Permit 7 CITY OF TIGARD y ELECTRICAL PERMIT
PERMIT #: ELC2003 -00525
u I� DEVELOPMENT SERVICES DATE ISSUED: •8/21/03
J II 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136AD-04000
SITE ADDRESS: 11505 SW PACIFIC HWY B
SUBDIVISION: VILLA RIDGE ZONING. C -G
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: Wall sign
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 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:
RAMSAY SIGNS
9160 SE 74TH AVE
PORTLAND, OR 97206
Phone: Phone: 777 - 4555
Reg #: LIC 63422
ELE 26- 106CLS
FEES SUP 493S1G
Description Date Amount
Required Inspections
[TAX] 8% State Tax 8/21/03 $4.27
[ELPRMT] ELC Permit 8/21/03 $53.40 Elect'I Final
Total $57.67
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 questions to OUNC at (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By: Permit Signature: --G
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 639 -4175 by 7:00pm for an inspection the next business day
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Electrical Permit Application FOR OFFICE USE ONLY
Received Electrical
l ate/By: gra 1 ( Permit No.:E- 'C,.203 - er) CRS -
City f Ti and Planning Approval Sign
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
M aim diy I t Date/By: Case No.:
Internet: www.ci.tigard.or.us ,..' I I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -417.5 Name/Method: Supplemental Information.
/ J . 7 - 1 ) 0 3 - 00
TYPE OF WORK PLAN REVIEW (Please check all that apply)
I New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
— ❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
p Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB 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: j i ' j 0 - tS St AJ Pate L-�t C_ 01)3 t _ j FEE* SCHEDULE
Suite #: Bldg. /Apt. #: f Number of inspections per permit allowed
Project Name: C o,n OL.c1C&�t i C � S.p r t 11 e e e Qty Fee (ea.) Total 1
Cross Street/l�l ChOriS to Ob site' New residential - single or multi- family per
J ��r dwelling unit. Includes attached garage.
S ( peAel ,� Q (Zn Sl. i Alf& Service Included:
C1." SU-) (.128.m` payKW ' 1000 sq. ft. or less 145.15 4
{' Each additional 500 sq. ft. or portion thereof 33.40 1
Lot #: Limited energy, residential 75.00 2
Subdivision: Limited energy, non residential 75.00 2
Tax map /parcel #: • Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
ELL ry LOCLOA S 19n
Services or feeders - installation,
Z'f1S� C
� 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
❑ PROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City/State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
[� APPLICANT ® CONTACT PERSON Branch n to h circuits amps 133.75 2
Branch circuits -new, alteration, or
Name: "'ant e c-_*:)t_rt,.on extension per panel:
A. Fee for branch circuits with purchase of
Address: 9 i to o SC. - 7 Lit `` P e._ service or feeder fee, each branch circuit 6.65 2
City/State /Zip: Pot 1 . OR. 9 7a o10 B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: i a - 7 7 7 - (I S 1 Fax: SO 3- 7 - n - tea O Each additional branch circuit 6.65 2
E -mail: S . ,ri Q €X IZ• e,ufrts.cuf $1 8r/5 , C Om Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
CONTRACTOR Each sign or outline lighting ( _ 53.40 5 , C/O 2
Job No: - Signal circuit(s) or a limited energy panel,
Business Name: Q � i Description:
tion:
or extension _Pie 2 2
Name: f 14LUYl5Lt_ `r 97 Description
Address : 91 S E 7 ere
Each additional inspection over the allowable in an of the above:
City/State /Zip: ?ca. O . q7aoLp Per inspection per hour (min. 1 hour) 62.50
Phone:5013 7'17- 1 -15SN - Fax:553' MM7 -Oa a Investigation fee:
a Lie. # 1:0- b10 L' LS other:
CCB LiC. #: (p 3zf a 0 Electrical Permit Fees*
Supervising electrici Subtotal $ 5 3 .L/ 0
signature required: Plan Review (25% of Permit Fee) $
Print Name: Chri S . he_ o Lic. #: 5 5 1'G- State Surcharge (8% of Permit Fee) $ 4 -I, a 7
TOTAL PERMIT FEE $ 5 7, 1,7
Authorized f� Q (6?,,E � + Notice: This permit application expires if a permit is not obtained within
Signature: l� e Date: O l 03 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
- ?::orulce._ A .'i c to n
(Please print name)
i:\Dsts\Permit Fotms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard 1
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
0 Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
ID Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
0 Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
0 Instrumentation
❑ Intercom and Paging Systems
Landscape Irrigation Control
Medical
EI Nurse Calls
Outdoor Landscape Lighting
Protective Signaling •
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Fomu\ElcPermitAppPg2.doc 01/03