w construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
ruJ ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition Other: `j (E IC) 74 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
❑ 1- and 2- family dwelling [r] Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder El Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
DI Emergency system. larger separately derived system.
0 Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: I app 61,0 72" /1 - e p 1 00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 7 ° ❑Health-care facilities.
0 Supply voltage for more than
` Z ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: '� Project name: �-'1-S E ❑ Service or feeder 600 amps or more.
��// ``--'' FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. 1 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 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
L 0 `VA CrKe-. 1 l J � / I L udt"- -. ( L residential (with above sq. ft.)
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
401 amps to 600 amps 200.34 2
Name: P.,1„ 1 tad w(( pi12_ Cu S -r 601 amps to 1,000 amps . 301.04 2
Address: ( 3 ) u p 1 '� 1) # 3 0 b Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
Cit
y P-(� � 0 �, c l' 7 Z 1iy relocation
Phone: (9) 3 ) ( - ' 75'7 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
Owner signature: /14 Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
[APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
' Business name: e_ e1 / 1` B. Fee for branch circuits without .Ail l ! service or feeder fee, first 56.18 2
Contact name: �(. vL .� S y� 1.1 branch circuit
Each add'I branch circuit 7.42 2
Address: ( c - Zo 5 St 7 4 - Th , `c_. Miscellaneous (service or feeder not included)
City/State /ZIP: 1:".4--t_ � 7 2:2-'1 Each manufactured or modular 67.84 2
r� " ,, dwelling, service and/or feeder
Phone: (03) (p ZO r g 2....0 CI Fax:: (--6,3) 1 --707 cf Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: n . \ .P.L vZ LL 11'1lev/ Pi S" li ✓l C-O •- co ✓L l Sign or outline lighting [ 67.84 ,7. 1 2
CONTRAt. TOR Signal circuit(s) or limited - energy
Business name: .... e ,p,}� panel, alteration, or extension. Page 2 2
■ �- CO Each additional inspection over allowable in any of the above
Address: �z S'
1 0 S LJ "i t-cfk fie_ Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: r c O P q 7 Industr plat (1 min) 66.25/ hr
' \ l Industrial plant (1 hr min) 78.118/ hr
Phone: (5 ! 60 - 2/0 -- E - 1...---0 O Fax: (g b 3)62...0 -7 O .7 Inspections for which no fee is 90.00/ hr
specifically listed (%2 hr min)
CCB Lic.: (4o ( Li Electrical Lic.: LS Suprv. Lic.:� f, S ( � ELECTRICAL PERMIT FEES
' Subtotal: (O'�}�
Suprv. Electrician signature, req 'red: '' - Plan review (25% of permit fee): .� l
Print name: I H't (_ R �� d �.. I 7c, _ Date: 1 t 4/11 State surcharge (12% of permit fee): ) 1
TOTAL PERMIT FEE: . 75 ''
Authorized signature:
t e . 4 . This permit application expires if a permit is not obtained within 180
e �Se{, - h Dat (p 3/
days after it has been accepted as complete.
Print nam
V 1 ( l (1 " Number of inspections a llowed per permit
1: \BuildingWermits\ELC- PermitApp.doc 07/01/10 440- 4615T(I1/05 /COM/WEB