Permit CITY OF TIGARD
ELECTRICAL PERMIT
C OMMUNITY DEVELOPMENT Permit #: ELC2009-00281
e-. Date Issued: 06/10/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S126CC00200
Jurisdiction: Tigard
Site address: 10065 SW CASCADE AVE
Subdivision: Lot: 0
Project: Toys R Us
Project Description: Install (1) sign lighting.
Owner: FEES
GIRAFFE PROPERTIES LLC Quantity Description Date Amount
BY TOYS "R" US, ONE GEOFFREY WAY
WAYNE, NJ 07470 1 ea Sign or Outline Lighting 06/10/2009 $53.40
PHONE: 1 ea 12% State Surcharge - 06/10/2009 $6.41
Electrical
Contractor:
RAMSAY SIGNS INC
9160 SE 74TH AVE
PORTLAND, OR 97206
PHONE: 503 - 777 -4555
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.81
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. ATTENTIO• e =•• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -001 rough OAR 95 - 9 01 -01 r s, You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
// /
Issued y: /� ■ ' 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 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.
Electrical Permit Application 1)\ FOR OFFICE USE ONLY
City of Tigard Received ei
Date/By: C Q tO f7 7 Permit No.: f% (r tt, Ct'� /
, 2Q
q 13125 SW Hall Blvd., Tigard, OR 97223 tk Plan Review _ ~mow v`
Phone: 503.639.4171 Fax: 503.598.1960 6 Date/By: Other Permit:
T I G A . R D Inspection Line: 503.639.4175 Date Ready/By: Juris. El See Page 2 for
Internet: www.tigard- or.gov Notified/Method. Supplemental Information
. PE OF WORK PLAN REVIEW
El New construction Add ition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGO OF CONSTRUCTION, exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION. ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "l -3 ",
Job no.: Job site address: /00 , �,,t}, 100IIP or more. occupancy.
- -_ _ . 0 a • C 1C�1 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: I (y A r d b 91 ZZ ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: To g US ❑ Service or feeder 600 amps or more.
/J \ � FEE SCHEDULE
Cross street/directions to job site: / 4 C )--.47 )--.47 5 S .f i �yy V
x / _ V 1 Description Qty. I Fee. I Total
5. �C New residential single- or multi - family dwelling unit.
j - "" 1 / \ C.Gc. -d.7 , Includes attached garage.
SubWision: 1 Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
tZ / Limited energy, (with b o e sq
75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
.4-e _v 200 amps or less 80.30 2
LI'PROPERTY OWNER _ I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name:
li `7 VS 601 amps to 1,000 amps 240.60 2
Address: / GO (A 5 S !Ai C t_.-cle. .6/ V l Over 1,000 amps or volts 454.65 2
City /State /ZIP: T ��J Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: )'V
I Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
ali APPLICANT ID CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: g S B. Fee for branch circuits
GtI�O without service or feeder fee,
Contact name: S f - P � e 1 , / first branch circuit 46.85 2
Address: Dj) ( S L _ - __. A V i Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: D-L X- D (� 77 r7 w Each manufactured or modular 90.90 2
/ ` dwelling, service and /or feeder
Phone: (503 )7 . ' _ v:5 � Fax:: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting / 53.40 S 90 2
Signal circuit(s) or limited -
Business name: 5a � energy panel, alteration, or
Address:
q y0 / � L/21- ,...„....x.„... � Li �1 v& extension. Describe: Page 2 2
City /State /ZIP: "/ a r . - ...1-- r . - ...1-- - /ry_ /'/t' Each additional inspection over allowable in any of the above
/ C./ Per inspection 62.50
Phone: (S 7.-7- 6-- 4 ,--- - 1 Fax: ( ) /e / // plant , Investigation per hour (1 hr min) 62.50
G�
- 714
/� ?) q 2...z..... u / �j
CCB Lie.: Electrical Lie.: 2 r ,i 6GLS Suprv. Lie.: 1 ' ST 4,. p t per hour 73.75
// gt / �� ELECTRICAL PERMIT FEES
Suprv. Electrician s required: Subtotal: 5? , L(a
Plan review (25% of permit fee): -ea-.
Print name: pw t l St - i r - 1 Date: ( ( (b l 69
State surcharge (12% of permit fee): (.0•11/ /
Authorized signature: TOTAL PERMIT FEE: 54 • $ l
This permit application expires if a permit is not obtained within 180
Print name: � -f... P. V e, a ` K Dater 1 1 d J D 1 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05 /COM/WEB