Permit CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00593
COMMUNITY DEVELOPMENT DATE ISSUED: 10/20/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 102 B D -01700
SITE ADDRESS: 12860 SW PACIFIC HWY • ZONING: C -G
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SUBDIVISION: FREWINGS ORCHARD TRACTS LOT : A - JURISDICTION: TIG
PROJECT: JIFFY LUBE
Project Description: Sign lighting for new 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: SIGNAUPANEL:
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:
DAVIDSON, WILLIAM G + DIXIE L SECURITY SIGNS INC
8915 SW COMMERCIAL 2424 SE HOLGATE BLVD
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Contact #: PRI 503 546 - 7114
FAX 503 - 230 -1861
FEES
Description Date Amount Reg #: ELE 26- 560CLS
[ELPRMT] ELC Permit 10/20/2001 $53.40 LIC 122809
[TAX] 12% State Surchar 10/20/2001 $6.41 SUP 383 SIG
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
Issued d ordance 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 0 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 01 -0010 through o • . • •2 -.01 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
��� � Permi ttee Signature: Ai m �i / i
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.
X'oN,Pcio, - •
' Electrical Permit Application FOR OFFI(I: t tin: o 1.1
City of Tigard � / dg Permit No.: E,C A vI - y3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 , i Date/13 . Other Permit:
Inspection In
sP Line: 503.639.4175 - n , ' � � � Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method FRI Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ pear; ❑Service over 225 amps, comm'l ❑Hazardous location
OService 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 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park _
Job no.: Job site address: 1 '� . IC S ❑Health care facility ❑der:
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l� l c Omit 2 sets of plans with any of the above.
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City /State/ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: I Project name: .1S<(y P , FEE* SCHEDULE "� W Description I Qty. I Fee I Talal ..
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 1 4
Subdivision: Lot no.: Ea. add') 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
DESCRIPTION OF WORK Each manufactured or modular
V( , � _ ` �,^ dwelling, service and/or feeder 90.90 2
{) Services or feeders installation, alteration, and/or relocation
t l 1 ` 200 amps or less I 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 I
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 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: 02 4, branch circuit
B. Fee for branch circuits
cn� �
Contact name: � �� f without service or feeder fee, 46.85 2
Address: • 1 each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
� Pump or irrigation circle 53.40 2
Phone: ( ` G ' ' ! P I i 1 I Fax: : ( 76") 1 ' Sign or outline lighting NA 53.40 153. t{8 2
E - mail: t t Ip�CkSc�� g l `7 s 2> t .0 0 f) 9C(Sca Signal circuit(s) or limited-
CONTRACTORI energy panel, alteration, or
extension. Describe: Page 2 2
Business name: '' (.,) , . (
Address: 2424 �" 1
\ Each additional inspection over allowable In any of the above
1 � Per inspection 62.50
'City/State/ZIP ... lic a a 4., 1110iP • + _ Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: ( ' Fax: , i (� • — ` ► r • '
'!� _ ELECTRICAL PERMIT FEES* .
CCB Lic.: IZZI CI Electrical Lic.: acroG i j j Suprv. Lici )(� Subtotal `j ? ) . c/p
Suprv. Electrician signature, required: 0 Plan review (25% ofRermit fee) —'
7 Print name: l C � ' 1 I Date: � O State surcharg permit fee) . ` 1 / /
TOTAL PERMIT FEE g
Authorized si ature:
This permit application expires it a permit is not obtained within 180
`1 days after it has beet accepted as complete
T }C
Print name: t op, r) Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
1:\ Building \Pennits\ELC- PermitApp.doc 12/03 440.4615T(10/02/COM/WEB
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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*
❑ Burglar Alarm
/ ❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system. $75.00
(SEE OAR 918- 260 -260)
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Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El 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\Permil ELC_PetmitApp.doe 04/03