Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00727
l DEVELOPMENT SERVICES DATE ISSUED: 9/27/2005
'---' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S134BC-00300
SITE ADDRESS: 12280 SW SCHOLLS FERRY RD ZONING: C -G
SUBDIVISION: GREENWAY TOWN CENTER LOT : JURISDICTION: TIG
Project Description: Sign Lighting.
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:
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Owner: Contractor:
VINNACOMBE CONSULTING ES & A SIGN &AWNING
12790 SE BLUFF RD 1210 OAK PATCH RD
SANDY, OR 97055 EUGENE, OR 97402
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Phone: 503 - 826 -1726 Phone: 541 - 485 -5546
FEES Reg #: LIC 145755
SUP 2
Description Date Amount
ELE 20-255 - 255CLS
[ELPRMT] ELC Permit 9/27/2005 $53.40
[TAX] 8% State Surcharge 9/27/2005 $4.27 REQUIRED ITEMS AND REPORTS
Total $57.67
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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 set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -6699 or 1 -800 -3 2
Issued By: i Permittee Signature: trri al L e,
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'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.
I
1 •
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received if 06 66 Permit No. itaD06 •D /
7a
13125 SW Hall Blvd., Tigard, OR 97223 DateB : ID Phone: 503.639.4171 Fax: 503.598.1960 %?+r '41 / '/ I I I �tIrr,WI `� OtherPernut:
Inspection Line: 503.639.4175 4lj a'1 I! Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us F Notified/Method: Supplemental information
TYPE OF WORK
SEP 2 2 6 I PLAN REVIEW
❑ New construction ❑ Addition /alteration/replatfet(t�rht OF TIGAKL) Please check all that apply:
❑ Demolition - Other:,51t6'.) BUILDING DIVISION ['Service over 225 amps, comm'l ['Hazardous location
OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ I- and 2- family dwelling [A Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi- family ❑ Master builder .Other: R(00 ❑Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
�� ❑Health -care facility ❑Other:
Job no.: 3', Job site address: 12p �� �.�� n-- Submit 2 sets of plans with any of the above.
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City /State /ZIP: T 6A447 I D t2 iii. -1. „" + The above are not applicable to temporary construction service.
7 FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: AZDAI tOA f.1 C,2tl7 /TUN 104 Description I Qty. I Fee. I Total I **
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
( C. I L'W µ I P 1 4'8'1) (4)I .4.--S1 L 1.1 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I 201 amps to 400 amps 106.85 2
cg 401 amps to 600 amps 160.60 2
Name: Ott , l!0M N 041 ry CJLopIr um, 0ti1 601 amps to 1,000 amps 240.60 2
Address: PQ R,u�c -j700 7.....
Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: vaU4-av 1 O g2.. q 7 4 0Z Temporary services or feeders installation, alteration, and/or
Phone: (4-41 , ti_ (,03S Fax: (51.//) '4'� G 4,..s--. 3 relocation
) k
�� 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 exchan cc to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
N W
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
APPLICANT I G3 PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Si .. .. 51L j p.. 0 JN Iwo branch circuit
Contact name: ��yy� B. Fee for branch circuits
l..tl?m - Pog-o without service or feeder fee,
each branch circuit 46.85 2
Address: I 2,1 0A-4. PTTLN 2,0 Each add'l branch circuit 6.65 2
City /State /ZIP:1.. (tie N G I on,. R l '#OL- Miscellaneous (service or feeder not included)
, L I) , /, � 7 / ! A vac � Pump or irrigation circle 53.40 2
( 7
Phone: `T y J ! ' �` Fax: ( J`7 ,l Sign or outline lighting / 53.40 53.V' 2
E -mail: (-#' - P!/We.! (0. a SO S 1 C1 ✓1 S •C.trv% Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 8 4..,4_ ,j mjc, A..U.,(tA.ftr
Address: 12 ( p cm,.v._ P Ztt�- 125 Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: 044 tpA1 I D 2. 9--)y Investigation per hour (1 hr min) 62.50
Phone: (W/ ) t 1 DS% Ts Fax: ow ) 7BS+ 3 Industrial plant per hour 73.75
Electric Lic.: p. S rv. Lic.: ELECTRICAL PERMIT FEES*
CCB Lic.:
I ( �l > v S'4 30SSI y Subtotal jje 410
Suprv. Electrician signature, equired: Plan review (25% of permit fee)
/�
State surcharge (8% of permit fee) 7. 27
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Print name: Date: gbe / Ds--
��� TOTAL PERMIT FEE ,S 767
Authorized signature edl� This permit app lication expires if a permit is not obtained within 180
C 1. days after it has been accepted as complete
Print name///11,' N/, Ll „ - / , „JGt / Date: 72 / 0 s.--- * Fee methodology set by Tri- County Building Industry Service Board
/` ** Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440 -4615T(10 /02/COM/WEB
CITY OF TIGARD
BUILDING DIVISION A PERMIT #:4)C) 0S''
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 j i
Inspection Requests (24 Hrs.): (503) 639 -4175 `'' �-.
I
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: ) 9:2 13 cCCv ( A- / _ CLASS OF WORK:
SUBDIVISION: l LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: 5 k PHONE #@RV
CONTRACTOR: PHONE #: 5311-b
Inspection Request Scheduled For: Date: 0 r--Gf "O) Pour Time:
Code # Inspec on ascription Confirm # Contact # Message .,...v.
i 9 r-,,L.,4 Corrections /Comments/ Instructions:
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A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr (% Date: 4 q 04 Phone #: (503) 718- ALL.