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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00595 t* � DEVELOPMENT SERVICES DATE ISSUED: 9/17/2004 -IIII 13125 SW H II B vd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 1S136AD-04000 SITE ADDRESS: , W PACIFIC HWY SUBDIVISION: VILLA RIDGE ZONING: C -G BLOCK: LOT : 007' JURISDICTION: TIG Project Description: Hook up for (1) signs to existing service. 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: SMITH, EDITA M SIGN CRAFT LLC 833 NW 170TH DR 9033 SW BURNHAM BEAVERTON, OR 97006 TIGARD, OR 97223 Phone: Phone: 503 - 639 -4910 Reg #: LIC 155420 ELE 34- 674CLS FEES Description Date Amount Required Inspections [ELPRMT] ELC Permit 9/17/2004 $53.40 [TAX] 8% State Surcharge 9/17/2004 $4 Rough - Elect'I Final Total $57.67 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1 -800- 332 -2344. Issued By( Li, Permit Signature: € ., \ p OWNER INSTALLATION ONLY 1 ` The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day ko - 0 2 Electrical Permit Application FOR OFFICE USE ONLY Ci and KCEIVED D` t Y `i' , 4 ,/ o v ( 3 Permit No.:�LC .0q -Oe) 13125 SW Hall Blvd., Tigard, O Plan Revie Phone: 503.639.4171 Fax: 503.598.1960 44 i :-,;•fa Date/By: Other Permit: Inspection Line: 503.639.4175 SEP 1 6 2004 - !,L crl I I Date Ready/By: Turfs: ei See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: I � f'' Supplemental Information ' - w , 'Y t e��r � 4 g ; a • a '.e M ^, r •'. raS +i •nr -esg •Y �$ , t• p,J A :ile1 a . t ?rxn�'0'• r 7 ,* ;t 6 .�F a'k II •`F ; ,'- pti, , i . l tc" ' = "F m �T1� hs x S.. E �1 . _ - tat iv-g -ir : .1 • _•�.. s n. k � }, y • ,-". - i 4a. .. . . ; !l New construction y ` • i • 14 o t • teratio. replacement Please check all that apply: ❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location ': , � -, ,,�, •. ,� , ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., sw; �' isx v =;� '.....,.....n. ,E OR (�) T :.. : .a_V of 1- and 2- family dwellings 4 or more new residential .4-'' �it;��;�i�= ��st +�;''. - ��i• � C4o.-.._,-:‘,>-. _ a - r.^&.��.,�.r �-.... ` ... �'` �. = ,--ii � El 1 - and 2- family dwelling Dil, Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi- family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more x ,. ,, _ .r N { ,� ['Occupant load over 99 persons ['Manufactured structures or w �> , i i Ir • 7 0 is 16 © r © ❑ Egress/lighting plan RV park `� ❑Health -care facility ['Other: no.: / S'34- Job site address: Submit 2 sets of plans with any of the above. City/State/ZIP: f 6 - 4 J _ q 2 1 23 A �I��' ///�k , The above are not applicable to temporary construction service. Suite/bldg./apt no.: Project name: 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: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 . 1 Limited energy, residential 75.00 2 Tax map/parcel no.: Limited energy, non - residential 75.00 • 2 fili..il.'� K ^F i y'i?!F � `� _Di fr' ' it M�``(j ��0 � 1p ' t � � . , - �r •.. . ``QQ -. � �' . .;,',1 f t _ t�;� • Each manufactured or modular lV- V r 1 a S s' (STINGS . dwelling, service and/or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation L --vl 200 amps or less 80.30 2 ;;. s ° '*: u; a... k .-- i,,E •x. .. "',1: i=' `:. " �'� 201 amps to 400 amps 106.85 2 a ...d* n x r t . fi `t 1= 4., F, _ , ` - ^�i,:': --� Name: b I Y� sr( ‘ 601 amps to 1, 0 0 amps 140.60 2 601 amps to 1,000 amps 240.60 2 Address: b"2.1 GL ' V i W � e I b Over 1,000 amps or volts 454.65 2 Y ` ' Reconnect only 66.85 2 City / State/ZIP: 14/274\44b eaL. Temporary services or feeders installation, alteration, and/or Phone: (619 Z 3 2 t - i ) I Fax ( ) relocation 2000 0 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 441$'101-70, i p /' tx�:� s ', ,)' ;.�w : -`. A. Fee for branch circuits with -•� z ._ K -.. , �- a •i x�.x . �'; service or feeder fee, each Business name: Coo Uic, branch circuit 6.65 2 Contact name: J 1 - " \ �i� /� 0 t ' B. Fee for service feeder circuits without service or feeder fee, 46.85 2 Address: ° `I) 7 Sc..) 1NW2M 7,lv ` _ - each branch circuit Each add'1 branch circuit 6.65 2 City/State/ZIP: TT O. 0,-- 2.2. Miscellaneous (service or feeder not included) I_ � v(,�0� ` Fax :: M Q -1 Pump or irrigation circle 53.40 _ . , 2 Phone: (07 v 3 ` O I (.Y/ `4 -1 Sign or outline lighting •53.40 1; ,' 2 E -mail: lj1& -n,) ,' Q. PC 2- CO r" Signal circuit(s) or limited - • •- :uu �•Y'•w1 .. a `�Lt3 Slu - .•= *. b�ay,,�.� �,�,,�� ; 0 z .�R'm R e"- `st. y , i ' 4.. ;g; °� energy panel, alteration, or Business name: 4 . Z .* ► Pile 11 '' extension. Describe: Page 2 2 Address: - (PA I J v.(2. / HAA" Each additional inspection over allowable in any of the above Per inspection 62.50 City/ State/ZIP: 6Q-- 4722 Investigation per hour (1 hr min) 62.50 Phone: ( ) (f -1(.0t. i 0 I Fax: ( ) W7 J `'C$ 5 Q, Industrial plant per hour 73.75 CCB Lic.: Jittrao I Electrical Lic. -.Wig .0.51 Suprv. Lic.:15 Subtotal t (. • Suprv. Electrician signature, required: Plan review (25% of permit fee) • • Print name: :m t b 4 Lu 1� . 0 /0 I Date: 4 n!b if State surcharge (8% of permit fee) i t TOTAL PERMIT FEE Authorized si afro ! `� '" ' �� i /, This permit application expires if a permit is not obtained 'within 180 t�� days after It has been accepted as complete Print name: p p 4 r Date: 9 " • Fee methodology set by Tri -County Building Industry Service Board •• Number of inspections per permit allowed. 1: NBuilding \PennitABLC•Pemritgpp.doc 12/03 440.4615r(10/02/COM/WBB - Electrical Permit Application - City of Tigard , , Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 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: w Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) 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 i :\Hmlding\Pamits\ffi.GPumitApp.doc 04/03