Permit ELECTRICAL PERMIT
II CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00015
T{GAAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/12/2012
Parcel: 1 S135BD00900
Jurisdiction: Tigard
Site address: 9770 SW SHADY LN
Project: Vern Fonk Subdivision: MEADOW VIEW Lot: 8
Project Description: Installation of one (1) permanent wall sign 1'6" x 11'8"
Contractor: VANCOUVER SIGN COMPANY INC Owner: DORR, PATRICK M
2600 NE ANDRESEN RD #50 10250 SW KABLE ST
VANCOUVER, WA 98661 TIGARD, OR 97224
PHONE: 360- 693 -4773 PHONE:
FAX: 360 -693 -2747
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 01/12/2012 $67.84
Specifics: •
1 ea 12% State Surcharge - 01/12/2012 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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. Th• e rules are set forth in OAR
952 001 - 0010 through OAR 952 001 - 0090. You • - y obtain a _ • • • • es or •ire • estions to OUNC by calling 503.232 •87 or 1 811 332 '4
Issued By/ L"" _ =� — Permittee Signature: -
ER 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 USE ONLY
City of Tigard R eceived 1 /- _ Permit No.:
13125 SW Hall Blvd Ti ,
Tigard OR '� Date/B : / ` _
II
g � - 1,O Plan Review
Phone: 503.639.4171 Fax: 503.59..1 0
Date/B
T I OARD Inspection Line: 503.639.4175 P\'‘‘ G���5} Date Ready /By: ® See Page 2 for
Internet: www.tigard or.gov "t �� i � rAOr Notified/Method: Supplemental Information
' TYPE OF WORGj s ' ,rs �G � ' I ` , . PLAN REVIEW
❑ New construction ❑ Addition /alteratiofi�
" I'cement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑ Marinas and boatyards.
' . ' ' „,:, ' CATEGO '' ' OF CONSTRUCTION • exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
' less to ground. or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling VI ommercial /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 ", "1 -2 ", "I -3 ",
Job no.: Job site address: q ` , - \ I IOOHP or more occupancy.
l?� (CJ 1 LQC� (� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Q `� J ❑ Health -care facilities. ❑ Supply voltage for more than
1 t acts., r ` ( 21, ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: kie,,, )� rvin, ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE'
Descripfion � . �� I Qty. I Fee. I Total
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'! 500 sq. ft. or portion 33.92 l
Limited energy, residential
. DESCRIPTION OF WORK • „ (with above sq. ft.) 67.84 2
Limited energy, multi- family
t l l L A V A . ; r l a k e l — w a I I Stay residential (with above sq. ft.) 67.84 2
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: / ejyt Fo�L 401 amps to 600 amps 200.34 2
V ` tom / 601 amps to 1,000 amps 301.04 2
Address: ? 77 p S LJ 5 hall l J� Over 1,000 amps or volts 552.26 2
City /State /ZIP: `'i e.'`, 0A J L/7-7 7 Temporary services or feeders installation, alteration, and/or
1 t LC_ relocation
Phone: ( ) Fax: ( ) , 200 amps or less 59.36 l
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
ig APPLICANT ` ' ' '®' CONTACT PERSON above service or feeder fee
7.42 2
each branch circuit
Business name:
okYlC.0,JI.V e.,Q"' S :ds 0 B. Fee for branch circuits
without service or feeder fee,
Contact name: R t%1 1 i. � ( m first branch circuit 56.18 2
Address: z (.00 NE- E- /AndJ . be n 1n a1G�4tSU Each add'! branch circuit 7.42 2
A Miscellaneous (service or feeder not included)
City /State /ZIP: kieLne.0 uwer. Ii) A '166,1 Each manufactured or modular 67.84 2
Phone: (3‘0 ) p 77 -• Fax:: (3 0 ) 1.O' 3 2,1.1{/ Rec Reconnect t only service and/or feeder
(pQ3 £ i! I l Reconnect onl 67.84 2
E - mail: ' Pump or irrigation circle 67.84 2
fE1 S� V d�ri f ►1gr1GQ.GO Y Y I P g
OONTRACTOR Sign or outline lighting i' 67.84 , 7r ri 2
Signal circuit(s) or limited -
Business name: V tel co uu et' S IQr energy panel, alteration, or
Address: Z coo w E A i e Rd * So extension. Describe: Page 2 2
!�/
City /State /ZIP: Each additional inspection over allowable in any of the above
Vnt VL 1.1 VC C' � �g ( (0 Per inspection 66.25
Phone: (36O) 0 Lill l F ax: (3 60) (0 Q 1 3 27q Investigation per hour (I hr min) 66.25
CCB Lie.: 6 zei 51 Electrical Lie.: 37.. , Supry Lie.: • '52.- Industrial plant per hour 78.18
J ELECTRICAL PERMIT FEE S
Suprv. Electrician signature, required: l . /1 ii311 Subtotal:
/ /` ' Plan review (25% of permit fee):
Print name: - r,,,,,,-1 t'Ie 1>- Date:
State surcharge (12% of permit fee): r, J'7
Authorized signature: 1 � - TOTAL PERMIT FEE: f25
This permit application expires if a permit is not obtained within 180
Print name: R e ,� r 5�.at' Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:A l5uilding V Permits VEI- C- PermitApp.doc I5 /01/09 440 -46 I5T(1l /05 /COM/WEI3 .
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
1: Building \Pcrmits\liLC- PCrmitApp.doc 10/01/09