Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00388
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/29/2009
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 90
Subdivision: Lot: 0
Project: Island Tanning
Project Description: Install (2) sign lighting.
Owner: FEES
13500 PACIFIC CORP Quantity Description Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS
INC, 21500 HAGGERTY ROAD, SUITE 100 1 ea Sign or Outline Lighting 07/29/2009 $53.40
PHONE: 1 ea 12% State Surcharge - 07/29/2009 $6.41
Electrical
1 ea Sign or Outline Lighting 07/29/2009 $53.40
Contractor: 0 ea 12% State Surcharge - 07/29/2009 $6.41
Electrical
MEYER SIGN CO OF OREGON INC
15205 SW 74TH AVE
TIGARD, OR 97224
PHONE: 503 - 620 -8200
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
•
Total $119.62
Required Items and Reports (Conditions)
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 if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Tho rules are set forth in OAR
952- 001 -0010 through •1; R 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.81%.332. .
r ^ , Issued By: 1 116,.._41 4I ! • 1 116 P ermittee Signature: \ Q
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 503.639.4175 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.
al,i �ovp- oor(o4 r Sr�t4 -oDr7o
E l e Electrical ctrical Permit Application FOR OFFICE USE ONLY
J UL 2 9 2 009 Received m •4-4, City of Tigard Date/B : `/ Permit No.g (gang , 6 - S
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
III C ' Phone: 503.639.4171 Fax: 503.598.1960 Date/B • Other Permit:
Inspection Line: 503.639.4175 CITY OF TIG ' t Date Ready /By: El See Page 2 for
T I G A R D g g BU ILDING DIVISI IPA
Internet: www.ti ardor. ov otified/Method: 11 41MI Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ® Other: Signs 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
❑ I - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation 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 "I -3 ",
Job no.: Job site address: 13500 SW Pacific Hwy. Six or or more. ua
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ Healthcare facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Islands Tanning ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Tigard Marketplace (next to Verizon, in Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
the front of the center Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
electric wall signs Limited energy, multi - family
Install (2 75.00 2
() residential (with above sq. ft.)
g
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ® TENANT 201 amps to 400 amps 106.85 2
Name: Islands Tanning 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 13500 SW Pacific Hwy. Over 1,000 amps or volts 454.65 2
City/State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)888 -1914 Fax: ( ) 200 amps or less 66.85 I
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 599 amps 133.75 2
Branch circuits — new, alteration, or ex_ tension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ® CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: (Same as Contractor) B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 2 53.40 106.80 2
Business name: Meyer Sign Co. of Oregon, Inc. energy panel, er or t on , or
energy panel, alteration, or
Address: 15205 SW 74 Ave. extension. Describe: Page 2 2
City/State /ZIP: Tigard, OR 97224 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 620 -8200 Fax: (503) 620 -7074 Investigation per hour (I hr min) 62.50
CCB Lic.: 64014 Electrical Lic.: 20- 190CLS Suprv. Lic.: 56651G Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �� Subtotal: 106.80
Print name: Phil Reynolds Date: 7 -29 -09 Plan review (25 % of permit fee):
State surcharge (12% of permit fee): 12.82
Authorized signature: TOTAL PERMIT FEE: 119.62
This permit application expires if a permit is not obtained within 180
Print name: Steve Murphy Date: 7 - - days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \ BuildingWermits \ELC- PermitApp.doc 05/23/06 440- 4615T(11/05/COM/WEB