Permit CITY OF TIGARD ELECTRICAL PERMIT
$ ° PERMIT #: ELC2007 -00093
COMMUNITY DEVELOPMENT DATE ISSUED: 2/9/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103DD -00800
SITE ADDRESS: 13815 SW PACIFIC HWY 100 ZONING: C -G
SUBDIVISION: LOT : 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:
DW SIVERS CO. MARTIN BROS SIGN INC
4730 SW MACADAM AVE. #101 3165 COMMERCIAL ST SE
PORTLAND, OR 97239 SALEM, OR 97302
Phone: NA Contact #: PRI 364 -2211
FAX 503 - 364 -4315
FEES
Description Date Amount Reg #: ELE 24 - 23CLS
[ELPRMT] ELC Permit 2/9/2007 $53.40 LIC 64761
[TAX] 8% State Surcharge 2/9/2007 $4.27 SUP 399S[G
Total $57.67 REQUIRED ITEMS AND REPORTS
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.
e 4 2 4. 40A4 4. _ Issued By: j Permittee Signature: c v pird Cc.4_4
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 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.
SC,,'J o1- 0,),...2.-.5
-EllsArical Permit Application f t-- rr, [W7r, FUR (wricL t;SEE: ()NIA.
City of Tigard ' " _ " R e cei
DateB ved-- - Permit No.'s Ca007 •• / •.• 3
. a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 F _3 0 0 ZO O7 Date/B Other Permit:
f I G n It D Inspection Line: 503.639.4175 Date Ready/By: EMI la See Page 2 for
Internet: www.tigard- or.gov , , ,,,i, W ),3 Notified/Method: Supplemental Information
n
TYPE OF WORK., iv 1 I N%%1l l "l 4 ' '' ' ryEE ltZ PLAN REVIEW
New construction El 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: where the available fault airrent ❑ 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
❑ 1- 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
El Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A "E ", "I -2 ", "1 -3 ",
I 100HP or more. occupancy.
Job no.: Job site address: 1 S sl
3 8 `
l � 1A)u ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP site ❑ Health-care facilities. ❑ Supply voltage for more than
�1 �(e d ❑ Hazardous locations. 600 volts nominal.
Suitt /bldg /apt no.: � Project name: L S ; ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ..-il CkCI _, a 0. rd�_ Description 1 Qty. I Fee. 1 Total I •
1
4P.:144.4... J New residential single- or multi- family dwelling unit.
C ( -�,_ ` Includes attached garage.
Subdivision: I 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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.) .
t c 1 -
Limited energy, multi-famil 75.00 2
LA) L ,, ' A _ - IA/bd. Sl I I �t'J�!' /` (� residential a
dential (with aboove e sq. ft.)
_ Services or feeders installation, alteration, on, and/or relocation
x� 200 amps or less 80.30 2
❑ PROPERTY OWNER I [TENANT 201 amps to 400 amps 106.85 2
Name: kt 1 ',� ,• — S; 401 amps to 600 amps 160.60 2
�3+� �'J 601 amps to 1,000 amps 240.60 2
Address: " • Over 1,000 amps or volts 454.65 2
City/State/ZIP: "! 4_ Sp y .... 16,/ Temporary services or feeders installation, alteration, and/or
y relocation
Phone: ( ) )(ILL- 9 /7 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 599 amps 133.75 2 .
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
DiPLICANT I CONTACT PERSON above service or feeder fee, . 6.65 2
each branch circuit
Business name: (1 S �� c B. Fee for branch circuits
Contact name: if LQ without service or feeder fee, 46.85 2
^,� first branch circuit
Address: �`�� �
Each add'I 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: ( ) I Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting / 53.40 S3 ' 2 .
Signal circuit(s) or limited -
Business name:L/y "z t.j n - .4_010.4_0101. C- 0 energy panel, alteration, or
Address: � Ls. � lrn� C>.R.X ..---1 S L C extension. Describe: Paget 2
City /State/ZIP: S Q7 30 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (b3) 16y _ a . a i Fax: ( S33 3 boy _ 44316— Investigation per hour (I hr min) 62.50 .
CCB Lic.: C 4/74 / Electrical Lic.: 4. a uprv. Lic.: 399., 399., s
i Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
ire .
Suprv. Electrician signature, requ Subtotal: 5.3.4°
Print name:'"( `' e. S Date: 1/3 / Plan review (25% of permit fee):
'� ( State surcharge (8% of permit fee): a7
Authorized signature: TOTAL PERMIT FEE: 5 7 • (o,,
•
Print name: Date: This 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.
l:\ BuildingWnmits \ELC- PetmitApp.doc 05/23/06 410- 4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard - '
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: •
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems* •
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System* .
❑ Vacuum Systems* •
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system -
(SEE OAR 918 - 260 -260) •
Check Type of Work Involved:
- El Audio and Stereo Systems
El Boiler Controls - .
El Clock Systems •
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
E l Intercom and Paging Systems
El Landscape Irrigation Control* •
El Medical
El Nurse Calls
El Outdoor Landscape Lighting* •
El Protective Signaling . •
El Other
Total number of commercial systems:
No licenses are required. Licenses are required
° for all other installations
I:\ Building 'Pemits'ELC- PemitApp.doc 0323/06
CITY OF TIGARD
BUILDING DIVISION A.
PERMIT #: ELC2007 -00093
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 219/2007
Phone: (503) 639 -4171 +`h
Inspection Requests (24 Hrs.): (503) 639 - 4175 �'' /..
INSPECTION WORKSHEET FOR DATE: 3/7/2007 TIME: 7:18AM PAGE: 51
SITE ADDRESS: 131315 SW PACIFIC HWY 100 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WINDFALL DELI
DESCRIPTION: Sign lighting.
OWNER: DW SIVERS CO., PHONE #: NA
• CONTRACTOR: MARTIN BROS SIGN INC PHONE #: 364 -2211
Inspection Request Scheduled For: Date: 3/7/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 0444500/ 503-364 -2211 N
Corrections /Comments / Instructions:
PLC & - 0 -
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 11v L Date: — 6 Phone #: (503) 718- TA
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00093
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/9/2007
Phone: (503) 639 -4171 v , �, �t •Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/7/2007 TIME: 7:18AM PAGE: 50
SITE ADDRESS: 13815 SW PACIFIC HWY 100 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WINDFALL_ DELI .
DESCRIPTION: Sign lighting.
OWNER: DW SIVERS CO., PHONE #: NA
CONTRACTOR: MARTIN BROS SIGN INC PHONE #: 364 -221'1
Inspection Request Scheduled For: Date: 3/7 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
140 Sign installation 04445002 503.364 -2211 N
Corrections /Comments/ Instructions:
IA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C-- � 12) � Date: I - t Phone #: (503) -1)-4410