Permit •
1)• .1 CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00550
i� DEVELOPMENT H P Tigard, ) 639 -4171 DATE ISSUED: 09/10/1999
PARCEL: 1S136CD-00100
SITE ADDRESS: 11705 SW PACIFIC HWY K
SUBDIVISION: ZONING: C -
BLOCK: LOT : JURISDICTION: TIG
Project Description: ADD SIGN OR OUTLINE LIGHTING
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:
PACIFIC CROSSROADS PROPERTIES, MEYER SIGN CO OF OREGON
BY WYSE INVESTMENT SERVICES CO 7340 SW LANDMARK LN
200 SW MARKET ST STE 345 TIGARD, OR 97223
PORTLAND, OR 97201
Phone: Phone: 620 - 8200
Reg #: LIC 00064014
SUP 569SIG
ELE 20 -190CL
FEES Required Inspections
Type By Date - Amount Receipt Wall Cover
PRMT GEO 09/10/199,c $60.00 99- 318101 Elect'l Final
5PCT GEO 09/10/199, $4.20 99- 318101
Total $64.20 ORIGINAL
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. /
PERMITTEE'S SIGNATURE ISSUED BY:
OWNER INSTALLATION ONL(
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: /1/i4 DATE: 9 /O - ff
LICENSE NO:
•
• Call 639 -4175 by 7:00pm for an inspection the next business day
1 T1 1 OF TIGARD Electrical Permit Application Plan Cher'
13125 SW HALL BLVD. • Reed B . -7I •
TIGARD OR 97223 Date Recd 9
Date to P.E.
Phone (503) 639 -4171, x 304 Date to DST
Print or Type
Inspection (503) 639 -4175 Permit # oe-e /w- o4, --
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) c t'rt F t r•1 A J CtAL Service included: Items Cost Sum
Address t 70 5 `VW PA C t Ft C NW I rt �A P t>, OR 4a. Residential - per unit -
K 1000 sq. ft. or City /State /Zip / e A r� to . O Fz E . I Each add tiona 500 sq. ft. or $110.00 4
Commercial j1 Residential 1=1 Limited thereof $25.00 1
Limited Energy $25.00
-
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor M 1= y ER St 4 1.4 co • a f ORE r, Installation, alteration, or relocation
Address 7-34 Sig/ I_ .a- N c) rv(A (.K LI . 200 amps or les $60.00
2
201 amps to 400 amps $80.00 2
City T t 4A i -i, State o Pt- t.. Zip ° 1 7 �- �3 401 amps to 600 amps $120.00 2
Phone No. • 6 2 0 - P co 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 20 - r9 -s Exp.Date
OR State CCB Reg. No. fv 4 0/ 4 - Exp.Date I- .3 0 °O1 4c. Temporary Services or Feeders
COT Business Tax or Metro No. I S99 Exp.Date 10 -I -99 Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n 7 e 201 amps to 400 amps $75.00 2
( ��J► 401 amps to 600 amps 2
Over 600 amps to 1000 volts,
License No. 56 c l r q Exp.Date V see °b" above.
Phone No. 620
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 ‘,Q,0 2
Each sign or outline lighting I --� a' ' °" 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: / D d0
Not required for temporary construction services. 5a. Enter tai of above fees $ �p
7 o Surcharge (.05 X total fees) $ 4" ��
NOTICE / ubtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY 6 /
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # [
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96