Permit 7 CITY CO TIGARD
ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00256
COMMUNITY DEVELOPMENT DATE ISSUED: 5/6/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 136AD -06507
SITE ADDRESS: 11460 SW PACIFIC HWY ZONING: C - G
SUBDIVISION: WAY LEE LOT : 003 JURISDICTION: TIG
PROJECT: QUALITY INN
Project Description: Installation of (1) sign lighting.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0.00 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 1
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:
QUALITY INN CLARK SIGNS
11460 SW PACIFIC HWY PO BOX 1113
TIGARD, OR 97223 ST HELENS, OR 97051
Phone: 503 - 245 -6421 Contact #: PRI 781 -4236
FAX NA
FEES
Description Date Amount Reg #: ELE 627SIG
[ELPRMT] ELC Permit 5/6/2008 $53.40 LIP 64933
[TAX] 12% State Surchar 5/6/2008 $6.41 SUP 5 - 18CLS
Total $59.81 REQUIRED ITEMS AND REPORTS
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 -00 ;1 • r.. = OA - • - - 001 - 0100.. You may obtain copies of these rules or direct questions to OU at 503.246.6699 or 1.800.332.2344.
Issued B : / /` ./ Permittee Signature: 612J
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 Applicatiioi "® FOR OFFICE USE ONLY
City of Tig 1.+ * Date/B : 2 Permit No.: 'a s ��
• 13125 SW Hall BI card, OR 97223 Plan Rev -11 ' I . Phone: 503.639.4171 F 3. \7 s $ Date/By: Other Permit:
T I G n It D Inspection Line: 503.639 Date Ready/By: Sufis: El See Page 2 for
Internet: www.tigard - or.gov (3 �U Notified/Method: Supplemental Information
I.i , O F; _ WORIC�S 1O"' PLAN REVIEW •
❑ New construction ilition/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 ❑•rommercial/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 ", "t -2 ", "l -3 ",
Job no.: Job site address: // ^^ ���C ,/' 1001 P or more. occupancy.
7[ J gay ❑Six or more residential units.
0 Recreational vehicle parks.
•
City/State /ZIP: '77&i Qo Oe O . 9 7 �� z3 ❑ Health-care
H�rdous locations. ❑Supply voltage for more than
cilities.
" y ` 600 volts nominal.
Suite/bldg. /apt. no.: 'f Project name J 4L../ / , A) ❑ Service or feeder 600 amps or more.
job site: ��/� Description FEE SCHEDULE
Cross street/directions to
j 'T U (� O 5 �o �/T/C K W 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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
} -�'rM� /• 1 ,n t✓ �/ Limited energy, multi - family 75.00 2
' / q w/C w A-LC-
C U! T C S I l „ / // 576-it) e 1 /( t S77/1) G residential (with above sq. ft.) _
C � 1. J Services or feeders installation, alteration, and/or relocation
r E j 200 amps or less 80.30 2
❑ PROPERTY OWNER NANT 201 amps to 400 amps 106.85 2
Name: au A- Li Ty / &) /l_J 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 114/(-)r) s G i,c7c / Over 1,000 amps or volts 454.65 2
City/State /ZIP: 7-7 &-.4ie n O
/ Temporary services or feeders installation, alteration, and/or
- / relocation
Phone: /- e 51s _ , v 2 / Fax: (tea) a yS . 6vz S 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
g A. Fee for branch circuits with
M46PLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
Business name: C t✓/'K S / (r706 Fee or branch circuit
B. Fee for branch circuits
_ c �,��
without service or feeder fee, 46.85 2
Contact name: g c.- first branch circuit
Address: Po ddx / / 1 3 Each add'I branch circuit 6.65 2
` Miscellaneous (service or feeder not included)
City/State /ZIP: sr /L./LE-A) 5 pee 9 7th/ Each manufactured or modular 90.90 2
/ V C dwelling, service and/or feeder
Phone: (3) -74:Fr 7 /_ Q 9 7 Fax: : L 3X /3 —5 —I (// Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting / 53.40 5344:3 2
Signal circuit(s) or limited-
Business name: CC p- tee S / S energy panel, alteration, or r
Address: / //
P o eo x i 3 extension. Describe: Page 2 2
City/State /ZIP: ST #1-f67.&-NS `'R 7 7l) s- Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: j ) z27-- 9943 Fax: (3728) .'T' --/ Si / Investigation per hour (1 hr min) 62.50
CCB Lic.: 6,993 3 Electrical Lic.: Sig C7 L Su r rv. Lic.: G 27$4 Industrial plant per hour _ 73.75 _
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: if GZ! Subtotal: s3 v
Plan review (25% of permit fee):
Print name: &-”, Ge/E C L RK Date: State surcharge (12% of permit fee): 6 4
Authorized signature: TOTAL PERMIT FEE: 5 9 CI.
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PennitApp.doc 05/23/06 440.4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
PRESIDENTIAL 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
T1 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
I:\ Building \Permits'ELC- PermitApp.doc 03/23/06
,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008 -00256
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/6/2008 '•'
Phone: (503) 639- 4171 °ujr'
b •
Inspection Requests (24 Hrs.): (503) 639 -4175 "� L.
INSPECTION WORKSHEET FOR DATE: 8/28/2008 TIME: 7 :00AM PAGE: 3
SITE ADDRESS: 11460 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: WAY LEE LOT #: 003 TYPE OF USE:
PROJECT NAME: QUALITY INN
DESCRIPTION: Installation of (1) sign lighting.
OWNER: QUALITY INN, PHONE #: 503 - 245 -6421
CONTRACTOR: CLARK SIGNS PHONE #: 781
Inspection Request Scheduled For: Date: 8/28/2008 Pour Time:
Code # Inspection Description 76on`fitm # Contact # Message
199 Electrical final 074813-01 t\ 503 -104 -0872 N
I titg
Corrections/Comments/Instructions:
c \ -''
1/1 6
4
A PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (5 1 v w L Date: 4 / Phone #: (503) 718- VILA