Permit CITY OF TIGARD
II
COMMUNITY DEVELOPMENT ELECTRICAL PERMIT
PERMIT #: ELC2007 -00341
D ATE ISSUED: 5/18/2007 I
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S110AB -00200
SITE ADDRESS: 14295 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: CANTERBURY SQUARE LOT: 1 -3 JURISDICTION: TIG
PROJECT: FOXY'S
Project Description: Sign lighting for (2) wall signs.
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:
KOLVE, G C CHANCO INC
14389 SW PACIFIC HWY 3521 SW CARSON
TIGARD, OR 97224 PORTLAND, OR 97219
Phone: Contact #: PRI 503 - 793 -3336
FEES
Description Date Amount Reg #: ELE C209
[ELPRMT] ELC Permit 5/18/2007 $106.80 LIC 171892
[TAX] 8% State Surcharge 5/18/2007 $8.54 SUP 6885
Total $115.34 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
suspende• : _ - than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those r es are set fo in • . - • 5 a 41 -0010 through OAR 952 -001 -0100. You may obtain copies of e es or1d ect uestions to OUNC at
503.24.7.6699 or 1.800. . 23 ,
Issued =y: ! � ' _ ir# ,I . i Permittee Signature:
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 • NLY
SIGNATURE OF SUPR. ELEC'N: '.1 a—te., A ' 4 ' 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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: S 11 0I Co AV Permit No.: ..' r
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' I I Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other P it:
T I G A It D Inspection Line: 503.639.4175 Date Ready /By: Sur' . ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: �� 1 � ( l �' 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: 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
❑ 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 ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: [9296.--a4) \ h 1 tW Six or more residential units.
or more. Recreational
❑ R vehicle parks.
City/State /ZIP: I C Gr ( �D O� q 7 Z z (� ❑ Six or ❑ Health -care facilities. 0 Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Sly Il.1 ❑ Service or feeder 600 amps or more.
111Vl1��.� FEE SCHEDULE
Cross street/directions to job site: 1 New residential single - or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
R.. S ICK a s C12) residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
,E (i. ROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: C . 7 Cj� 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: (t3) 60,_ lT Over 1,000 amps or volts 454.65 2
City /State /ZIP: `l c,1 Pry 02_ c 7 zZA Temporary services or feeders installation, alteration, and/or
relocation
Phone: ll 3) �Zp - 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, I it, or - 'ch./ e, according to ORS 447, 449, 670, d 7 1. 401 amps to 599 amps 133.75 2
7 Branch circuits — new, alteration, or extension, per panel
Owner signature: IMO •_ •••• — Date: `' ' 7 d l- A. Fee for branch circuits with
PPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
Business name: �� C ovf C2 each branch circuit
itt B. Fee for branch circuits
Contact name:
without service servicic feeder or feeder fee, 46.85 2
O 1 first branch circuit
Address: 1 L1 3 g9 S� t �` C Rt-oi Ech add'I branch circuit 6.65 2
l N. ♦ Miscellaneous (service or feeder not included)
City/State /ZIP: - 7 c.. . 4 - At 0 ®2- q ( ? 2_2_ k Each manufactured or modular 90.90 2
�C3 � I dwelling, service and/or feeder
'� Z
Phone: (3 Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting e l, 53.40 I�• 2
Business name: rPlRs ; � 1 ° ! , /s1 circuit(s) or limited -
■ ;iGcm:S �` ______ ./1/......' _ l gy panel, alteration, or
Address: , S 4 , j +- extension. Describe: Page 2 2
l
City/State /ZIP: OILI O Q ga q m O Each additional inspection over allowable in any of the above
3 Fax: ( ) Per inspection
Phone: 62.50
L� 7 3,c, Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Alizheitl Lic.: 40-6 7 Industrial plant per hour 73.75
' q ELECTRICAL PERMIT FEES
Suprv.
1" i t ctah srture, required: C 967 ELECTRICAL /o4
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): g. SY
Authorized signature: TOTAL PERMIT FEE: ii c. 3 y
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.
I :\BuildingTermits\ELC- PermitApp.doc 05/23/06 440- 46t5T(ti/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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
•
.system ,
(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 k '
❑ Landscape Irrigation Control*
❑ : Medical •
❑ . Nurse Calls
❑
'�
Outdoor Landscape Lighting* : P
❑ Protective Signaling -
❑ Other -•
Total number of commercial systems:
, *No licenses are required. Licenses are required .
for' all other installations
I:\ BuildingWermits \ELC- PermitApp.doc 03/23/06
05/17/2007 22:49 5036845811 GCKOLVECO PAGE 02
411 Y Ur I ICiAKL)
` COMMUNITY DEVELOPMENT I G Z g31P
T:� R LI ��� ,
13125 s Hal Blvd, Tigard, OR 97223 503.639.4171 i 5C) /
sa 2 , 0 4- L/y6
Electrical Signature Form
IMPORTANT PERMIT NOTICE
CHANCO INC
3521 SW CARSON
PORTLAND, OR 97219
Permit #: C2007 -00341
sauce; q�
Parcel: 25 2s110AB -00200 �® 1/�
Site Address: 14295 SW PACIFIC HWY
subdivision: CANTERBURY SQUARE • 410 2 6
1 -3
Jurisdiction: TIG e (sj �� C� 7 11 00]
Zoning: C.G 4 '
Project Name: FOXY`S C,o707
Description: Sign lighting for (2) wall signs.
•
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd.. Tigard. OR 97223. or you may fax the form to: 503.624.3681.
If you have any questions please call 543718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
KOLVE, G C CHANCO INC
14389 SW PACIFIC HWY 3521 SW CARSON
TIGARD, OR 97224 PORTLAND, OR 97219
Phone #: Phone #: 503- 793 -3336
•
Reg #: ELE C209
LIC 171892
SUP 688S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
C ■ g) Awe /9? RR
Signature of Supervising Electrician Name (printed) SUP LIC #
CITY OF TIGARD _, .,
BUILDING DIVISION PERMIT #:041001, 003i)
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 t
Inspection Requests (24 Hrs.): (503) 639 -4175 _..W'
INSPECTION WORKSHEET FOR DATE: (e' Zed' on TIME: PAGE:
SITE ADDRESS: '49.2' S SW WGg t W"A CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ,
DESCRIPTION: 2 51Q6 NS -
OWNER: PHONE #:
CONTRACTOR: C,ApAC4__ PHONE #:
Inspection Request Scheduled For: Date: 4 ' Z'"' 7 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Va C= ; 0Al -- F-►Lt 565-113- 33 3k,
Corrections /Comments /Instructions:
PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: q'Zil v . ) Phone #: (503) 718- 24$0