Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00555
DEVELOPMENT SERVICES DATE ISSUED: 9/5/03
..� I I 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2 S 112 DA -0030 0
SITE ADDRESS: 15230 SW SEQUOIA PKWY 190
SUBDIVISION: ZONING. I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: (2) each 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: 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:
PACIFIC REALTY ASSOCIATES MULTI -LIGHT SIGN CO.
15350 SW SEQUOIA PKWY #300 -WMI 809 N E LOMBARD
PORTLAND, OR 97224 PORTLAND, OR 97211
Phone: Phone: 281 -3083
Reg #: LIC 64107
SUP 343SIG
FEES ELE 26 -90CLS
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/5/03 $106.80
[TAX] 8% State Tax 9/5/03 $8.54 Rough -
Elect'I Final
Total $115.34
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 3) 246 -6699 or
1 -800- 332 -2344.
Issued By: 02 di5ti Permit Signatures
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: Sr 6-
Call 639 - 4175 by 7:00pm for an inspection the next business day
' .2-13
`r ,. 56 1\1 0-05 3 — I . 1--
-
Electrical Permit Application
Date receive . 6 U3 Permit no. o — oe>5
' . ..I I City of Tigard RECEIVED Project/appl. o.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: B I Receipt
Phone: (503) 639 -4171 cC 0 5 2003
Fax: (503) 598 -1960 SEP C ase file no.: Payment type:
Land use approval: Y OF TIGARD
. � _________,:,;..___1,4: • ING
TYPE OF PERMIT
. 0 1 & 2 family dwelling or accessory c ommercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: 167,1)0 S. I Su1 �� ur , 1 ;--. t (441 Bldg. no.: „ Suite no.: Tax map /tax lot/account no.:
Lot:' Block: bdivision: II o
Project name: t.."3eSj irA Act iki.Q I Description and location of work on premises: _t,c) 2,_,, g LT �ie 5
Estimated date of completion/inspection: • 1 ' -
CONTRACTOR APPLICATION .' FEE SCHEDULE
Job no: ) (, Fee Max
Business name: rn0L7- I, 1 ,„/— Description Qty. (ea.) Total no. insp
Address: C6 9 S 1 Q W New residential - single or multi- family per
OS ', (n
VJ nvtn dwelling unit. Includes attached garage.
City: p�0 -- N o � State R I �:q�21 ( • Service included:
Phone: try; 253i ;os 3 I Fax: I E -mail: 1000 sq. ft. or less 4
CCB no.: (o !.i ioi I Elec. bus. lic. no: ;26...q,0 c (� Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
, City /metro lic. n0.: Limited energy, non- residential 2
L (2 _ ) 44 ,,C„,,, „ Each manufactured home or modular dwelling
f s
Signature oup rvising electrician (required) Date / Service and/or feeder 2
Sup. elect. name (print); v 2 P . License no: _ 3S/ Services or feeders- installation,
alteration or relocation: _
PROPERTY OWNER 200 amps or less • 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps . 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only -1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 1 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER . Branch circuits - new, alteration, ,
or extension per panel:
Name: • _ • A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit • 2
City: I State: I ZIP: B. Fee for branch circuits without purchase ,
of service or feeder fee, first branch circuit: • 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of 1&2 ' ❑ Hazardous location Each sign or outline lighting 2 5gla I� ( 2
family dwellings, ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ,
❑ System over 600 volts nominal ' more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan • ❑ Other. Per inspection
, Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
I e�
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ tDsP
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ ��
Credit card number: / / within 180 days after it has been State surcharge (8 %) $,
• Expires accepted as complete. TOTAL $ (15 j
Name of cardholder as shown on credit card -
•$
Cardholder signature Amount 440 -4615 (6I00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
• Complete Fee Schedule Below: ' ' TYPE OF WORK,INVOLVED - RESIDENTIAL ONLY -
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total :- i' ,',
C heck Type of Work Involved:
Residential - per unit .
1000 sq. ft. or less $145.15 4 - i ®' .' : `Audio and Stereo Systems .
Each additional 500 sq. ft. or " .
portion thereof $33.40 • 1 n Burglar Alarm
Limited Energy $75.00 .
Each Manufd Home or Modular ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑
201 amps to 400 amps $106.85 2 Vacuum Systems
401 amps to 600 amps - $160.60 - 2 •
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts . $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation . Fee for each system $75.00
200 amps or less $66.85 • , 2 (SEE OAR 918 - 260 -260) .
•
201 amps to 400 amps $100.30 2
401 amps to,600 amps $133.75 . - r 2 Check Type of Work Involved: ,-
Over 600 amps to 1000 volts, '
see "b" above. Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
. with purchase of service or 0 Clock Systems _
feeder fee. - ' •
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation •
b) The fee for branch circuits ,
without purchase of service • El fee. Alarm Installation
or feeder. fee. .
• First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation •
(Service or feeder not included)
Each pump or irrigation circle $53.40
•
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems •
Signal circuit(s) or a limited energy
panel, alteration or extension • • $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00 -
Each additional inspection over ❑ Medical •
the allowable in any of the above ,
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: - ❑ Protective Signaling ,
•
Enter total of above fees $ I I Other •
• 8% State Surcharge $ Number of Systems •
25% Plan Review. Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application. , -
Fees:
Total Balance Due $ '
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $ •
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms \elc- fees.doc 08/30/01 -
•
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 / 6 O `Se_5 u D i Q �
PK( Suite /9 0 MEC
Contact Person / , °a- 21 Ph ( ) X 21— 3 ° Z 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner — 0 053
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors S
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm -
Susp'd Ceiling
Roof
Other: 1/
Final -
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service ?
Rough -In
UG/Slab
Low Voltage
Alarm s
Final • \5 • ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
SITE ❑ Please call fir reins +ection RE: Unable to inspect — no access
Fire Supply. Line
ADA Date /67 Approach/Sidewalk Inspecto - �I.. - Oct Oct
Other:
Final DO NOT REMOVE this inspection recor rem the Ob site.
PASS PART FAIL