Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00483
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/15/2009
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Safeway
Project Description: (3) wall signs.
Owner: FEES
GMS FIVE LLC Quantity Description Date Amount
5973 AVENIDA ENCINAS STE 300
CARLSBAD, CA 92008 3 ea Sign or Outline Lighting 09/15/2009 $160.20
PHONE: 1 ea 12% State Surcharge - 09/15/2009 $19.22
Electrical
Contractor:
SECURITY SIGNS INC
2424 SE HOLGATE BLVD
PORTLAND, OR 97202 -
PHONE: 503 -546 -7114
FAX: 503- 230 -1861
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Total $179.42
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 a • • - ce • 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. A NTION: Oregon - re• • - you to follow' the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 1010 through OAR 952 -00 . %100. •u m- • •twin a copy of the rules or direct questions to OUNC by calling 503.2 •699 or 1.800.332.2344.
Issue • By: — ` �L � .L � Permittee Signature: A. _ �I/
• 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.
Elec irical Permit Applicati fiEcE FOR OFFICE USE UNI
City of Tigard oar 4 /5-157.10E Permit No.: of -60183
° 13125 SW Hall Blvd., Tigard, OR 97223S EP 15 2009 Plan Review
' II • Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: ions' ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: I Co. Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
ID New construction ® Addition/alteration/replacement
❑ 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 ",
"')per ` Six or or more. occupancy.
Job no.: Job site address: } �i � � ., ,I(v\ N.( I __
• .-- - y❑ Six or more residential units. 0 Recreational vehicle parks.
City / State/ZIP: Health - care facilities. ❑ Supply voltage for more than
`� � Hazardous locations. 600 volts nominal.
j. y �
Suite/bldg. /apt. no.: Project name: C {_ ❑ Service or feeder 600 amps or more.
V FEE SCHEDULE
Cross street/directions to job site: Description I Qty I Fee, I Total I •
New residential single- or multi - family dwelling unit.
•
I Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
L energy, multi- family
75.00 2
. \\ o ),,.: \ residential (with above sq. ft.)
*mount only* Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: Security Signs B. Fee for branch circuits
without service or feeder fee,
Contact name: Melissa Hayden 46.85 2
first branch circuit
Address: 2424 SE Holgate Blvd Each add'l branch circuit 6.65 _ 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Portland, OR 97202 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 546 7114 Fax: : (503) 2301861 Reconnect only 66.85 2
E -mail: melissa @Securitysigns.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting �{ 53.40 /60. e 2
Business name: Security Signs Signal circuit(s) or limited- �
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City / State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: 122809 ' 1 Electrical Lic.: 26560c1s I Suprv. Lie.: 383sig Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: � ' Subtotal: 766 al
. d
• Print name: Mark Linguist Date:
Plan review (25% of permit fee): 4)---
/� State surcharge (12% of permit fee): / 9. a 9. Authorized signature: e �__�l rr / TOTAL PERMIT FEE: / 7 9 • [f
Print name: Melissa Hayden / 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.
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