Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00253
44 r4 , 64•1 4, DEVELOPMENT SERVICES DATE ISSUED: 5/16/01
,.� I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 102 C B -02700
SITE ADDRESS: 13050 SW PACIFIC HWY
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: LOT : 020 JURISDICTION: TIG
Project Description: Installation of sign lighting.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS 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:
ANTHONY CAPONE LUMINITE SIGN CRAFT INC.
13050 SW PACIFIC HWY 9033 SW BURNHAM
TIGARD, OR 97223 TIGARD, OR 97223
Phone: Phone: 503 - 639 -4991
Reg #: LIC 116449
ELE 34- 530CLS
SUP 159SIG
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 5/16/01 $53.40 2720010000( Elect'I Final
5PCT CTR 5/16/01 $4.27 2720010000(
Total $57.67
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty Codes and all other applicable lain.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow r adopted • he Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 - 00 ! ro • h OAR 952 - 001 - 0080. You may obta' copies of these ru -s ordirect questions to OUNC at (503)
246 -6699 or 1 332 - 2344. ,
i
Permit Signature: . I �� ���� Iss d By: 4. /4
//it,
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: . —699 4A DATE:
LICENSE NO:
Call 639 - 4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Date received: D - Permit no.a f 473
...4 :)%i: •,/1 City of Tigard Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 ' '0 [ — 6/0 ? Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory l$ommercial/industrial ❑ Multi- family ❑ Ten itt improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 1 - •. d -w "ilk., - Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: 'rrq- (,ZL��Q1 q- I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION —`- ' FEE SCIIEDU.E
Job no: Fee Max
Business name: 10%. 0-6,e, ■.) Newre�dentlal- single ormuion Qty. (ea.) Total no. insp
family per -
Address: 1''O rJO., 3. t 3 (o dwelling mtit. Includes attached garage. •
City: 16 , 4 c Q • I State I ZIPS 1 7 ,g f Service included:
Phone:50%4 N- 0991 I Fax: I E -mail: 1000 sq. ft. or less 4
CCB no.: ii (y(.}ti q I Elec. bus. lic. no: 34 -5o tC'i✓`j Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. no.: Limited ener
gy, non - residential 2
6 .44_ Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect, name (print): License no: Services or feeders
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): ei NTH?, iv 1 OA. Po AD E. 201 amps to 400 amps 2
Mailing address: 1 ZDS(v �w 1�rte t A", M� r y 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: 'l a it e..-1. I State: 02I ZIP: Er 7 99, 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, alteration, 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 am .s 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
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
❑ Service over 320 amps - rating of 1&2 0 Hazardous location Each sign or outline lighting r 5'3,'iO 2
family dwellings ❑ 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
O Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
❑ Egreess/lightingplan ❑ Other Per inspection I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other f
Not all jurisdictions accept credit cards, please call Jurisdiction for more information. Notice: This permit application Permit fee $ 53, 7 D
O Visa ❑ MasterCard expires if a permit is not obtained' Plan review (at _ %) $
Credit card number: i / within 180 days after it has been State surcharge (8 %) .... $ 'V ' 7
Expires accepted as complete. TOTAL $ 51.6)7
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00/COM)
Electrical Permit Fees: Limited Energy 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 I
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 . ❑ Burglar Alarm
Limited Energy $75.00
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
201 amps to 400 amps $106.85 • 2 ❑ Vacuum Systems
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 LI HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy V
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 Other
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 $
Total Balance Due $
i:\dsts\forms\elc- fees.doc 10/09/00
Community Development ELECTRICAL PERMIT APPLICATION
. A
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
, Permit #
i1 .1 Phone (503) 639 -4171 Date Issued
""'` FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175 SC 1J .2-00/ - UO o? 6,
1. Job Address: 4. Complete Fee Schedule Below:
Name of Detelgpment Number of Inspections per permit allowed
Address /O %.i.n hg...( D1'U/v ' Service included: Items Cost(ea) Sum
City /State/Zip `16 O ar) - . ► LJ 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
Name (or name of business)-PMWeeiA Each additional 500 sq. ft. or
portion thereof $25.00 1
-
Commercial Residential El Limited Energy $25.00
Each Manuf d Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
l �y Installation, alteration, or relocation 2
Electrica Contractor �,t(, r tii It Ill. i 9 M L�IW (, 200 amps or less $60.00 2
-
Address T b /Sal a S 1031(0 201 amps to 400 amps
p $80.00 2
401 amps to 600 amps $120.00 2 -
Cityl� tJ State ) Zip 9 1,5Z (6) 601 amps to 1000 amps $180.00 2
Phone Klo. r ,S'B 3 (g `4 Ai' g q i Over 1000 amps or ions $340.00 2
-
Contractor's License No. .9U - >; 3 tcL'5 Reconnect only $50.00 -
Contractor's Board Reg. No. /IL. Ny9' 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n ettriA/ 2 00 amps or less $50.00 2 - $75.00 2 - License No t' q SAN PhNo. !D 3 9' 'y#79* l 201 amps to 400 amps
401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installations: see 'b' above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00 2
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2 - Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00 -
Per hour $55.00
-
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services.
5. Fees:
NOTICE 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. ❑ Trust Account # $
Balance Due $
w.p....d.A.6.-prm.app 1