Permit CITY OF TIGARD K - .• ELECTRICAL PERMIT
4
PERMIT #: ELC2003 -00650
DEVELOPMENT SERVICES DATE ISSUED: 10/23/03
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 110A B -00200
SITE ADDRESS: 14385 SW PACIFIC HWY
SUBDIVISION: CANTERBURY PLACE ZONING: C -G
BLOCK: LOT : 1 -3 JURISDICTION: TIG
Project Description: Installation of lighting for (2) sign placement.
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 YOUNG ELECTRIC SIGN CO
14389 SW PACIFIC HWY 10535 SW AVERY STREET
TIGARD, OR 97224 TUALATIN, OR 97062
Phone: Phone: 503 - 612 - 6672
Reg #: LIC 69308
SUP 465SIG
FEES ELE 37 -51CLS
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/23/03 $106.80
[TAX] 8% State Surcharge 10/23/03 $8.54 Rough -in
Elect'l Final
Total $115.34
This Permit is issued subject to the regulations contained in the Tigard Muniapal Code, State of OR. Specialty Codes and all (t. er applica•le 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, cr if work suspended
for more han"T80 days- ATTENTION: O •on law requires you to follow rules adopted by the Oregon Ut";, N.,tfication Cente . Those ules are set
fort ' OAR 952 - 001 -0010 through 0 • - 9 - 001 -0100. You may obtain copies of these rules or direct •. : sti»ns to OUNC at .03) 24; • 699 or
00- 332 -2344.
(Issued By: ,� /� ii / ;�: � Permit Si nature: /0
OWNER INSTALLATION ONLY
The installation is being ade 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
Electrical Permit Application .. FOR OFFICE USE ONLY
Received Electrical �, ^ a' 3 2 5Z)
Date/By: Permit No.: !-
City of Tigard Planning Approval Sign �/
y g Date/B Permit No.: ..,..],A, - ii eV OTO
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503-598-1960 / , , ,,,,, Post-Review Land Use
13 I Date/By: Case No.:
Internet: www.ci.tigard.or.us ,� I Contact ® See Page 2 for
�~
24 -hour Inspection Request: 503- 639 -4175 Name/Method:
/ /Co' Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ■ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑
El [] �1.5v Addition /alteration/replacement []'other: l� ❑ Bilding Hazardous location
over 10
r, n
Service over 320 amps - rating of 0 over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
❑ I & 2- Family dwelling El Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories 10 Feeders, 400 amps or more
El Accessory Building 1:1 Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
El Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: l4 4 Ptrc�i -le Haig FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: r(/ 1-y& ki-/AD Xot, pP 0,2 Description Qty Fee (ea.) Total
Cross street/Directio s to job site: New residential- single or multi - family per j
dwelling unit. Includes attached garage.
. t Fl e k'4 4' d l$'irolz wuzi lit•iAz, Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2 _
Over 1000 amps or volts 454.65 2
Naive: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
401 ❑ APPLICANT B
❑ CONTACT PERSON Branch 600
ch amps 133.75 2
c
Br circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of 6.65 2
service or feeder fee, each branch circuit
^ City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 PP AO 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: ) ali" �t4 i7Z /C. Al ffD Description:
Address: }0 t9N
Cit /State /Zi 7 /� 'n _ X10 Each additional inspection over the allowable in an of the above:
Y P B TU // y v P er inspection per hour (min. 1 hour) 62.50
Phone, &42. 1/dri2 Fax: la)S ,if.„ O /, /4 Investigation fee:
CCB Lic. #: 04,94 Lic. #: Other:
Electrical Permit Fees*
Supervising electrici : Subtotal $ 1 CV. q
si: ature rep, ired: ' J/ , Plan Review (25% of Permit Fee) $
Print Name. M' / /, J #: ' / State Surcharge (8% of Permit Fee) $ S�,
TOTAL PERMIT FEE $ I L
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard _
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
Burglar Alarm •
❑ Garage Door Opener •
❑ Heating, Ventilation and Air Conditioning System
Vacuum Systems
El Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
Boiler Controls
Clock Systems
0 Data Telecommunication Installation
Fire Alarm Installation
HVAC
❑ Instrumentation •
0 Intercom and Paging Systems
Landscape Irrigation Control •
• Medical
Nurse Calls
Outdoor Landscape Lighting
• Protective Signaling •
•
❑ Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations •
•
is \Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD ' 24 -Hour
BUILDING • Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / AM PM BUP
Location / 4 /3 1 g:5 — P C Suite MEC
G -V � R 7' - / 7 8s
Contact Person �► P ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing j 00 SO
Foundation ► ; . �. ,�,: "by t1 i sc s:.
Ftg Drain �� ,'�, - ��� �., -: 1 ••� �;:n s � "4 , � •
r �.trn '°`� ` _f - •?�r � ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors _
Ext Sheath/Shear •
Int Sheath/Shear
Framing ✓
Insulation
Drywall Nailing
Firewall
Fire Sprinkler .
Fire Alarm
Roof Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam .
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin./ Manhole
Storm
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL •
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
.e
ire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date / -oz Inspector t Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
•