Permit CITY OF TIGARD
ELECTRICAL PERMIT
Iz COMMUNITY DEVELOPMENT • Permit #: ELC2009 -00519
TIGARD 13125 SW.Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/06/2009
Parcel: 1 S135DD03301
Jurisdiction: Tigard
Site address: 11945 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Joann •
Project Description: Install (1) sign outline lighting.
Owner: FEES
TIGARD PLAZA LLC Quantity Description Date Amount
8320 NW HWY 99
VANCOUVER, WA 98665 1 ea Sign or Outline Lighting 10/06/2009 $67.84
PHONE: 1 ea 12% State Surcharge - 10/06/2009 $8.14
Electrical
Contractor:
QUICKSILVER NEON AND SIGNS LLC
2325 NW 154TH PL.
BEAVERTON, OR 97006
PHONE: 503 - 626 -7020
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
•
Total $75.98
Required Items and Reports (Conditions)
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 ork is suspended for more the 180 •
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification , ter hose rule : set forth in OAR '
952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.24 • r : 61 .332. •
Issued By: C Q.akI'\ AO I LA3 Permittee Signature:
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' Date:
LICENSE NO.
Call 603.639.4175 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.
N
� , 'Electrical Permit Application
Q
City of Tigard Received
Date/By: Date/By: Permit No.: C (� q I Z q
111, • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: C.J Other Permit:
- Ft G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: I la See Page 2 for
Internet: www.tigard - or.gov Notified/Method: / Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ID Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
0 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ lodallation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
• ❑ Addition of new motor load of ❑ °A ^, °E ^, °I -2 ^, "1 -3 ",
Job no.: Job site address: lA 9A PAZ/ C W!ed 'j • loot - tP or more. cccupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: - 774 21 `yam D fz,e7,.a,t/ 9--/ 7-2-3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name:p -71.N/,t/ ,543/21 GS ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
I Qtr. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: •
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
t, Limited energy, multi- family
v /S� S ff D- �4•tri✓ .Sign/ 2�� -10 vE 000t/
residential (with above sq. ft.) 67.84 2
jb
/^/S :dam // .0 ,� GS X.460 4 -rb4�s // c./4 Al • . Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I TENANT ,�j 401 amps to 600 amps 201 amps to 400 amps 133.56 2
Name: 77474/2-4) 7,.,2,4 LLB 601 sT �,t�C+� "' Y ' / 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000
amps or volts 552.26 2
City/State/ZIP: • Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) • I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or ex tension, r panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: . Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting / 67.84 2
Business name: Qv/ G,(G.s /L I/C7G i1/G�.t✓ An/0 Si4nr1 Signal panel, or limited -
energy panel, alteration, or
Address: 2 3ZS' it/kJ /S / ".b:3CE extension. Describe: Page 2 2
City/State/ZIP: .'Sp✓ 2. 7V4/ e.)/L74p t/ 9700 4. Each additional inspection over allowable in any of the above
Phone: (S-03) �,! - 70 2-0 O Fax: 7 Per inspection 66.25
L
(Sill dz� - � Investigation per hour (I hr min) 66.25
CCB Lic.: 4r 2r4 I Electrical Lie.:CLS I Suprv. Lie.: 724 S I cr Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: St..1-c(? Subtotal: (..,„7. p 7. °-
_
Print name: 81"44 /J 0 4.J 3� 4:31_. Date: P-5-71 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 8. 14 -
Authorized signature: TOTAL PERMIT FEE: 7S . l g
Print name: 2)41(//) ,4 k4 0 Date: / G / � s� �f permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
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