Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00471
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/23/2011
Parcel: 2S 102AD02700
Jurisdiction: Tigard
Site address: 8970 SW BURNHAM ST
Project: Tigard Auto Body & Paint Subdivision: BURNHAM TRACTS Lot: 5
Project Description: Sign lighting for monument sign.
Contractor: CLARK SIGNS Owner: BARRY F SHEASGREEN LLC
PO BOX 1113 8905 SW GREENSPARK LN
ST HELENS, OR 97051 TIGARD, OR 97224
PHONE: 503 - 789 -1147 PHONE:
FAX: 503 - 543 -5141
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 08/23/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 08/23/2011 $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 .!1-0090. You may obtain a copy of the rulesquestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: — % Permittee Signature:
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•C) .
Electrical Permit Application -)
FOR OFFICE USE ONLY
s \ Recei / 677
ved ,
City of Tigard ch 1% \ Date/13 ,: f Air Permit No.:
, ° 13125 SW Hall Blvd., Tigard, OR 9 223 r - p _
IN .... Plan Review - _...: • //I It 7
Other Permit: . i 0 20/ _ _. - A
Phone: 503.718.2439 Fax: 503.598.1960 03 Date/By:
10
Inspection Line: 503.639.4175
TIGARD i• 1.' (NA, Date Notified/Method See Page 2 for -
Internet: www.tigard c l i 0%. HIM Supplemental Information
i 1
El New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
II ;IIIVI'IAI/411461 •tl IIIIIIII=IVIII exceeds 10,000 amps at 150 volts or 0 Floating buildings.
ll.:Ix::IA 1iipl"Iiri0,.;:i4..-V',..:ll.N.,,l,=.6.,.. ...,,,,:t„.,isilitt,o..0,4,.,.. VN:,..*#,' AlleArlHA:661 1-„.1 less to ground, or exceeds 14,000 0 Commercial-use agricultural
O 1- and 2-family dwelling l Commercial/industrial El Accessory building amps for all other installations. buildings.
O Multi-family 0 Master builder 0 Other: El Fire pump. 0 Installation of 75 KVA or
't-Ilo"! , !r , p 0. ,' ,, ,,, spq-f- -, .. , , tiv , r ,-,,.., ;: -.„, 177 - i2r. -.,, 0 Emergency system. larger separately derived system.
i&cilft4It : o Addition of new motor load of
Job no.: Job site address: ; 5(..)1/4) 51-( vi hcAm h a a El 12 100HP or more.
Six or more residential units. I=1 0 occupancy.
Recreational vehicle parks.
City/State/ZIP: - \ r . C '• 0 Health-care facilities.
0 Hazardous locations. Supply voltage for more than
I( (1,yA 0
600 volts nominal.
_
Suite/bldg./apt. no.: ' Project name: ‘, •
4 ill. "N 11.0 ID Service or feeder 600 amps or more
• FRA7r
Cross street/directions to job site: Description I QIY. 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 1
Tax map/parcel no , Limited energy, residential
!'11*14 atWiA0111fivirsit iW., (with above sq . ft.) 75.00 2
4 siff
F 4.,t4; 11t71181aiqk . 1 0: , 1 4e1aXi , i.t.4.) - -c ,
Limited energy, multi-family
75.00 2
1
r \ MN\ U. n S Ictn residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
1461 V4:1141..„Llori- - ,.,,i: 4:41.7.*:•li-i. 201 amps to 400 amps 1 33.56 2
',:.,,_:;_•',;,-24 - w- ' :). -.,-.-- - ,
401 amps to 600 amps 200.34 2
Name:
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: ( ) 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
..IIISAItlireIeWilliiiiita-SiTVINIMP4',11.1"SN4VranliteelAC4**PERSON:,.•.-4,,,,ijoig-*A: above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
__,,,, , _ Sign or outline lighting
1 67.84 ( VI 2
nitwil:r,hai3:tmP--E,--Str2::g',AkijSYmo , ;r.;ti,lx,ni Signal circuit(s) or limited-energy
panel, alteration, or extension. Page 2 - 2
Business name: , yic loIns
Each additional inspection over allowable in any of the above
Address: P ) I I 13 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: 31,, R ir 0 r (i-) 1
Industrial plant (1 hr min) 78.18/hr
Phone: (SiCi ) - ) ILA --1 I Fax: (5Ca ) 0-13 5H i Inspections for which no fee is
specifically listed (I/ hr min) 90.00/ hr
CCB Lic.: , (4 3 Electrical Lic 5 g _ as Suprv. Lic.: •r. 5 ,:i:.,2-,rii '1
-- -, 7 ,. jc)
Suprv. Electrician sig larure, required: r
.1 - AliPr Plan review (25% of permit fee): ---
Print name: 7 z. ---- L c ijq , ;e1(... ,
/ Date: g / yo ii State surcharge (12% of permit fee): ..--- I t(
.. . TOTAL PERMIT FEE:
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.
1: \ BuildingWermits \ELC-PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB