Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00071
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/21 /2012
Parcel: 1 S136AD06000
Jurisdiction: Tigard
Site address: 11437 SW PACIFIC HWY
Project: Carl's Jr. Restaurant Subdivision: VILLA RIDGE Lot: PTS 1 -2
Project Description: Installation of (1) freestanding sign.
Contractor: ADVANCED ELECTRIC SIGNS INC Owner: EJM PROPERTIES INC &
1550 DOWN RIVER DR MAVERICK DECATUR GEORGIA LLC
WOODLAND, WA 98674 3633 E BROADWAY
LONG BEACH, CA 90803
PHONE: 360 - 225 -6826 PHONE:
FAX: 360- 225 -8299
FEES
Quantity Description Date Amount
7 ea Sign or Outline Lighting 02/21/2012 $474.88
Specifics: 1 ea 12% State Surcharge - 02/21/2012 $56.99
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $531.87
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 a 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. NTION: Oreg la , equires you to follow the rules adopted by the Oregon Utility Notification Cen =r. Tho a rules =re set forth in OAR
952 -0 1- 0010th •ugh OAR 95 1 01 -109•. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 r +.80/ .2344
Is ed By: / ' d • / Permittee Signature: �/.i�//l//.
y
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 Ina conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the Ume of each Inspection.
QllizaZ- •oo19 0 . 54 N24/2. - mac o O0wb8 0450 .
Electrical Permit p plicatioR EC E I i/ / - _ FOR OFFICE USE ONLY
City of Tigard DBteia J �!1 � Permit No.. . . i )I). -c�O7I
II • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
I Phone: 503.639.4171 Fax: 503.598.1960 JAN 2 7 2012 DateBy: Other Permit: 13w a,d61 -c.kx) 1
TIGARD Inspection Line: 503.639.4175 Date Ready/By: - kris: ® See Page 2 for
Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: Supplemental Information
3' , } '�' 'A:�.l a l �.. Y X 5... L 4'i
_;'::';'m'. ,1._ :�:.:: ? = 1 n::; ;= ; TYPE OF >P utisIV�1 C` giitig`�r `,tf x�,' '•'' t14.* �? di ,PLAN; REVIEW,_ Rff W4 i': :i J; 'Y6
New construction . 0 Ad dition/alteration/replacement Please check all that apply (submit j sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition 0 Other
where the available fault current ❑ Marinas and boatyards.
.: , ;: : . , t:'; `,'W,if i;: CATEGORY. OF: CON STRUCITONX,'`.k HAbi' ' {" .' ' lr.,i{ .: exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
Commercial/industrial less to ground, or exceeds 14,000 0 Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ COmmerCla
❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder , I Other: S Ie .j ❑ Fire pump. ❑ Installation of 75 KVA or
�`, : E '' N INFORMATIO AND LOC ATION`' v`? ia •i: ;r3;.p , ,.';! ?',; ❑ Addition o system. larger E". 1 -2 ", "1 -3 " system.
" • ' JOB SIT ,. El Addition of new motor load of ❑ "A", "E , "1 -2 ", I - , 3"
Job no.: Job site address: I I U 37 -4 PAtIftc J-Wy loo or or more R
ree occupancy.
1 St 0 or more residential units. ❑ Recreational vehicle parks.
Ci State/ZIP: I I GA r7 Oln ❑ Health -care facilities. ❑ Supply voltage for more than
1 �- ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: C ❑ Service or feeder 600 amps or more:
L -F1R.� s �YL ... ;- .4;;;_ : xt�.T.st. i,r•;,ir.» : FEE SCHEDULE • =I"` ..
Cross street/directions to job site: cription I tom. I Fee. I Total Ihr l I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
. . Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.:
Limited energy, residential 75.00 2
", i .. : y %u :.1 DESCRIPTION OF WORK! :r'r4;, &yAIi :=I I''.. ikd :' q: (with above sq. ft.)
``�� Limited energy, multi- family 75.00 2
3 RLAt 1 p 111 S I (INS / I I�IG Si (..14 (..14 ^ / IA1 R tA residential (with above sq. ft.) _
Q Services or feeders Installatlon and/or relocation
S 1(.1.x 1. oro..0r - n- . 3 L _ b 1450*` & l Q) A 200 amps or less 80.30 2
.. - ❑ PROPERTY, OWNER . ; g. ..®.,TENANT,i :; citV, l aiti' /x• 201 amps to 400 amps 106.85 2
Name: � l�l �I S S� 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address:. 1193-) s j PPS.6c "'^'% • Over 1,000 amps or volts 454.65 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
11 � +A�n cut.. relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 I
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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
, :;. ., ' .' ' . APPLICANT. t ' .,� ".. i. ' I;,. ;. ' .t':; . ❑ CONTACT. PERSON;4y',: ;!r ' above service or feeder fee,
each branch circuit 6.65 2
Business name: Aty i-rwch El EcIltic SICK B. Fee for branch circuits
� without service or feeder fee,
Contact name: ""
oA e. 5i ni first branch circuit 46.85 2
Address: ' 55o Co■y404.1vE.rt r Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: WORD L ALD 1,...17k gS6-244 Each mimufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ()(x,) aar G$ I Fax: : (3fia )a n9.3 Reconnect only 66.85 2
E-mail: Puna or irrigation circle 53.40 2
;.,,-!.-•:..•
DAUB. AD .�ANGar�EI I.G - lyltG y S'/1../�1. Garin, Pump g
,. i :. •• :;. . ; ::�._ CONTRACTOR v a. ,. K u •: ' ,0 Si or outline lighting 7 S • 7 2
CONTRACT R;�,,_ = =; i .�'rta�'. ,' � :-' :�. :• F• .. Sign Hh 8
Signal circuit(s) or limited- !o 7 - $t'
Business name: c.
Sp411n E AS AVf)t 14 energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: 105 Electrical Lic,33)- ICLS Suprv. Lic.: 766 T I G. Industrial plant per hour 73.75
T ELECTRICAL PERMIT FEFS . . . .'
Suprv. Electrician signature, required: Di Snt� Iq Subtotal: t1 1 14. gg
Print name: D� S it Date: I- 1 7 „ / 1 Plan review (25% of permit fee):
ri State surcharge (12% of permit fee): , 99
Authorized signature: J TOTAL PERMIT FE 531. g 7
Print name: �+ Date: This If permit application expires a permit b no obtained within 180
�� J+S • I I� 7 ` I days after It has been accepted as complete.
• Number of inspections allowed per permit.
I :\ Building \Permin\E1.C- PermitApp.doc 05/23/06 440.46I5T(I t/0S/COM/WEB