Permit CITY O F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002-00510 DEVELOPMENT SERVICES DATE ISSUED: 9/30/02
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S136CA -01601
SITE ADDRESS: 11665 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Sign lighting connection.
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 HMI 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:
KEY BANK HIGHLIGHT SIGN CORP
11695 SW PACIFIC HWY 8200 SW HUNZIKER
TIGARD, OR 97223 TIGARD, OR 97223
Phone: not available Phone: 503 - 620 -8205
Reg #: ELE 26- 888CLS
FEES Required Inspections
Description Date Amount Elect'I Final
[ELPRMT] ELC Permit 9/27/02 $53.40
[ELPRMT] ELC Permit 9/30/02 $0.00
[TAX] 8% State Tax 9/27/02 $4.27
(additional fees not listed here)
Total $57.67
' This Permit is issued subject to the regulations contained in the Tigard Munidpal 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: r` Permit Signature �L l,/.. _ , , ,
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: s / 7
Call 639 -4175 by 7:00pm for an inspection the next business day
A t -- - QU/ 7/ _ --PO v_?
-� - Ele Permit Applicat
Date receiv —j0 Permit no.:+
ti��I ) a .6e .4
_, .l l! City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: Bb9* I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
❑ 1 & 2 family dwelling or accessory Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: /LPL '• — - -_
Std. Me."Iflri Ift,uy, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: (Subdivision:
Project name: eat/ Moor I Description and location of work on premises: .
Estimated date of completion/inspection: NO V'
CONTRACTOR APPLICATION FEE SCII
Job no: Fee Max
Business name: �.}��� / (p�(J Q�q� Description Qty. (ea.) Total no.insp
New residential - angle or multi - family per
Address: I: ,1 > t tj , MA Z/ /,C dwelling mit. Includes attached garage.
City: 7)/A, cc, I State: OIL, ZIP: g vie,g • Service included:
Phone: 41 B ?oS I Fax: ( J7S i'I E -mail: yt. s f % r PI e4a4 1000 sq. ft. or less 4
CCB no.: �q / I Elec. bus. lic. no:. 01 S 1-� Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. no.: 3'74 f Limited energ IHNiriZPC y, 2
f oa Each manufactured home or modular dwelling
Signature of supeivis clan (required) date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders— installation,
PROPERTY OWNLR alteration or relocation:
200 amps or less 2
Name (print): kff4.4 0A.Nt<c , 201 amps to 400 amps 2
g /(L 4 r /O/IC.11 I C /4(.LJ
401 amps to 600 amps 2
Mailing a ddr ess: f w. u
—(' 2
601 amps to 1000 amps
City: `h Yjp''�» State: mnr I ZIP: Q 7 pa 3 Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alterat[on,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel: \
Name: A. Fee for branch circuits with purchase of \ `'l
Address: service or feeder fee, each branch circuit
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 0 Hazardous location Each sign or outline lighting 1 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other. Per inspection
Submit sets of plans with any of the above. Investigation fee •
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. • Notice: This permit application Permit fee $
❑ Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $ •
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4
Check Type of Work Involved:
Residential - per unit
. 1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1
Limited Energy $75.00 ❑ Burglar Alarm
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 El Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits •
New, alteration or extension per panel ❑ Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑
(Service or feeder not included) Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting i $53.40 6'3_..-/U ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ I I Othe
8% State Surcharge $
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $ ( . (
Enter total of above fees $
❑ Trust Account #
8% State Surcharge $
All New Commercial Buildings require 2 sets of plans.
Total Balance Due $
i :\dsts\forms \elc- fees.doc 08/30/01
CITY OF TIGARD 24 -Hour
BUILDINL•.r y Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
7 Received Date Requested _ S / AM PM BUP
Location I I t0 (Q Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) 6 aD 8a 05 SWR
BUILDING Tenant/Owner K Lioj ELC
Footing ELC 47 v 5/ D
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
& Beam s•(r A) a - o0 / 7/
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 1
Drywall Nailing 1 �
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final j�
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
CI (EL-EC-MICA
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
trial 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Vilibb "ART FAIL
❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 2 Inspector,% Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL