Permit ITY O F TI GARD ELECTRICAL PERMIT
ia: PERMIT #: ELC2004 -00575
,,, DEVELOPMENT SERVICES DATE ISSUED: 9/13/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 15135BC -00201
SITE ADDRESS: 10763 SW GREENBURG RD,y80 D
SUBDIVISION: ZONING: C
BLOCK: LOT : JURISDICTION: TIG
Project Description: Lighting for (1) wall 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:
ROGER BELANICH ADVANCED ELECTRIC SIGNS INC
BY SOUTH LAND CORP 1550 DOWN RIVER DR
PO BOX 711 WOODLAND, WA 98674
DALLAS, TX 75221
Phone: Phone: 360 - 225 -6826
Reg #: LIC 105405
ELE 37 -841 CLS
FEES SUP 307S1G
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/13/2004 $53.40
[TAX] 8% State Surcharge 9/13/2004 $4.28 Rough -in
Elect'I Final
Total $57.68
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 N otification Center. Those
rules - - o OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
24. •699or1 -800 -33 344.
.,rte
Is ued By: _�.• " 1 ,7 � _ / )1 Permit Signature: K--rt/7
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 639 -4175 by 7:00pm for an inspection the next business day
•
ti y •
Electrical Permit Application /
Datereceived:. gym Permit no.: f - •„ _ ' O
- 4: °Jljl City of Tigard . :.. - Project/appl. no Expire date: .
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Dat issue ' By: Receipt no.:
Phone: (503).639 -4171 .
Fax: (503) 598-1960 . • Case file no.: Payment type:
Land use approv :. 4 1 - 00 Z 3 (o .
.. :. TYPE OF , {,' r• .
❑ 1 & 2 family dwelling or accessory • ❑ Commercial/industrial • ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ' • then .5 J- f ❑ Partial
JOB SITE INFORMATION
Job address: /0 7 g -./e,i_(/5i.1g 1.-c44- . gN Bldg. no.: Suite no.:, Tax map /tax lot/account no.: '
Lot: I Block: • Subdivision:
Project name: OA f / 2, 4.-6 [ Description and location of work on premises:
Estimated date of completion/inspection: -
FEE SCIIEDU,E. '`
_. -• • � � .. CONTRACTOR APPLICATION • ,
Job no: f Fee Max
• Description Qty. (ea) Total no. insp
Business name: 4 t l/A ti.IC:J ii p_2;47 a t ..54 n /S New residential - single or mull- family per
Address: AS OLo ,k, f/,cieZ • • R4 VF. dwelling unit. Includes attached garage.
City: i ) e.rgdLf I I State}ZIP: gRs /f Serviceincluded: • .
1000 sq. ft. or less 4
Phone: ,225 682 L Fax;1,2 S'�Z1 E-mail: Each additional 500 sq. ft. or portion thereof
CCB no.: /0 S S" I Elec. bus. lic: no: , 3 7 -g4.l 4L S Limited energy, residential 2
City/ a etro ic. no.: p c?-e, if e9 Z q • Limited energy, non- residential 2
_ — 9 —,%' Each manufactured home or modular dwelling
�'�
:nat e of supervt mg electrician (required) • Date Service and/or feeder 2
Servicesorfeeders — installation,
Sup. elect. name (print): S % e!/ r License no: 7gt alteration or relocat
' q.--...i. :. .•:., . 'PROPERTY OWNER - ''', 200 amps or less 2
201 amps to 400 amps 2
Name (print): L , Derr { 6 4 F E ►_Ar I.L(+ 401 amps to 600 amps 2
Mailing address: • 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: 'Fax: . I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - .
installation, alteration, or relocation:
which is not intended for sale, lease, rent, or exchange according to 200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
• Owner's signature: . r - A 1 CO k - Date: • 401 to 600 amps 2
Branch circuits - new, alteration, .
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: tt ' • - service or feeder fee, each branch circuit 2 •
City: J� I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2 •
Phone: Fax: E -mail: Each additional branch circuit:
• .
PLAN RLVIEW (Please check all that apply) -_,, • Misc. (Service or feeder not included):
l] Service over 225 amps - commercial Each pump or irrigation circle
0 facility l r 2
(� 2
❑ Service over 320 amps - rating of I &2 ❑ Hazardous location Each sign or outline lighting .7 5�
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 voltsnominal more residential units in one structure
alteration, or extension' 2
❑ Building over three stories . . O Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection I I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
• Not all jurisdictions accept credit cards, please call jurisdiction for more information Notice: This permit application
•
P ermit fee $' r
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ j . t
Expires accepted as complete. TOTAL $ ?
Name of cardholder as shown on credit card
$ •
Cardholder signature Amount 440 -4615 (COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7 — AM PM BUP
Location /0 b3 Suite PO MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 2.00y — 00 57.E
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: . f �.� SIT
Post & Beam �/
Shear Anchors MEW
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 516/4 )46
Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water•Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL (
MECHANICAL e t fSB
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S Please call for reinspection RE: Ei Unable to inspect — no access
Fire Supply Line 1614 A i / r R v
ADA Approach/Sidewalk Date 0 ( ( Inspector Ext
PP
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL