Permit q CITY OF TIGARD ELECTRICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00527
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/30/2011
TIGARD g Parcel: 2S 102AA00904
Jurisdiction: Tigard
Site address: 12060 SW MAIN ST
Project: Value Village Subdivision: PAYLESS SHOPPING CENTER Lot: 1
Project Description: (2) sign lightings for new wall signs
Contractor: VANCOUVER SIGN COMPANY INC Owner: JASUE LLC
2600 NE ANDRESEN RD #50 NATHAN - JEFFREY LLC
VANCOUVER, WA 98661 BY ALBERTSON'S #65
PO BOX 20
BOISE, ID 83726
PHONE 360- 693 -4773 PHONE:
FAX. 360 - 693 -2747
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 09/30/2011 $135.68
Specifics:
1 ea 12% State Surcharge - 09/30/2011 $16.28
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $151 96
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 OA
952- 001 -0010 through OA : 952- 001 -0090 You may obtain a co. of the r - • direct questions to OUNC by calling 503 23 :87 or 1 811 332 2 4
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.
•
Electrical Permit Application FOR OFFICE US ONLY
Received ^, M
City of Tigard D ate /B �3 Permit No. ��� r C ( ��
13125 SW Hall Blvd., Tigard, OR 972 Plan Review Ar
M I ill
' Phone: 503.639.4171 Fax: 503.598 1960 1 Dat /B Other Permit.
TIGARD.
Inspection Line: 503.639 4175 LI Date Ready /By• Juris El See Page 2 for
Internet: www tigard- or.gov SEP 23 201 Notified/Method: Supplemental Information
TYPE OF W9RK.,wir -,p,,, PLAN, REVIEW
va la e trf tt - en tt • fip Please check all that apply (submit 2 sets of plans w /items checked below).
New construction ❑ Addition/altefation/rep ❑ " J. L o./llIV U 1 i / i ce 1 ON ID Service or feeder 400 amps or more ID Building over three stones.
❑ Demolition Other: 91 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 El Commercial -use agricultural
❑ 1- and 2- family dwelling g 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 - ", "I - ",
100
Job no.: Job site address: 1 O S W ,1A CL# 11 S t' or s. occupancy.
1 ❑ Six o or r moo re e residential units El R ecreational vehicle parks.
City / State/ZIP: ` ���� p + ^h ❑ Health -care facilities CI Supply voltage for more than
cn l J ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 Project name: V c11/4.� we. \ I i 11, , n ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: 1 ""� Description FEE SCHEDULE
I Qty. 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
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq ft.)
f Limited energy, multi - family
67.84 2
Z ;11 u yl/l,I vi tom' GC. Wad f 5 l n residential (with above sq. ft.)
J Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
PROPERTY OWNER 'TENANT 201 amps to 400 amps 133.56 2
Name: U� 401 amps to 600 amps 200.34 2
t I 1 �� e_. 601 amps to 1,000 amps 301.04 2
Address: j O (00 � 5 Mal Itt S t Over 1,000 amps or volts 552.26 2
City / State/ZIP: Temporary services or feeders installation, alteration, and/or
Il�j� rd, � � relocation
Phone: ( ) J 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
APPLICANT ,CONTACT PERSON above service or feeder fee,
7.42 2
Business name: Vast each branch circuit
V „il VL C 0 U� V e r � i q y1 B. Fee for branch circuits
J without service or feeder fee,
Contact name: R e, t(lrl first branch circuit 56.18 2
Address: — (no, ni/ A rid,re„5en, � 4 Sri Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: l� Q � Vf ,,� � A C o L , 6 I Each manufactured or modular
67.84
V 2
dwelling, service and/or feeder
Phone: (3bo ) (oCi 3 LI I7 7, Fax:: (36,()) 61 5 z 7 t17 Reconnect only 67 84 2
E -mail: f e. j CLS e- 11 u n , S i cAn C O t c 0 Pump or irrigation circle 67.84 2
CONTRACTOR - Sign or outline lighting (7\) 67.84 5(0V 2
Signal circuit(s) or limited-
Business name: Vcu' co iAA1 C I Si C� `n energy panel, alteration, or
Address: Z c700 N And, f e S e,n Rd, so extension. Describe: Page 2 2
City /State /ZIP: 1 /a,1.C.0 t.0 e _ r WA c 4 f Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (364 ) 6c y T7 7 Fax: (3t3) 693 Z7 y 7 Investigation per hour (I hr min) 66.25
CCB Lie.: 6 7 3 9, 5 ) Electrical Lie.: 37 l/ /a5 Suprv. Lic.:5 industrial plant per hour 78.18
' ,! • ."ELECTRICAL, PERMIT` FEES .
Suprv. Electrician signature, required: = —, /` Subtotal: • / 35.695
Print name: �/� 6,1-- Date: - Plan review (25% of permit fee): : - —
tr.„ State surcharge (12% of permit fee): ' / (p. 01 g
Authorized signature: �
^ TOTAL PERMIT FEE: /5/ , 9
t � (� Y' This permit application expires if a permit is not obtained within 180
Print name: Q e l id , D
/ ` days after it has been accepted as complete.
* Number of inspections allowed per permit
I•\nmldmg \ Permits \ELC- PermnApp.doc 10/01/09 440- 4615T(1 l /05 /COM/WEB