Permit ir
CITY OF TIGARD ELECTRICAL PERMIT
11111i q P er mit #: ELC2009 -00382
� COMMUNITY DEVELOPME
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/28/2009
TIGARD 13125 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 120
Subdivision: Lot: 0
Project: Little Caesars Pizza
Project Description: Installation of (2) sign lightings.
Owner: FEES
SN PROPERTIES PARTNERSHIP Quantity Description Date Amount
1121 SW SALMON ST
PORTLAND, OR 97205 2 ea Sign or Outline Lighting 07/28/2009 $106.80
PHONE: 1 ea 12% State Surcharge - 07/28/2009 $12.82
Electrical
Contractor:
SECURITY SIGNS INC
2424 SE HOLGATE BLVD
PORTLAND, OR 97202
PHONE: 503 - 546 -7114
FAX: 503- 230 -1861
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $119.62
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 i . -= • _ - with 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. ' ENTION: Orego law r- • uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95. 001 -0010 through OAR 952 • , -010*. Y• ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.; $0 < • .2344.
ssued By: % /� / ' . u 1 —A i
.. � Permittee Signature: al _ t
OWNER INSTALLATION ONLY NW
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.
1
Sc /J Li✓ 0 - 00 /7
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard
RECEIVED Received .. 0
1111 " r' Date/By: 21 Permit No.: E44 �3g
13125 SW Hall Blvd., Tigard, OR 97223 i 2 8 2009 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 D Other Permit:
Ti G A R D Inspection Line: 503.639.4175 Date Ready/By: Iuris: See Page 2 for
Internet: www.tigard or.gov CITY OF TIGP► Notified/Method: Supplemental Information
TYPE OF Wo 'ilLDING DIV1S1O ' PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction 02 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.
ID 1 - and 2 - family dwelling ® Commercial/industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Accessory building snips 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 ", "1 -3 ",
/� 100HP or more. occupancy.
Job no.: Job site address: ��((JJ
G
['Six or more residential units. ❑ Recreational vehicle parks. g
City/ State/ZIP: ID Health facilities. ❑ Supply voltage for more than 1
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ip Project name: Ei TI l2 G\CZarS ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'1 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
11 • Limited energy, multi family
` s1g residential (with above sq. ft.) 75.00 2
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: ( ) 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 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: Security Signs B. Fee for branch circuits
Contact name: Melissa Hayden without service or feeder fee 46.85 2
first branch circuit
Address: 2424 SE Holgate Blvd Each add'I 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 I 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 2 53.40 /d .) 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 Lic.: 122809 Electrical Lic.: 26560cls Suprv. Lic.: 383sig Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: (CVO
. $O
Plan review (25% of permit fee): �,+
Print name: Mark Linguist Date: a ` Q n
State surcharge (12% of permit fee): i19.,,
Authorized signature: r , TOTAL PERMIT FEE: /! 9 . r! ,2..
Print name: Melissa Hayden v Date: This p ermit 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: Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05/COM/WEB