Permit -CITY OF TIGARD ELECTRICAL PERMIT
4i k PERMIT #: ELC2004 -00458
1� DEVELOPMENT SERVICES DATE ISSUED: 7/23/2004
„� li 13125 SW Hall Blvd., Tioard, OR 97223 (503) 639 -4171
PARCEL: 1S136AD-04000
SITE ADDRESS: 11507 SW PACIFIC HWY C
SUBDIVISION: VILLA RIDGE ZONING: C -G
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: Sign: Outdoor electrical cabinet 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:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: 2
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:
CIRCLE A W PRODUCTS COMPANY BIGFOOT SIGNS LLC
ATTN: PHIL PINGSTERHAUS 2413 LITTLE KALAMA RIVER RD.
BY B-LINE SYSTEMS, INC WOODLAND, WA 98674
HIGHLAND, IL 62249
Phone: Phone: 360 - 255 - 9011
Reg #: ELE 37- 990CLS
LIC 155744
FEES SUP 569SIG
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/23/2004 $106.80
[TAX] 8% State Surcharge 7/23/2004 $8.54
Total $115.34
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all othe : , •licable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuan.-, • if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility N • lc- '•n Center. Those
rules a re set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of - - - rules or direct • on , o OUNC at (503)
246 -6699 or 1 -800- 332 -23
Issued By: Permit Signature:
OWNER INSTALLATION ON
The installation is being made on property I own which is not intended for sal : 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
Electrictt►Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit No.!��' .. /
7 O �
Date/By:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 // �ec'dr 0' + Date/By: Other Permit:
Inspection Line: 503.639.4175 4.11 .„ Date Ready/By: Jura: See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
, ,. - TYPE OF WORK - • - . .. - '..,., ;.::PLAN REVIEW, '
® New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition Other: 3 � f/J ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION ' : - - of 1 - and 2- family dwellings 4 or more new residential
1 - an d 2 dwelling g ❑ Commercial/industrial 0 Accessory building ❑System over 600 volts nominal units in one structure
ID Multi - family ❑ Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION gh ' g plan RV ark
❑Egress/li tin lan P
Job no.: Job site address: 11.507 5c01 Fite u rItaI + D B ❑Health care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/ State/ZIP: tSAt.d ed.. . .97a 2 3 The above are not applicable to temporary construction service.
. FEES SCHEDULE : ' •
Suite/bldg./apt. no.: Project name:
P r a RCsa,,«<. C`• kr Description I Qty. I Fee. I Total I "
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
�,,{�// DESCRIPTION OF WORK Each manufactured or modular
• 0 e(ttta 1 �b tt I� dwelling, service and /or feeder 90.90 2
OV74
�. ��+GT �/43/l Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER g TENANT . - 201 amps to 400 amps 106.85 2
L 401 amps to 600 amps 160.60 2
Name: L1 AC.C1iL c iAc-c et) 601 amps to 1,000 amps 240.60 2
Address: /1 t 3'C l Sr` P4 a PV a D • Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Ti$At-C$ 02 7 ,2a3 Temporary services or feeders installation, alteration, and/or
C/
( ) r 1/ '` Fax: ( ) relocation
Phone: �� a 8 7 77 200 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
• ❑ APPLICANT I g] CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Y 67e....,4144,1 - lJ / 5i srd S branch circuit
Contact name: T / a � B. Fee for branch circuits
V Zf►ri►GS WA ger without service or feeder fee, 46.85 2
11 each branch circuit
Address:
sot Sa J.1 t4' keb 1...T L)12 Each add'l branch circuit 6.65 2
City/State/ZIP: 5k „rd Og 7/4s Miscellaneous (service or feeder not included)
Phone: ( J3) 770— sy j v Fax:: (9 3) ( S 6g2S Pump or irrigation circle 53.40 2
. Sign or outline lighting a , 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
IB45or S/ eJ s G. 4 c, n
Address: o? 13 Lti�7/G 1<A 4 IZt ter 12,1 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: (/vjn,d login ci ( g`7iL. Investigation per hour (1 hr min) 62.50
Phone: (34o) ohs 1 Fax: ( 340 ) ga S 41 RS' Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: j5" 7 EN Electrical Lic.: 37. Q Suprv. Lic.: (o0 Subtotal / a'
Suprv. Electrician signature, required: b Plan review (25% of permit fee) `
Print name: / /YY1 f „ q �� Date: - �a31j�J State surcharge (8% of permit fee)
1 c� " TOTAL PERMIT FEE •"
�
�
Authorized signature.
Y. ' , 1 This permit application expires if a permit is not obtained within 180
/
(
Print name ! , � t
Ct Date: 7 / 293 / 6r • Fee methodology days set after by it Tn - County been Building accepted as Industry Servic/Bla
:
•• Number of inspections per permit allowed.
i:i Building \Pcrmits\ELC- PermitApp.doc 12/03 440.4615[(10 /02/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*
El Burglar Alarm
•
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System* °
❑ Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY: • I • .
Fee for each commercial system $75.00
(SEE OAR 918 - 260 - 260)
Check Type of Work Involved:
•
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation 4 .,, . ,
❑ Intercom and Paging Systems
•
,
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
Y 11 't •
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\ Building\Pemtiu\ELC- PrnnitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: " (503) 639 -4171
BUP
Received II Date Requested 7 AM PM BUP
Location f / 57 7 P Suite MEC
Contact Person Ph ( 3606 G 00 - 5 PLM
Contractor Ph ( ) SWR `
BUILDING Tenant/Owner ELC 0 (7 -00 its -8i
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors w
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall 197 r�.11 PA7�
Fire Sprinkler i '���� —
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
Low olt /�
Low Voltage
Fire Alarm
41,1517.1- Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
11110 PART FAIL
❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line 41.- ADA --- 3 D - l 6 kV Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL