Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00235
• TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/24/2012
Parcel: 1 S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY Z
Project: Petco Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: Sign lighting for (3) signs.
Contractor: INTEGRITY SIGNS OREGON Owner: PACIFIC CROSSROADS PROPERTIES IN
PO BOX 88 BY \NYSE INVESTMENT SERVICES CO
HUBBARD, OR 97032 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97205
PHONE: 503 - 981 -3743 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 04/24/2012 $203.52
Specifics:
1 ea 12% State Surcharge - 04/24/2012 $24.42
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $227.94
Required Items and Reports (Conditions)
This perm ed subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be • •ne in accordance •th 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
drys. ATTENTION Oregon ` law equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
' 52- 001 -0010 t rough OAR 952 1 You may obtain a copy of the rules or direct questions to OUNC by c 03.2 2.1987 or 1.800.332 2344.
..sued By: Permittee Signa ( Li:U"r C 1
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 the next available inspection date.
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.
Electrical Permit Application FOR OFFICE USE ONLY
11. City of Tigard y �� Date/B '
�� /i P No: e
. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503,598.1960 Date/By Other Permit:
TIGARD Inspection Line: 503.639.4175 � % \ Date Ready /By: turfs: ® See Paget for
Internet: www.tigard- or.gov �Y � Notified/Method: 7% Supplemental Information
,
N . �� �_ ' .' ''. -N - . t;'. , °, s' 1
-.. - , r ri. '" ", TI')?E' "OF�.WORK " � �" �1G 1Q :`�` ; ` _ . r. ( ° , PLAN ;REVIEW , , . .
❑ New construction ❑ Addition /alteration /replaC - ` 6
�` l` 0 Please check all that apply (submit 2 sets of plans w /items checked below):
CI Service or feeder 400 amps or more ❑ Building over three stories.
1=1 Q ' Demolition )n Other: 5 ( [ a ,us C where the available fault current ❑ Marinas and boatyards.
t { r '_' exceeds 10.000 amps at 150 volts or ❑ Floating buildings. tr
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural pQ
❑ 1- and 2- family dwelling XI Commercial /industrial El Accessory building amps for all other installations. buildings.
El Multi - family El Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑Emergency system. larger separately derived system. 6 .
JOB -SIZE ` INFORMATIO ND - LOCATION ❑ Addition of new motor load of ❑ "A" "E" "I 2 ". "t -3 ". rD
100HP or more. occupancy. J
C1 �\
Job no.: Job site address: I I ' n S �_E j.1'n , ' ( N ❑ Si x or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: l l �� t ! ��1� ❑ Health -care facilities. El Supply voltage for more than 4 I l l Dolt ❑ Hazardous locations. 600 volts nominal. G
Suite/bldg. /apt, no.: , Project name: pp4 e ❑ Service or feeder 600 amps or more.
, .,,, • ,, - FEE-SCHEDULE ° '' . .
Cross street/directions CO job site: ,_p/�Ci ( e J C Sit-1.4)k :t- Description I Qty. Fee. I Total I � *
,t lA O New residential single- or multi - family dwelling unit.
l OA.. Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
75.00
. � _ ' -� .: - ; •DEGRIPTION' OF,'� WORK " - . ( with above s q ft.)
Limited energy, multi- family
3d lD 11 JIRA Sibyls ,c1,/ residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
ff PROPERTY OWNER _ . E x'3 ` -. ❑ TENANT ; -,, :,, 201 amps to 400 amps 133.56 2 •
Name: ( W . 96 1 . c--h my 401 amps to 600 amps 301.04 2
601 amps to 1.000 amps 301.04 2
Address: I I l SW - - .Q .- 1 I DO Over 1.000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: f ---/ relocation
Phone: ( 5 - b -- a c t II_ _ ci4 pp Fax: ( )
200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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 extension, per panel
Owner signature: Date: A. Fee for branch circuits with
Er s above service or feeder fee
PLICANTONTACT= PERSON 7.42 2
$ each branch circuit
Business name: B. Fee for branch circuits without
S V11 �� t+,Q�� service or feeder fee, first 56.18 2
Contact name: 1� V branch circuit
YLQ Each add'I branch circuit 7.42 2
Address: QU Miscellaneous (service or feeder not included) •
� Each manufactured or modular
City /State /ZiP: `}4 �l 1 9'7 3 dwelling. service and/or feeder 67.84 2
Phone: (y3) C1 g)_ 3-74/3 Fax: : ( Sa3 qRa _ g J53 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
/gip or outline lighting 3 67.84 j03, sa. 2
- , -: ,CONTRACT,OR.6 . ., - ` Signal circuit(s) or limited energy
Business name _ c / panel, alteration, or extension. Page 2 2
✓1 t ` >I °�h5 D1 - 3 0----- 0----- Each additional inspection over allowable in any of the above
�
Address: 0 &, g �J `J Additional inspection (I hr min) 66.25/ hr
O Investigation (1 hr nun) 66.25/ hr
City /State /ZiP: 4I �� / 6- q -2().;a industrial plant (1 hr nn) 78.18/ hr
Phone: (g)-) � 9k'� - 371/3 Fax: ( , 3 9p / S3 Inspections for which no fee is 90:00/ hr
specifically listed ('/ hr min)
CCB Lie.: I Cii_l )Ss Electrical Lie.: C i _ S D Suprv. Lie.: 3% 5 (4 " ' , ELECTRICAL' PERMIT "FEES ' •
Suprv. Electrician signature, required: Subtotal: aO �j • S o.
Plan review (25% of permit fee):
Print name: • S Date: State surcharge (12% of permit fee): 't} ?.
1,. ail ko ) ��
TOTAL PERMIT FEE: a�� 6 1•i •
Authorized . _ . . -. This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
1:A Building \ Permits \ELC- I'crmuApp.doe 117/01/10 4411 -461 ST(1 I /115 /COM/Wt I5