Permit CITY T�/ T �± /� p ELECTRICAL PERMIT
1 ®FF TI GAR PERMIT #: ELC2005 -00302
DEVELOPMENT SERVICES DATE ISSUED: 5/4/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112AC -00700
SITE ADDRESS: 07440 SW BONITA RD ZONING: I -P
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: (1) 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:
• MEYER SIGN CO OF OREGON
15205 SW 74TH AVE
TIGARD, OR 97223
Phone: Phone: 620 -8200
FEES Reg #: LIC 64014
Description Date Amount SUP 566SIG
ELE 20- 190CLS
[ELPRMT] ELC Permit 5/4/2005 $53.40
[TAX] 8% State Surcharge 5/4/2005 $4.27 REQUIRED ITEMS AND REPORTS
Total $57.67
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty 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 OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct •uestions to OU a 503 - 246 -6699 or
1- 800 - 332 -2344. r�
Issued By: /61 Permittee Signature: - _ 41).;
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
c, to ?�cDS- --coi3,
• Electrical Permit Application ' " ,,,FOR OFFICE USE ONLY ' '
R eceived Electrical ., ,�', C _ _
Date/By :J O 60 yt f Permit No.:Ci ( '�L0ZG "'J .- 6,3 7 ,422
Planning Approval Sign
City of Tigard I� Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
. Tigard, Oregon 97223 , Date/By: . ' Permit No.: •
• Phone: 503- 639 -4171 Fax s, 81124115
A ��,���..ppp Post - Review Land Use
1 - _ / ,m" � iI I + D ontac t Case No.:
Internet: www.ci.tigard.or.us �•� Contact Juris.: . ® See Page 2 for
24 -hour Inspection Request -5 3- 6O�' -4n Name /Method: A 16 Supplemental Information.
BUILDING DIVISION
. : ., r, 15 - _ " PLAN °REVIEW:(Pl'eiwehimeill,that'a 1"":
.�: .�yr�Y =� s " �':�1'1'PE #QF }VORKx�;` =?:�'�„t �:y:.,...�__., .. -.
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
t , commercial ❑ Hazardous location
❑ Addition /alteration/replacement .- ther: SL61J ❑ Service over 320 amps - rating of ❑Building over 10,000 square feet,
; , CAT
t; EGORY OF, CONS.TRU,CTION; ON V:, % ,
-;':.. 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling 'Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Egress/lighting plan . ❑ Other:
„ ❑ Other: s . >,.• - Submit sets of plans with any of the above.
' ,_' °° ~' ,,OB SITE`Its3,70 IATION,aiifa CATION. '`ii°• ,a `,:- :=
Th e above are not applicable to tempora construction � a Ls
,�,._��xza:�;.4 temporary service.
Job site address: ' _ s ''����:;' �h=z: �?' ��F. EE * c,, � �.�, °. - .. . .
Suite #: B . /Apt. #: Number of inspections per permit allowed
Project Name: 400,4, .}' -T 6u,s/A.23..z. . 3 ( 651 i S. Descrip Qty Fee (ea.) Total —
New residential- single or multi - family per •
Cross street/Directions to job site: dwelling unit. Includes attached garage.
GEC 0ane E 7 ` ° Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax ma /parcel #' Each manufactured home or modular dwelling 90.90 2
rvt- - ='s,W : service and/or
"DE CRI T � - "�..� ��.���a �
"" �"�' °�'°°' ` Services or feeders - installation,
V �%►��(Z � �(1� alteration or relocation:
�7 / �e� [ 1�� 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
PROPERTY OWNER -,� ,�� x , 601 amps t o 1000 am 240.60 2
- =�k° rg : 0E 111 :0, n ' 2
Over 1000 amps or volts 454.65 _
Name : - .4-- (A.JZ3S5 , �[/i s Reconnect only 66.85 2
Address: 79-µo Secs dy xt� JQ.Li,, Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: - 77G- -,q72?) i 42 • 9 -- /z Z t/ 200 amps or less 66.85 1
F ax 201 amps to 400 amps 10030 2
Phone: �qs • - / /nf� 2 '�� - I D /.5 40I to 600 amps 133.75 2
AP,PLIWIT c: *: 1 e..., * 1 CONTACT PERSON °.-. ' Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: l Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
;. :ra, ; ".; ,3 Each pump or rrigat
53.40 2
., :- r., =fir;_ 'i` " G NTRAC:TOR - : c ri ion cir 53.40 2
r's:. - -, . - Y e, •R= O Each sign or outline lighting
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 ?
Business Name: L-. - Lci7t/ a. 4 9 p ! ^ Description:
Address: AS o St,) `7 0 t `=-
9 / /' Each additional inspection over the allowable in any of the above:
City /State /Zip: �cyrf2 j pg , ( 1 Y' ' / P- - inspection per hour (min. 1 hour) 62.50
Phone: ea. 2 Z
O Fax: (0o- 7a7`�' Investigation fee:
. Other: _ ,
.._!_
CCB Lic. #: p • ► I. #: __ j �O :AlectrieirPermitTai": 1,5nt a '= F -', ' '
Supervising electricia Subtotal $ 3 / d
signature required: Plan Review (25% of Permit Fee) $
Print Name: P
/CP L : , • y 7c. #: 5/ . , 6 State Surcharge (8% of Permit Fee) $ 1
,) TOTAL PERMIT FEE $ 57.-6 7
Authorized If 10 Notice: This permit application expires if a permit is not obtained within
Signature: _AMA, ` Date 3 ^ d_1 180 days after it has been accepted as complete.
-
.■. I *Fee methodology set by Tri- County Building Industry Service Board.
Q- Le 0_Gc. ' P 11 ' ` 1
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
. -LIMITED ENERGY PERMIT FEES: •
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00 •
Check Type of Work Involved:
Audio and Stereo Systems
❑ Burglar lar Alarm
17 Garage Door Opener
I Heating, Ventilation and Air Conditioning System .� •
I] Vacuum Systems
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
F - 7 Data Telecommunication Installation •
n Fire Alarm Installation
n E1VAC
Instrumentation
n Intercom and Paging Systems
I I Landscape Irrigation Control
r7 Medical
n Nurse Calls
I I Outdoor Landscape Lighting
I I Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03