Permit CITY OF TI GA R D ELECTRICAL PERMIT
PERMIT #: ELC2004 -00805
DEVELOPMENT SERVICES DATE ISSUED: 12/16/2004
2
' II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135DD-00600
SITE ADDRESS: 11831 SW PACIFIC HWY
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING. C -G
BLOCK: LOT : 040 JURISDICTION: TIG
Project Description: Sign 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:
YOUNG'S FUNERAL HOME INC MARTIN BROS SIGN INC
11831 SW PACIFIC HWY 3165 COMMERCIAL ST SE
TIGARD, OR 97223 SALEM, OR 97302
Phone: Phone: 364 - 2211
Reg #: LIC 64761
SUP 399SIG
FEES ELE 24 -23CLS
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/16/200' $53.40
[TAX] 8% State Surcharge 12/16/200' $4.27 Rough -in
Elect'l Final
Total $57.67
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: d ,,( 4' % Permit Signature. 4 1f k 464A,--
--)
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
r
SC iv wog - O O 3$ 6
Electrical Pern lication FOR OFFICE USI ONLY
' ii-'y of Tigard E Date /B : .4,. / �` 4 Permit No _ AO - , Ji� �i;
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503 9 960 � i(1 Date/B : Other Permit:
Inspection Line: 503.639.4175 IDLC 16 2004 _„_ Nv '• Date Ready/By: UM ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
CITY «34 egeltICiviVIRD PLAN REVIEW
[a'New construction BumolN it t itimr cement Please check all that apply:
['Service over 225 amps, comm'l ❑Hazardous location
12 Demolition Other: 5 (��
❑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- and 2 - family dwelling _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
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Q C , ❑Health -care facility ❑Other:
Job no.: Job site address: (. 3 .7�1� C (, Submit 2 sets of plans with any of the above.
City/State /ZIP: "r, _ IN I d 9' o ,3 The above are not applicable to temporary construction service.
, I,n T Y FEE* SCHEDULE
Suite/bldg./apt. no.: Project name: Y "T WIG Description I Qty. I Fee. I Total I '*
Cross street/directions to job site: S - W - , „,,. �.� . New residential single- or multi - family dwelling unit.
lJU Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: t L Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
`I't0 4, �/' TY'eiLT S ' �' Tt d Limited energy, residential 75.00 2
Tax map /parcel no.: S ba - 74 '] & 4 Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
n h'l I - dwelling, service and/or feeder 90.90 2
9
'. 5- ...LL ruA-.7) LAM St cr, Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
E PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: p )�
1 A won i w_hC 601 amps to 1,000 amps . 240.60 2
Address: 3 1 1 £ 1 `' 5.� I is Over 1,000 amps or volts 454.65 2
1 l _ Reconnect only 66.85 2
City/State /ZIP: C In e , 1 , r1 ,4 ;' ■ft Li Sao Z Temporary services or feeders installation, alteration, and /or
relocation
Phone: 3) 3 i a I Fax ( ) 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
13 I a CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: i/y>i _ 4j ft _ , � ` 0 14.c..... branch circuit
if B. Fee for branch circuits
Contact name : \ . * • 1�4 4 t.i...�5 without service or feeder fee, 46.85 2
Address: `�i each branch circuit
Each add'I branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
C _ Pump or irrigation circle 53.40 2
Phone: (s5,3) 364 .. as II I Fax: : (583 ) 3 6 q - 7/3loS Sign or outline lighting 1 53.40 G.3, 4 2
E -mail: �1 pa, i s c ms 6-4- v E,1b -,S j q r ., GO I. Signal circuit(s) or limited -
CONTRACTOR • energy panel, alteration, or
1 / extension. Describe: Page 2 2
Business name: ` Ina) - -.. DIMS. �kLC�
Address: 3 t , � - S Each additional inspection over allowable in any of the above
l 4, Per inspection 62.50
City/State /ZIP:SaJ Q ,N}1 t 9 73 6 Z Investigation per hour (I hr min) 62.50
4/ _ .(�
Phone: (� 36 e . f Fax: ( 3) I r�1.S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
•
CCB Lic.: by7(/ Electrical Lic.' C./.S Suprv. Lic.: _54_ Subtotal 63 * SPo
Suprv. Electrician signature, required: I _ c ° Plan review (25% of permit fee)
Print name ve ��(.L vL[aS Date: /a/i �L /� c d State surcharge (8% of permit fee) ,
T/ 7 TOTAL PERMIT FEE 3-9 6,7
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\Building\Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
CITY OF TIGARD ' . ,.
BUILDING DIVISION 1 PERMIT #: C de) 00 8
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 A l l
Inspection Requests (24 Hrs.): (503) 639 -4175 _..�..� `__..
INSPECTION WORKSHEET FOR DATE: 3 - 1/ TIME: PAGE:
SITE ADDRESS: / I Ej 3I P CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: Re 1,A c k•k_O- ct1;40 A(4 S1 4
OWNER: / / - �j� PHONE #: 2,6,(1 —2, Z
CONTRACTOR: Q , ' S
Jr� I , /- PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
0
Correc otionslComments /Instructions:
' c (.__
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
,E1
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 9� Date:- -• 3 - 6 Phone #: (503) 718 - >�