Permit C ITY OF TIGARD ELECTRICAL PERMIT
r PERMIT #: ELC2005 -00892
4 DEVELOPMENT SERVICES DATE ISSUED: 11/14/2005
411 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 112 D D -01600
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE 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: SIGNAUPANEL:
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 SECURITY SIGNS INC
15350 SW SEQUOIA PKWY #300 -WMI 436 SE 12TH AVE
PORTLAND, OR 97224 PORTLAND, OR 97214
Phone: 503 - 624 -6300 Phone: 503 - 232 -4172
FEES Reg #: LIC 122809
• ELE 26- 560CLS
Description Date Amount
[ELPRMT] ELC Permit 11/14/200' $53.40
[TAX] 8% State Surcharge 11/14/200' $4.27 REQUIRED ITEMS AND REPORTS
Total $57.67
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 -81 332 -2 • • .
Issued By: P y � - 4 . Permittee Signature
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.
SGN ,Aocs - oo3s0
Electrical Permit Applic tOISlnla JNlall �o Al a I OR OI 1'ICI liSl O\I
Cl of Tigard Receuved Permit No. L' , ,05--- 319 (- '� 5001 V T Al Date,B . //
11125 n4 Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 Date/B . Other Permit:
Inspection Line: 503.639.4175 a 3/113 u.92 - I �� Date Ready/By.
® See Page 2 for
Internet: www.ci.ti ger .or.us NNotified/Method: � Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other ['Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps -rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park •
1 ❑ I -care facility ❑der:
Job no.: 1 Job site address: � , .�C ( ' QOl A-
�J'' --'' KL F i 2 sets of plans with any of the above.
City/State/ZIP: ( 1 z The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: ia ,, a- 0 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. @. or less 145.15 4
Subdivision: I 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
am _ w ` � /n A S '
dwelling, service and/or 90.90 2
�. C�/v o � C- - _i, Cpk( Services or feeders rs installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone:
(. ) I Fax: : ( )
Sign or outline lighting . i 53.40 ) 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: ....- r )2 l" r C--. L L,>)),1 S
Address: 2 ti s 1 __ lr + (- LOk� Each additional inspection over allowable in any of the above
t � `' Per inspection 62.50 _
City/State/ZTP: ex(/1 , cz • * L.2 / Investigation per hour (I hr min) 62.50
Phone: ( ) 231_ Li 71 Fax: ( ) 2701 S ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Vi Z 7ej Electrical Lic.: t6ez,ez 4uprv. Lic.:3g3S jr, Subtotal 3 .e../CI
Suprv. Electrician signature, required: ' Plan review (25% of permit fee)
Print name: , r Dat . l State surcharge (8% of permit fee) 4
- ' t TOTAL PERMIT FEE J Lr . '7, ( - 7
Authorized signature: .. . This permit application expires if a permit is not obta within 180
days after it has been accepted as complete
Print nam - . II ' _ ' 4 4 ` 1 / , • Fee methodology set by Tri -County Building Industry Service Board
• • Number of inspections per permit allowed
i:\ Building \Pennits\ELC- PamitApp.doc 12/03 410- 4615T(l0/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 Supplemental Information 4
LIMIT D ENERGY PERMIT FEES:
RESIDE • WORK ONLY:
Fee for all r =: idential systems combined $75.00
Check Type o Work Involved:
❑ Audio an.• Stereo Systems*
❑ Burglar Al. m
.
❑ Garage Door • pener*
❑ Heating, Ventil. ion and Air Conditioning. .
System*
❑ Vacuum Systems* •
❑ Other:
COMMERCIAL WORK ONL • -- �— .
Fee for each commercial system.' 5.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
. ❑ Boiler Controls •
❑ Clock Syste
❑ Da . "elecommunication Installation
N Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
•
❑ Other
Total number of commercial systems: .
*No licenses are required. Licenses are required
for all other installations .
i:\ BuildingWennite \ELC- PamitApp.doc 04/03
•
CITY OF IGARD
BUILDING DI ■ SION PERMIT #: ELC2005 -00892
13125 SW Hall Blvd., Tig: d, OR 97223 DATE ISSUED: 11/14/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): •03) 639 -4175 e1 ll..
INSPECTION WORKSHEET FOR DATE: 12/12/2005 TIME: 7:02AM PAGE: 63
SITE ADDRESS: 15495 SW SEQUOIA ` WY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE + NTER LOT #: TYPE OF USE:
PROJECT NAME: DENTAL PROFESSIONAL
DESCRIPTION: Sign lighting
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 -6 3 0 0
CONTRACTOR: SECURITY SIGNS INC PHONE #: 503232-4172
Inspection Request Scheduled For: Date: ' 12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 023266-01 555 -121 -2555 N
Corrections /Comments/ Instructions:
PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N ''` Date: VII l Cr Phone #: (503) 718- 2-446
CITY OF TIGARD ._ 1
BUILDING DIVISION PERMIT #: ELC2005-00892
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2005
Phone: (503) 639 -4171 . trillit
Inspection Requests (24 Hrs.): (503) 639-4175 .......„...W __
INSPECTION WORKSHEET FOR DATE: 12/9/2005 TIME: 7:04AM PAGE: 64
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: DENTAL PROFESSIONALS
DESCRIPTION: Sign lighting.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 5036246300
CONTRACTOR: SECURITY SIGNS INC PHONE #: 503-232-4172
Inspection Request Scheduled For: Date: 1219/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 023169-01 503-5437114 N
Corrections /Comments /Instructions:
N 1 ST Z-Vfat, 1/46 .
•
CiNL. No W -- R.c 2 EtNitL—
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
A FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CriNt Nw Date: 1 6 1 W Phone #: (503) 718- Z'L"Gb-