Permit A ; , CITY OF TIGARD ELECTRICAL PERMIT
• PERMIT #: ELC2004 -00616
to SERVICES DATE ISSUED: 9/27/2004
! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 102CC -00500
SITE ADDRESS: 13500 SW PACIFIC HWY
SUBDIVISION: ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: (2) sign lightings.
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: 2
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:
13500 PACIFIC CORP BY CAP ADVISORS HIGHLIGHT SIGN CORP
38345 W TEN MILE RD STE 170 8200 SW HUNZI KER
FARMINGTON HILLS, MI 48335 TIGARD, OR 97223
Phone: Phone: 503 - 620 - 8205
Reg #: LIC 104599
SUP 517SIG
FEES ELE 37- 660CLS
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/27/2004 $106.80
[TAX] 8% State Surcharge 9/27/2004 $8.54 Rough -in
Elect'l Final
Total $115.34
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 • • OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules , r direct ions to OU C at (503)
246 -669• • r 1 -800-33 3
Issue By: __ �•;�.�.i.� Permit Signature: ..3
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
Electri Permit Application FOR OFFICE USE ONLY
CO f Ti and r Received
r .� q
g DateB : / 4 0 W--196 , /.
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 44 ip yy I t- Date/B : Other Permit: S 6 N a 00 C.I _O. ,, 3
Inspection Line: 503.639.4175 IL Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK . , ' . - PL;AN`. REYIEW ...,
construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps - rating ['Bulldog over 10,000 sq. ft.,
. . CATEGORY OF CONSTRUCTION' • ; • . -- 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
Job no.: Job site address: /? �'i) p . N # eS ❑Health -care facility DOther:
Submit 2 sets of plans with any of the above.
e.
City/State/ZIP: or W420 DA The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: c Wpqp G14Mt r, S FEE *.. SCHEDULE
Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: ?e . New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
. DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. ❑ PROPERTY 0 ER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: l SSW Ot I 1 CO Q, Ay CAP VI J) 601 amps to 1,000 amps 240.60 2
Address: 3 45 t �t3 1 L� la.,,, , 17 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: j iam 06 , rn „„ )-1 $ 3 3s Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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
. Q.-APPLICANT I ®•eoNTACT PERSON A. Fee for branch circuits with
( i,/ . /ro/) Cg/O service or feeder fee, each . 6.65 2
Business name: branch circuit
Contact name: t ( : r e*9 B. without for service circuits
es
without service or feeder fee, 46.85 2
Address: �'jo AuJ - Hv .02iW/?��
each d'I branch circuit
`f� Each add'1 branch circuit 6.65 2
City/State/ZIP: 1764 "49 CA t Miscellaneous (service or feeder not Included)
Pump or irrigation circle 53.40 2
Phone: (SO) ax:: )
�� Fax: ( Sign or outline lighting 9.. 53.40 /f)d, ,�t� 2
E -mail: , Signal circuit(s) or limited -
CONTRACTOR ' ji energy panel, alteration, or
extension. Describe: Page 2 2
Business name: G , 6, 11- I-- P6711 al•
e A9 _ C al ii ! l! �4 Each additional inspection over allowable in any of the above
Address: k-6
PP�p �e'' ^� Alf / � / Per inspection 62.50
City/State /ZIP: ��� �//�- t c Investigation per hour (1 hr min) 62.50
Phone: (j ) 4 , ' e ' Pe7 Ai \, ax: (bo)) 6p?.. it - ? 79-,/ Industrial plant per hour 73.75
. ELECTRICAL PERMIT FEES'
CCB Lic.: /OR'}'S - 7/ Electrical Lic.: 510.517 Suprv. Lic.: ;`j-{ i C e iS Subtotal /n /_ . $O
cP
Suprv. Electrician signature, required: .kiehk, Q l - _ /. /� �O V Plan review (25% of permit fee) Q
Print name: nd, � &p � c at 7/ 7 1t, State surcharge (8% of permit fee) Q • 5,/ , � / ��� TOTAL PERMIT FEE �� •
Authorized signature: / 1 e " �� This permit application expires if a permit is not obtaine within 3 180
y
q days after it has been accepted as complete
Print name: 4, /4 Date: ! A97 JQ�
• Fee methodology set by Tri- County Building Industry Service Board
/ • Number of inspections per permit allowed.
i:\ Building \Pcrmits\ELC- PermitApp.doc 12/03 440- 46I5r(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information k
LIMITED ENERGY PERMIT FEES:
;< RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning ,
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: • •
•
Fee for each commercial system $75.00
(SEE OAR 918 - 260 - 260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
•
•
• ❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pemtiu\ELC•PennitApp.doc 04!03