Permit P
A �,.. C ITY OF TIGARD CAR ELECTRICAL PERMIT
k p
„ yr PERMIT #: ELC2005 -00161
+L Ail ' • DEVELOPMENT SERVICES DATE ISSUED: 3/18/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135AA
SITE ADDRESS: 10225 SW HALL BLVD 102 ZONING: C - N
SUBDIVISION: METZGER ACRE TRACTS LOT : 037 JURISDICTION: TIG
Project Description: Sign lighting
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:
JOHNSTON, TERRANCE F + SIGNCRAFT LLC
MARY H 9033 SW BURNHAM
PO BOX 1608 TIGARD, OR 97223
TUALATIN, OR 97062
Phone: Phone: 503 - 639 - 4910
FEES Reg #: LIC 155420
ELE 34- 674CLS
Description Date Amount SUP 75S1G
[ELPRMT] ELC Permit 3/18/2005 $53.40
[TAX] 8% State Surcharge 3/18/2005 $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 questions to OUNC at
503-246-6699 or 1 -a:6- 332 -2344. .. A... ,... , _ _ Lr � ' � `�.
Issued By: • ; J _� J .A Permittee Signature: k54 /(, j,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 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.
RECEIVED o -000 i
Electrical ;Qermit Application -`� h FORtOFFICEUSEONLY'. :
City of Ti L
d MAR 18 2005 Received PemutNo.'
Tigard, OR 97223 Date/By: w 1461 Q t ' y) c vvh" -'(9.0 f 6
13125 SW Hall Blvd., Ti
$ Plan Review //
Phone. 503.639.4171 Fax: 503.59 �/ t h' Other Permit:
QTY O TIG ' t • Date/By:
Ins ection Line: 503.639.4175 : t. Date Read B Juris. H See Page 2 for
P BUILDING c _.v. : Y Y •
Internet: www.ci.tigard.or.us BUILDING DIVI el Notified/Method: T/C Supplemental Information
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Iii 1 ew construction ❑ ' Addition/alteration/replacement P lease check all that apply:
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_ ❑ Demolition hey: - *16 N ❑Service over 225 amps, comm'l ❑Hazardous location
' , r4 ye ,, . _, , _ _,, . Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
_. " a%9 `tOL,IM§I.-�j� i T O r .i r e 4A of 1- and 2- family dwellings 4 or more new residential
:'.�, -: �'" �Y« �' ���:.' k.:: o-��a :,t��'�.N�_� r:;.±zs..u*:,,.riwxs .. pa,« x «',.. s.,: ���,:;,. a; ��:% ��?: �.: S�u �.:�•.t�4:c!.e�:;;:�.r�;aiM�
❑ 1- and 2- family dwelling �ommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑ Other: ['Building over three stories [Weeders, 400 amps or more
Occupant load over 99 persons ❑Manufactured structures or
c`� ' n1" > ?�f 'aF -ga.ss �.+ ysuzaer,,. �: :. tnrr.' h `:. esN: .�n;�:a ='szv`;�-:'• " °� _ "'
"��.::', :, 'rQB : ,,.,., b.� 1...R' ONg` ,T * O t1,�' , "_ .e . > iru plan RV. park
RM t s ['Egress/lighting lan P WA(l Shah
Job no.: Job site address: 10 5'lu ��[� I G7� i4 ❑Health -care facility Other: v
Submit 2 sets of plans with any of the above.
City/State /ZIP: T 0 a ra , OR q72.2.3 *3 The above are not applicable to temporary construction service.
g P 102 Project : TAOLIO SALON rip z:;.
./a t. no.: ( Pro ect name. lfil • .-'�:fft ' D M
Suite/bldg./apt. ..
Description Qty. Fee. Total
Cross street/directions to job site: LOG(f sr New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
st <J, 3t,3 Limited energy, non - residential 75.00 2
s, '„ R t ``)}E G ZTPTIO , O ' 1 % „ ; :a f ' �' . *`' ,� Each manufactured or modular
Kook up '' e(ec t ca I Service eX t 5ft ri g dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
a+ s f for i Uu M una +ecl. wall 50,1 200 amps or less 80.30 2
W, "r u i r rl tj rc f mxza:-. t'. Vkc, ',R ; tireiggaa u - ,s: 4 201 amps to 400 amps 106.85 2
eta `, a..::u .a".. a .,:rte" .. a. '. , rale %a °. = ..: f +t<: w::xm: - -'... w 401 amps to 600 amps 160.60
Name: Dr. Wayne 'er( 601 amps to 1,000 amps 240.60 2
Address: l 0225• S •u1 • l{aII Wei Sut+e l0 t Over 1,000 amps or volts 454.65 2
Reconnect only . 66.85 2
City /State /ZIP: ;lard, OR 4 17223 Temporary services or feeders installation, alteration, and /or
Phone: (66 3) c e 4....:14 t 0 Fax ( ) relocation
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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
"'IV 23W- y , r$ r:�:,• . A s t - -3 sln - _ ate' ++M t " `> i . -
�' � � � t � `��`�' °�� ' :�1 �,° " " x �„; A. Fee for branch circuits with
3 1 .6-4 4 LL „ 3 'a ' „ ° a„. . _ a< C.0 1 .� Tit` E„2SQ £
�ssz3 �� _ a -�x� M s '. , „ service or feeder fee, each
Business name: 5 (Qn Cra.f t E lectnca l ,A ive�r-ti i fr 1a LIZ , branch circuit
B. Fee for branch circuits
6.65 2
Contact name: C.�Illelte . Calvet `.JJ
Q without service or feeder fee, 46.85 2
Address: 9033 SW $urvihawi 9f- each branch circuit
n Each add'1 branch circuit 6.65 2
City /State /ZIP: T Qard !. O�, 97223 Miscellaneous (service or feeder not included)
Phone: (603) (03 ✓ 1 - 4.110 Fax:: (503) &'3't - 4tigq Pump or irrigation circle 53.40 2
Sign or outline lighting t 53.40 53. 40 2
E -mail: S t a, he rf ♦ Gv P G eZ • cowl Signal circuit(s) or limited -
}, ,- �si'e?,- .,- ,. - c `;.aa""' ; . .ems. ..� : °"'7"„ .at. a', \
�y>s�. �''�",v, r emylT oto "`" 4 N a; ' '4; : �:; r.,. " energy panel, alteration, or
`:n "$. .�g„y�. ,».ea x, 83 , . , 3 /� �,C . �s•F} ri "�v.�'`, -Y`�'' : 4..111.z"- ':e..:.. �`.k...:c SN:.'�t�'s�
S { a of 1 E tec cc I A4V�� Sth9 �.(� extension. Describe: Page 2 2
Business name: ��
-
Address: .1033 Sb,) ' jurn ham gI Each additional inspection over allowable,in any of the above
Per inspection 62.50
City /State /ZIP: and , OR. 97223 Investigation per hour (1 hr min) 62.50
Phone: (56 03 • 490 Fax: (50) 6 3e1 • 4.49 1 Industrial plant per hour 73.75
CCB Lic.: 156420 Electrical Lic.: al - •o5 Suprv. Lie.: Subtotal 5-2
Suprv. Electrician signat required: $ . ) a,044.. V . Z J Plan review (25% of permit fee)
Print name: D aV i 4 tivi t k. i oi'� V Date: � State surcharge (8% of permit fee) y �
�' / t, • V s TOTAL PERMIT FEE ,-7. h--) Authorized signature: `a�� %y�/ ���� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: sh cal Date: 5•1 • a r * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
is\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM/WEB
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Electrical Permit Application - City of Tigard * i
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r RP S llM •w EO T Kw .:.. w _ 11 ;,_,, t., ,,_°
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm.
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning '
System* •
❑ Vacuum Systems* .
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260) • . - - -
Check Type of Work Involved:
Ill Audio and Stereo Systems . . • . . ' , •
❑ Boiler Controls , • . '
❑ Clock Systems
❑ Data Telecommunication Installation
• ❑ Fire Alarm Installation .
❑ HVAC
❑ Instrumentation •
❑ Intercom and Paging Systems V
. .. • ).. . : •
❑ Landscape Irrigation Control* . . , • ; .
❑ Medical • •
❑ Nurse Calls . • . ' .
n Outdoor Landscape Lighting* • ' •
• ❑ Protective Signaling - :
Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations ; • . . .
i:\ Building \Permits\ELC- PermitApp.dac 04/03