Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00117
DEVELOPMENT SERVICES DATE ISSUED: 2/28/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136AD-06400
SITE ADDRESS: 11440 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Sign lighting (2).
RESIDENTIAL UNIT TEMP SRVCIFEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 2
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:
TIGARD BP SERVICE CO INC MEYER SIGN CO OF OREGON
11440 SW PACIFIC HWY 15205 SW 74TH AVE
TIGARD, OR 97223 TIGARD, OR 97223
Phone: Phone: 620 -8200
FEES Reg #: LIC 64014
tion Date Amount SUP 20
Description ELE 20- 190CLS
[ELPRMT] ELC Permit 2/28/2005 $106.80
[TAX] 8% State Surcharge 2/28/2005 $8.54 REQUIRED ITEMS AND REPORTS
Total $115.34
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 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct que -'.ns o OUNC at (503)
246 -6699 or 1-800-":
Issued By: At , , . � _ 0 7 Permittee Signature'
OWNER INSTALLATION ONLY ter_
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 639 -4175 by 7:00pm for an inspection the next 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.
.` FOR OFFICE USE ONLY
Eletr�ical Permit Application Receive• Electrical
Date/B e .g... / . � � Permit _l OP//
City of Tigard • Planning • ppro al Sign
Date/B Permit No.:
13125 SW Hall Blvd. G,N, t Plan Review Other Ak.
Tigard, Oregon 97223 Date /B : • Permit No.:
Phone: 503 -639 -4171 Fax: 503 -5/98` 60 Post- Review Land Use
*� ' • 'i•i 1 '• , � Date/B : • Case No.:
Internet: www.ci.tigard.or.us c F �'� ( Contact IZ See Page 2 for
V �^. _.: ..J
24 -hour Inspection Request: 503- 639 -417 1G A -4I Name/Method:' WA. Su lemental Information.
CI TYPE OF WO: • ' � 1 ' ,:;..,:--'_ .. ' 7 -. . • ` PLAN REVIEW (Please_check all that apPlY). " •` - ,.
•
❑ New construction • III Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition /alteration/replacement 21 Other: J 4/ ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
'!: " . 'CATEGORY OF•CONSTRUCTION 1 : , ' - -- '' : • 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling M Commercial/Industrial ❑ System over 600 volts nominal one structure
1 ❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
- .40H SITE INFORMATION and LOCATION .' _ Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: / .. -
• I t f�D 5 OA- �( fF(,P � r (�'P� — '" FEE * SCHEDULE '- ; ,v ;■: • .
Suite #: Bldg. /Apt. #: . Number of inspections per permit allowed
Project Name: ( f (ir Descri tion Qty Fee (ea.) Total
New residential - single or multi- family per •
Cross street/Directions to job site: dwelling unit. Includes attached garage.
,{W eh --5 Service included:
°� 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 l
Subdivision: I Lot #:
Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
sDESCRIPTI //O``N-- IkLet � service and/or feeder 90.90 2
-
r � 6 ✓t,tpl � "-`-A (/(
Services a ion feeders - Installation,
''''33 alteration or relocation: -
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
- e'PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
// „ / Over 1000 amps or volts 454.65 2
Name: C wo e° P /(,( ut /) S / TL�scd Reconnect only 66.85 2
Address: 4 oo /J , (( Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: r ¢Sti,..pa2 �( ) 7 7D 7 9 200 amps or less 66.85 1
Fax: 201 amps to 400 amps 100.30 2
Phone: 1 401 to 600 amps 133.75 2
El APPLICANT •:''- - ..0'CONTACT PERSON, - Branch circuits - new, alteration, or
Name: _taie, /,(.txR.p t I( extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR • Each pump or irrigation circle 53.40 2
Each sign or outline lighting y. 53.40 2
Q Job NO Signal circuit(s) or a limited energy panel,
n alteration, or extension Page 2 2
Business Name: 44,8 S(G,t.) Lin• 4%6 19,,„d26- Description:
1 Address: /5.' S,(
ao ., 7v QA� - _
_ Each additional inspection over the allowable in any of the above:
1
City /State /Zip: -Ti GAIL ) OR_ . ? 7 L Z P r inspection per hour (min. 1 hour) 62.50
t' 2.
r Phone: o --g 2cs� Fax: 6 2.0 _70 /
In vestigation fee:
Other:
CCB Lic. #: & .t+ Lic. ° : 2.0 — ( C°_ 5 Electrical Permit Fees* : '.
Supervising electrican 1 Subtotal • $ / .6 ( . K
signature required: /. Plan Review (25% of Permit Fee) $
Print Name: Q DSI Lic. #: cS /G s - 4 State Surcharge (8% of Permit Fee) $ g. 5r
J0 ��! TOTAL PERMIT FEE $ / /.5 .. 3 t
Authorized ^ p _ Notice: This permit application expires if a permit is not obtained within
Signature: --
-411 t Date: Z� 2. 180 days after it has been accepted as complete.
�.r!!►`r.
*Fee methodology set by Tri- County Building Industry Service Board.
f - V� A4.4.Q'�'y
( •
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information _
r,
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00 •
Check Type of Work Involved:
• Audio and Stereo Systems
O Burglar Alarm
• Garage Door Opener
n Heating, Ventilation and Air Conditioning System +� :
El Vacuum Systems
• Other _
•
COMMERCIAL WORK ONLY: ,
Fee for each system $75.00
(SEE OAR 918 - 260 -260) •
Check Type of Work Involved:
0 Audio and Stereo Systems •
•
0 Boiler Controls
0 Clock Systems s
Data Telecommunication Installation •
Fire Alarm Installation
HVAC
n Instrumentation
n Intercom and Paging Systems •
• El Landscape Irrigation Control
r7 Medical
Nurse Calls •
Li Outdoor Landscape Lighting
Protective Signaling
/
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
•
•
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03 •
CITY OF TIGARD
� J
BUILDING DIVISION I PERMIT #: ELC2005 -00117
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/28!2005
Phone: (503) 639 -4171 //titid�,� I
Inspection Requests (24 Hrs.): (503) 639 -4175 ' F'! � ..
INSPECTION WORKSHEET FOR DATE: 8/9 /2006 TIME: 7:04AM PAGE: 63
SITE ADDRESS: 11440 SW PACIFIC HINY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: UNION 76
DESCRIPTION: Sian lighting (2).
OWNER: TIGARD BP SERVICE CO INC, PHONE #:
CONTRACTOR: MEYER SIGN CO OF OREGON PHONE #: 620-8200
Inspection Request Scheduled For: Date: 8!912006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 034603 -01 503-620-8200 * N
Corrections /Comments /Instructio :
....
x PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 14% ( Date: 1 s 6 Phone #: (503) 718- 1,1140
CITY OF TIGARD 1 y
BUILDING DIVISION PERMIT #: ELC2005-00117
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/28/2005 .
Phone: (503) 639 -4171 Ns40,0,0, ii''I
Inspection Requests (24 Hrs.): (503) 639 -4175 - I '- _ ..
INSPECTION WORKSHEET FOR DATE: 6/2/2005 TIME: 7:12AM PAGE: 84
SITE ADDRESS: 11440 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: UNION 76
DESCRIPTION: Sign lighting (2).
OWNER: TIGARD BP SERVICE CO INC, PHONE #:
CONTRACTOR: MEYER SIGN CO OF OREGON PHONE #: 620-8200
Inspection Request Scheduled For: Date: 6/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 008123 -02 503-620-8200 N
Corrections /Comments /Instructions:
n A "°' The electrical installation defects noted
���{ on this report shall be corrected and
\ill As 'D04.? an inspection request made within 20
calendar days per OAR 918- 271 -0030
Sil f cA .• CI AR N btl.g reel
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
X FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: l Date4<Z Phone #: (503) 718-
.