Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00428
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/28/2011
Parcel: 2S113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES !FERRY RD 200
Project: Oregon State Bar Subdivision: Lot:
Project Description: Sign lighting for (1) wall sign. •
Contractor: INTEGRITY SIGNS OREGON Owner: OREGON STATE BAR, THE
PO BOX 88 16037 SW UPPER BOONES FERRY RD
HUBBARD, OR 97032 TIGARD, OR 97224
PHONE: 503 - 981 -3743 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 07/28/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 07/28/2011 $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 eortrance 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 NTION: Oregon at,tv requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 010 through OAR 952 -001 4•0. Y. • ay obtain a copy of the rules or direct questions to OUNC by calli... 13.232.1987 or 1.800.3 2.2344.
Issue By: ■ 1[41 _ Permittee Signatu .
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.
S ON-.,t —
Electrical Permit Application @ FOR OFFICE USE ONLY
-
III City of Tigard q� � Date/ Received d Permit No.:7 ' i (? (/..... I)e
q 13125 SW Ha Blvd., Tigard, OR 97223
g n\ Pl Revi /j/
Phone: 503.718.2439 Fax: 503.598. 6; Date/By: � 0 �� Date /B Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: taris See Page 2 for
Internet: www.tigard- or.gov \\\`� 1' ifi ed /Method: J / L upplemental Information
�v ar \l'R�
. . , ' . t TYRE, OF - WORK . k,,x0 x_ . - , PLAN_ REVIEW -
❑ New construction ❑ Addition /alteration /repla���
r` rteti'i;k\5 "' Please check all that apply (submit 2 sets of plans w /items checked below):
{ \ l J ❑ Service or feeder 400 amps or more ❑ Building over three stories.
��,
❑ Demolition �vther: 5 ((p Qj where the available fault current ❑ Marinas and boatyards.
amps or a
' - CATEGORY Ol :CONSTRUCTION ,, exceed s 10.000 mps at 150 volts o Floating buildings.
less to ground, or exceeds 14.000 El Commercial use agricultural
❑ 1- and 2- family dwelling [t]- Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
L El Emergency system. larger separately derived system.
.
^ � JOB SITE 'INFORMATION AND EQUATION OCATION , ° � ' ' 12 Addition of new motor load of ❑ "A ", "E'. "I 2 ", "1 -3 ",
Job no.:' Job site address: // ' -1 I00HP or more. occupancy.
l 1p O 31 1 5u)') . '�Q • ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 1 ��p Kai ❑ Health -care facilities. . ❑ Supply voltage for inure than
�� '�O��, I ll „-� [� ❑ Hazardous locations. 600 volts nominal.
�1 Suite /bldg. /apt. no.: - Project name: S' ❑ Service or feeder 600 amps or more.
Cross street /directions to job site: Description EEE 5CHED I Qty. I Fee. I T - T otal I a
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add] 500 sq. ft. or portion 33.92 1
Limited energy. residential 75.00 2
. DESCRIPTION OF W ' ' (wit above sq. ft.)
' Limited energy, multi - family 75.00 2
1 —12.—) S
• residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
' - PROPERTY OWNER, ' . . IENANT - '� ' 201 amps to 400 amps 133.56 2
,
401 amps to 600 amps 200.34 2
Name: U � �
v� ° C �Q ___ 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: _ Date: A. Fee for branch circuits with
[3'A . PLICAN ' T.; - above service or feeder fee
Ia LCONTACT PERSON ' 7.42 2
each branch circuit
B. Fee for branch circuits wit/iota Business name: t j� � service or feeder fee, first
56.18 2
Contact name: branch circuit
- Each add'l branch circuit 7.42 2
Address: °.b . b 7 / V,i Miscellaneous (service or feeder not included)
" 0 Each manufactured or modular
City /State /ZIP: 1 t L 6 ,t � - 0 3 a dwelling, service and/or feeder 67.84
Phone: ' 3) ` ( , 3 3 Fax:: ( 4g _ 91,53 Reconnect only 67.84 2
I Pump or irrigation circle 67.84 2
E - mail:
t outline lighting 1 67.84 � g� 2
;'.CONTRACTOR' ignal circuit(s) or limited energy
1 �, panel, alteration, or extension. Page 2 2
Business name:
j/a ASS + St 0 Each additional inspection over allowable in any of the above
Address: Q g3 � r1 Additional inspection (1 hr min) 66.25/ hr
Investigation (t hr min) 66.25/ hr
City/State/ZIP: � ` Y �� ll n
I &�� ! 0 3.a. . Industrial plant (1 hr nun) 78.18/ hr
Phone: (S31 9 8 i „ 314 Fax: ( ) Inspections for which no fee is 90.00/ hr
}� specifically listed ('h hr min)
CCB Lie.: i�(,� t S Electrical L' -4, Q0 Suprv. Lic.: , ' ELECTRICAL PERMIT FEES - '
1 Subtotal: ( gii
Suprv. Electrician signature, required: —! / V� ['
�►' Plan review (25% of permit fee):
Print name: �� n ,� ��
Date: ," State surcharge (I2% of permit fee): � 1 o TOTAL PERMIT FEE: X15- 9S
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.
I:\ Building \I'ennits \ELC- PermitApp.doc (17 /(I I /10 44(1- 4615T(1 1/05 /COM /Wt13