Permit `9N CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00717
141 DEVELOPMENT I
r SERVICES 503) 639 -4171 DATE ISSUED: 12/11/03
13125 SW Hall PARCEL: 1S135AA-01400
SITE ADDRESS: 10215 SW HALL BLVD
SUBDIVISION: METZGER ACRE TRACTS ZONING. C -N
BLOCK: LOT : 037 JURISDICTION: TIG
Project Description: (2) each 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: 2
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:
INTEGUMEND LLC BY SCOTT COLLINS MD SECURITY SIGNS INC
& MARIA ROSS MD 436 SE 12TH AVE
9495 SW LOCUST STREET PORTLAND, OR 97214
PORTLAND, OR 97223
Phone: Phone: 503 - 232 -4172
Reg #: L1C 122809
ELE 26- 560CLS
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/11/03 $106.80
[TAX] 8% State Surcharge 12/11/03 $8.54 Rough -
Elect'I Final
Total $115.34
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 -800 -3 2 -2344.
Issued By: .. 424,4_, )/ Permit 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'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrioial Permit Application .„,.
FOR OFFI USE ONLY v-"-!:-.'''' r . .
Received
} Date/By: /2 /'/ Permi N rJ �O )5 --‘,7
3 O7/ '
Permit No.'
City of Tigard Planning Approval Sign
Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
+ Case No.:
Internet: www.ci.tigard.or.us s.) � I . Date /By:
Co ntact
�� 9 � Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
-_, _ u YPErOF': W.O . ;4;'•;i::. ;_x 7 x* 3 ,7NIPLANAEVLEW e(Please'c6eclt= a1Dt1iaC aPPIjW..:, evq.t4i-,
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
El i
Addition/alteration/replacement ❑Other: commercial ❑ Hazardous location
t Service over 320 amps- rating of ❑ Building over 10,000 square feet,
:
=`' I,Z: , `aCATEGORY;OF CONSTRUCtTION'":�':' _ :` I & 2 family dwellings
` "� � ~'� ~ 3 ` four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons .0 Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
r ', t;41,OB SITE- .INF.ORMAtTION<audILO:CATION 'n'- : " >:' ";`:,' ' Submit _ sets of plans with any of the above.
Job site address: l pZ Sc 5` \>� k 9 The above are not applicable to temporary construction service.
k .* ':, " r ., rry FUtS CHEDULE s ° ntg.' ' `; , I,', ;,
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: 1 t - v cstu`'v1. iJL Description I Qty Fee(ea.) Total
New residential - single or multi - family per v
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: Limited energy, residential 75.00 2
Lot #' Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
I ' :,: 4 11 4 ,£ :. • DESCRIPTION:OF,'W : `"'' 4 a i _ " service and/or feeder 90.90
Services or feeders - installation,
C2—� 1 t L t.--...., . , s .
4-7 ,::j 4 . - A. If s 5 alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
® OWNER ;' 5:ni iii TENi .NT; ` : ,fi ' E.:1 ; - .4,'s , 601 amps to 1000 amps • 240.60 2
Over 1000 amps or volts 454.65 2
Name' Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
-` Ei AP•,PLICANT � :), i;: ::. _ : � ..'': ® .CONTACT PERSON_'?':; r :,,, = 401 Branch circuits 133.75 2
. Branch circuits - new, alteration, or
Name: extension per panel:
Address: A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
'r� `tT °) a.�,; k.� -•, Each ump or irrigation circle
-< ��,� "". },CONTRACTOR`. =� �,��,�� ° >,�; ` �,;: p 53.40 2
t�� ter �: �� m ,, �-�°'r'u,, �t�;�; , � `nw e =. . �a�� "i �aFt�,w.
Each sign or outline lighting a.. 53.40 /0 .80 2
Job No: Signal circuit(s) or a limited energy gn O gy panel,
Business Name: alteration, or extension Page 2 , 2
I LV -T`T' S� L- .�
t( � Description:
Address: / 5-9- 1 -.
City/State/Zip: �Z- . Jl �� — Each additional inspection over the allowable in any of the above:
sKIJ Per inspection per our (m
er hour (min. I hour) 62.50
Phone: 1 -n_ Fax: -z-3,O, 1 S(,:. / Investigation fee:
CCB Lic. #: 1 e,(: Lic. #: z.6- S6, 1c.�.5 Other:
Supervising yr , : , >g *,
• s ng electricia � � .;� �Elecfrical�Per' „� �, `� _•$;.�? r M � �- °
_ Subtotal $ /06. go
Si: ature re. uired: ` � Plan Review (25% of Permit Fee) $
Print Name: ,.._ Zi..ci..>t N . L v
u State Surcharge (8% of Permit Fee) $ g . J `f
TOTAL PERMIT FEE $ //1 ,`3 9
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: ate: l •' , •03 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
�J c eigT ' L Q -113 i4A .c2
(Plea se print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
• Garage Door Opener
ri Heating, Ventilation and Air Conditioning System
Vacuum Systems
• Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
• Audio and Stereo Systems
n Boiler Controls
F1 Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
Nurse Calls
I I Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
is \Dsts \Permit Forms \ElcPermitAppPg2.doc 01/03