Permit -� CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -10065
isivAr DEVELOPMENT SERVICES DATE ISSUED: 3/23/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 1S134BC-00200
SITE ADDRESS: 12198 SW SCHOLLS FERRY RD ZONING: C -G
SUBDIVISION: GREENWAY TOWN CENTER LOT : JURISDICTION: TIG
Project Description: (1) sign lighting
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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: 1
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:
ELLIOT ASSOCIATES INC MEYER SIGN CO OF OREGON
50 SW PINE ST 15205 SW 74TH AVE
PORTLAND, OR 97204 TIGARD, OR 97223 •
Phone: 503 - 972 -7192 Contact #: PRI 503- 620 -8200
FAX 503 - 620 -7074
FEES
Description Date Amount Reg #: ELE 20 190CLS
[ELPRMT] ELC Permit 4/5/2006 $53.40 LIC 64014
[TAX] 8% State Surcharge 4/5/2006 $4.27
Total $57.67 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
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are - - in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these r es or direct questions to OUNC at
503 -24. .699 or 8: 2344.
Issued = : ! vJ Permittee Signatu s --��,
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
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SIGNATURE OF SUPR. ELEC'N: 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.
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Electrical Permit Application . FOR OFFICE USE ONLY .
eceve I Electrical
Date/By: 3P31% qh Permit No.: no 066- /o 0 6,5
Planning Approval I Sign
City of Tigard
Date/By: • Permit No.:
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
/ :mp I
Internet: www.ci.tigard.or.us a . I Date/By: Case No.: Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: _ Supplemental Information.
- - -;TYPE OF WORK " .A`. .' PLAN REVIEW (Please check all that apPIY) ` ' ', -
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition /alteration/replacement [Other: 5[� ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION .. 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ommercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
Submit _ sets of plans with any of the above.
_ JOB SITE INFORMATION and LOCATION'` "` The above are not applicable to temporary construction service.
Job site address: /z I Qg stu -h0i5 FEE* SCHEDULE = i'
Suite #: I Bldg./Apt.#: ' J Number of inspections per permit allowed
Project Name: Tj1rtlNgj2s IV tut k h � Dri tion esc Qty Fee (ea.) Total
j
U New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
) OZiS / Service if or less 1000 0 q ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: I Lot #• Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
�,,;, service and/or feeder 90.90 2
_- DESCRIPTION . WORK; Services or feeders - installation,
SC�G - (/) dtCP-6 r Ali a r alteration or relocation:
J 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
601 amps to 1000 amps 240.60 2
[PROPERTY OWN ER ❑ TENANT • _ " ' Over 1000 amps or volts 454.65 2
Name: % ei, "A f Ssa' L� Reconnect only 66.85 2
Address: 5 sc..) P(, ,.Q Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: .Qa)+ O • ii 7 ZQC./ 200 amps or less 66.85 1
Phone: ? 7 l -7 9 2— Fax: 201 amps to 400 amps 100.30 2
I 401 to 600 amps 133.75 2
0 APPLICANT • ., ., ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
Each pump or irrigation circle / 53.40 2
CONTRACTOR Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: Iblics-V - , i&.c) a. (.60p., J r Description:
Address: 1s „let) c" p 1 / Each additional inspection over the allowa in any of the above:
City /State /Zip: T e , D - c A
l7 Z T Per inspection per hour (min. 1 hour) 62.50
/ I n vestigation fee:
Phone: 620- -g 20 F ax: tozo -- 70 chest
CCB Lic. #: 6. �d Lic. #: 2o-190 i 5 Electrical'Permit Fees*
Supervising electrici n _ Subtotal $
signature required: 4 Plan Review (25% of Permit Fee) $
Print Name: p L' i J c Lic. #: 5 /G Si C. — State Sur (8% of Permit Fee) $
Authorized t � TOTAL PE FEE $ ,- 1 . b t • i Notice: This permit application expires if a permit is not obtained within
�
Signature: \ _ Vy7: Date: �- ZZ 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
67 - VA -- JAI R-() "I
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03 -
Electrical Permit Application - City of Tigard
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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
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Burglar Alarm
D Garage Door Opener
El Heating, Ventilation and Air Conditioning System
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0 Vacuum Systems
0 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
n Data Telecommunication Installation
El Fire Alarm Installation
HVAC
❑ Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control
n Medical
0 Nurse Calls
n Outdoor Landscape Lighting
0 Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit FormskElcPermitAppPg2.doc 01/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200 &.100G5
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/23!2i10L:
Phone: (503) 639 -4171 ����i���
Inspection Requests (24 Hrs.): (503) 639 -4175 ..- ':_..
INSPECTION WORKSHEET FOR DATE: 5/1/2006 TIME: 7:00AM PAGE: 14
SITE ADDRESS: 12190 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: GREENWAY TOWN CENTER LOT #: TYPE OF USE:
PROJECT NAME: DINNERS DONE RIGHT
DESCRIPTION: (1) iign lighting
OWNER: E_L.LIOT ASSOCIATES INC, PHONE #: 60 : ?2 -1192
CONTRACTOR: MEYER SIGN CO OF OREGON PHONE #: 503.620 8:00
Inspection Request Scheduled For: Date: 5/1/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
140 Sign installation 029039-01 503 - 860.70/0 N
'99 F-iNal..
Corrections/Comments/Instructions:
Zij
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G1\9 1 `i rz Date: 1 4 Phone #: (503) 718-1M,