Permit CITY OF TIGARD ELECTRICAL PERMIT
Per
COMMUNITY DEVELOPMENT
Permit #: ELC2009 -00244
T [ G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/27/2009
Parcel: 2S102AB03600
Jurisdiction: Tigard
Site address 12289 SW MAIN ST
Subdivision: Lot: 0
Project: Portland PC Repair
Project Description: (1) sign outline /lighting.
Owner: FEES
JOHNSON FAMILY TRUST & Quantity Description Date Amount
JOHNSON, REES C TRUST &, JOHNSON, 1 ea Sign or Outline Lighting 05/27/2009 $53.40
MARYANNE G TRUST, 3112 SW SANTA 1 ea 12% State Surcharge - 05/27/2009 $6.41
PHONE:
Electrical
Contractor:
HIGHLIGHT SIGN CORP
18270 SW BELTON RD
TIGARD, OR 97,223
PHONE: 503 - 729 -7978
FAX: 503- 624 -3725
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Total $59.81
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 . - is suspended for more the
180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifica'••n Center. • os- rules are -et forth in OAR
952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5y 246.6. • • • • ;06 2.2344.
Issued By: y at. LQ c-4(? 1,( Z� Permittee Signal • > / / ' 'Si / //�
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.
Electrical Permit Application RECEIVED FOR OFFICE USE ONLY
Received
- t
City of Tigard Date/By: Perm
No.: �e . 0r� q i-
lig
13125 SW Hall Blvd., Tigard, OR 97223 MA 2 7 2 009 Pl an R �J
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: V7009 .
T I G 1 R D Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: Juris: Page 2 for
Internet: www.tigard- or.gov Notified/Method: 1 j �, Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
New construction ❑ Addition/alteration/replacement 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.
CATEGORY OF 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 re CommerciaUindustrial ❑ 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 ", "l -2 ", "l -3 ",
/ n 1 8? sal , Six or or more. occupancy.
Job no.: Job site address: ITT �/� �,�
ry7 ❑ Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: 'y' q. f 9 7 ‘9. 3• ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Fba pC w /Q ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 54J. Now 4 igL 1 . Description I Qty. I Fee. I Total 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 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
/0••U PO/ 4- a- )411) ale Urt C /IAA residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER 1 llg TENANT 201 amps to 400 amps 106.85 2
Name: 1/11,4 0/c jp g L` / ildg'r - dO pt. ApAsix 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
0 APPLICANT I fiej CONTACT PERSON above service or feeder fee, 6.65 2
f j• y / , ar �P • Fee for circuit
Business name:
� �.�, � A/9,0 B . Fee for branch circuits
wiihoui service or feeder fee,
Contact name: SOWN— 4,444.4W14 D ' first branch circuit 46.85 2
Address: / a, $7Q C.U. s 104-70u Each add'l branch circuit 6.65 _ 2
^'_. Miscellaneous (service or feeder not included)
City/State/ZIP: 7 Web C)A' • Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: () ) (p sin $' ,2471.. Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting r‹ 53.40 2
Signal circuit(s) or limited -
Business name: 1.+1,A kip y 5944 Qin „ x energy panel, alteration, or
Address: 1 Pir7t7 PA). �jfi.kra� extension. Describe: Page 2 2
City/State /ZIP: c i4,(n ce Each additional inspection over allowable in any of the above
Phone: ( a)) (.Port gOr Fax: ( ) Per inspection 62.50
S Investigation per hour (1 hr min) 62.50
CCB Lic.: 041-91 Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
/ Plan review (25% of permit fee):
Print name: in l /'/ I Date: ; a 7/�
' State surcharge (12% of permit fee):
Authorized sign. �, -.000 TOTAL PERMIT FEE:
D ate: ,T .. This permit application expires if a permit is not obtained within 180 • Print name: • 11It , V / A ._ ! ... , i -/ v 0 7 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \Building'Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
•
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
•
❑ Landscape Irrigation Control*
❑ Medical
•
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling •
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \ Building \Permits\ELC- PennitApp.doc 03/23/06