Permit CITY OF TIGARD ELECTRICAL PERMIT
"'!'' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00710
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/20/2011
Parcel: 1 S134BC00200
Jurisdiction: Tigard
Site address: 12186 SW SCHOLLS FERRY RD
Project: Game Haven Subdivision: WINDSOR PLACE Lot: 32
Project Description: Sign lighting for (2) signs.
Contractor: GRESHAM NEON & SIGNS Owner: GREENWAY CENTER LLC
21551 SE STARK ST ANA KALAKAUA CENTER
GRESHAM, OR 97030 2155 KALAKAUA AVE #602
HONOLULU, HI 96815
PHONE: 503 - 417 -4774 PHONE:
FAX: 503 - 253 -9407
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 12/20/2011 $135.68
Specifics:
. 1 ea 12% State Surcharge - 12/20/2011 $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 OAR
952- 001 -0010 through • R 952 - 001 -0090. ou ma • stain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. '-
• , 1
Issued By: Permittee Signature:
Apz
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.
6, • 0002 14-/27
Electrical Permit Application FOR OFFICE USE ONLY
CI Of Tigard Received
By: Penult No. / 7
`J g E 2 C 1 VED Date/BY: iyl t� //) f
° 13125 SW Hall Blvd., Tigard, OR 2 ` Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date /By: Other Permit'
TI GARD Inspection Line: 503.639.4175 U C [ O Date Ready/By: ____________ See Page 2 for
Internet: www.tigard or.gov Notified /Method: Supplemental Information
TAPE OF t • ti RK I I � _ PLAN REVIEW
❑ New construction Add ition /alt
L — r p ertva!'t' 1, .1 t t s .l a ce :I tvt t- t II I I U Please check all that apply (submit 2 sets of plans w/items checked below):
lo. s ' - replament—
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ['Other: where the available fault current ❑ Marinas and boatyards
CATEGORY CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
I OOHP or more occupancy.
Job no.: Job site address: 114 sz 6 co q� it ❑ Six or more residential tends. ❑ Recreational vehicle parks.
City /State /ZIP: •- ,,. . e � � e� e� 2 l fzrye-y ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 6-0114.7„e_ - 4a(/ 2 In1 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I
W '�-rs n , � 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.) 75.00 2
Limited energy, multi- family 75.00 2
"I h 0.40 K2 I COLS residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 1 I \ 401 amps to 600 amps 200.34 2
s , Aa ICi `4- ri , m , ,, R 601 amps to 1,000 amps 301 04 2 Address: �) 0 ) AA iv Q � 4 * r Over 1,000 amps or volts 552.26 2
Cit /State /ZIP: '� �f� f� �y 1 Temporary services or feeders installation, alteration, and /or
Y 1 1 1 i a i2 (/ a 3 relocation
Phone: ( � ) I Fax: ( ) 200 amps or less 59.36 1
yo. 201 amps to 400 amps 125.08 2
Owner installation: its inst Ration is being made on property that 1 own which is not
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 ( y CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: 0 fic, '� _ 4 - . �wC B. Fee for branch circuits without
4 service or feeder fee, first 56.18 2
Contact name: ( � V .� e.� branch circuit
V Ea ch add'I branch circuit 7.42 2
Address: V t0 2 4 & 2.Lt.._ — Miscellaneous (service or feeder not included)
City/State/ZIP: - � -h( ` Each manufactured or modular
Ci 67.84 2
ty 0 CI T� (c, dwelling, service and/or feeder
Phone: (( 2 s-- 5 _ i if p / I Fax.. ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited energy
I panel, alteration, or extension. Page 2 2
Business name:
iQ > ha “k Nt Q_ rn "-t q V S Each additional inspection over allowable in any of the above
Address: Ce / /_ o JO r— V i lea b ¢ S11,. >" 1 ►^a- t ( �Z i P Additional inspection (I hr min) 66.25/ hr
City/State/ZIP:
Y / Investigation (1 hr min) 66.25/ hr
a ° A. Y J - 0 • Industrial plant (I hr min) 78.18/ hr
Phone: (& )15‘0 4. Fax: ( /a 1 l Inspections for which no fee is 90.00 / hr
,j ? / >/ / p t t � specifically listed ('h hr min)
CCB Lie.: l p�p le- al Lie.: _
Subtotal:
t� .sl Sup rv. Li e.: (,lt �;�S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, requ -d: ' f l / v" . IIIJJJ i - 1
J--L----- Plan review (25% of permit fee):
Print name: , ,. Dates 6-- . State surcharge (12 %of permit f � �
g
- 12.. - 1 / �, /��,' TOTAL PERMIT FEE:
Authorized si natu 1 , /
This p ermit application expires if a permit not obtained within 0
— j ' V . days after it has been accept d as cootete.
Print name: r Date: Cl
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