Permit CITY OF TIGARD ELECTRICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELC2011 -00416
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 09/23/2011
Parcel: 1 S 135BD01200
Jurisdiction: Tigard
Site address: 9802 SW SHADY LN
Project: Portland Bagel Co Subdivision: Lot:
Project Description: (1) sign lighting
Contractor: HANNAH SIGN SYSTEMS LLC Owner: BURDICK - FORBES INVESTMENTS LLC
1660 SW BERTHA BLVD BY DONALD C BURDICK
PORTLAND, OR 97219 434 RIDGEWAY RD
LAKE OSWEGO, OR 97034
PHONE 503 - 946 -8373 PHONE
FAX' 503 - 206 -4900
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 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 ATT ION Ore.. law : • tyres you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 through OAR 9 • %11-00•I '•u may obtain a copy of the rules or direct questions to OUNC by calliw...599'232 1987 or 1 800 332 23 4
Issue By: / . //L � -i - Permittee Signatur
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' , 4 .a.6.1r 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.
Electrical Permit Application -, - ° • ' -- FOR OFFICE USE ONLY - ti : v .
- R a ved ��- /_
City of Tigard Date By oZ I� ti , Permit No. "7,62 7 //_ d� y/1 tP
U PI
-
q 13125 S W Hall Blvd , Tigard, OR 97223 JUL 2 6 2011 ply Revie �7
` Phone: 503.639 4171 Fax: 503.598.1960 Date/By Other Permits'G^/�0 _ I le 027
7
Inspection Line: 503.639.4175 CFFY OF TIGAR Date ReadyBy .ions r ® See Page 2 for
TIGA, RD OF i r i c7
Internet: wwwtigard- or.gov
BUILDING ni\lti ic otified/Method Supplemental information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /+terns checked below)
, New construction ❑ Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: 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 agncultural
❑ 1— and 2- family dwelling KCommercial/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 denved system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: I Job site address: 50� S 7 L.� I ❑ Six or more occupancy.
Six o or r more residential units ❑ R ecreational vehicle parks
City/State /ZIP: t�A��� q , 2 ID Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg./apt. no.: Pro name: ❑ Service or feeder 600 amps or more
Project �, LA [�� - (�Z Cry .,
job site: FEE SCHEDULE
Cross street/directions to
J � ��),(��(� 1� Descri l Qty. I Fee. I Total
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
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
Limited energy, multi- family
I S I lit, C 1 P-c, -, %r' residential (with above sq ft.) 67.84 2
Services or feeders installation, alteration, and/or relocatio
200 amps or less 100.70 2
❑ PROPERTY OWNER R 201 amps to 400 amps 133.56 2
Name: Jess tc_a c.JA�-►ov 1 C..-Z- 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 913U 3a.J AiS y L--is Over 1,000 amps or volts 552.26 2
Cit /State /ZIP: Temporary services or feeders installation, alteration, and /or
y tiA ] Fes- 9-72_2.3 relocation
Phone:3 ) 37 •l 9 ,{ I Fax: ( ) 200 amps or less 59.36 1 ,
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date:
A Fee for branch circuits with
®. APPLICANT J ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: 44"),vq.4 S NU S yjremSt Lt- -L B. Fee for branch circuits
Contact name: without service or feeder fee,
56.18 2
c� ' L A>`s Pet 12 first branch circuit
Address: I Le, (Jac) sw ` .1� (3 `�6 Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: 1 � - C.:42._. 5-72-1. e Each manufactured or modular
dwelling, service and /or feeder 67.84 2
Phone: ( gbl ) 9� 8,3 7r3 Fax: : (g ) 200=, L tc-) Reconnect only 67.84 2
E -mail: y6 4 1tvA-7lS4 t s ys: ms_ C Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting f 67.84 2
Signal circuit(s) or limited -
Business name: .E A S o.l energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Phone: ( ) Fax
inspection 66.25
( iSuprv. f I / Investigation per hour (1 hr mm) 66 25
CB Lie.: I,�.��Z 7 Electrical Lie.: aL$ (( Lic.: 67625 1/. lndustnal plant per hour 78.18
ELECTRICAL PERMIT FEES
4uprv. Electrician signature, required j� S Subtotal: 6 T. asy
Print name: )4 0(3 A Date: 7 _ Z S _ It
Plan review (25% of permit fee):
../.)4 �' State surcharge (12 /u of permit fee): J y
Authorized signature: TOTAL PERMIT FEE: 15", is)
This permit application expires if a permit is not obtained within 180
Print name: � ( LAN t - fal). —� Date: "? — S---1, days after it has been accepted as complete.
j-- * Number of inspections allowed per permit
I \Building\Permus\ELC- PermitApp doe 10/01/09 440- 4615T(1 I /05 /COM/WEB