Permit CCITY TIGARD ELECTRICAL PERMIT
I PERMIT #: ELC1999 00564
Mk DEVELOPMENT SERVICES DATE ISSUED: 9/20/99
. . .. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135BD -00300
SITE ADDRESS: 09735 SW SHADY LN ` ZONING: C -G
SUBDIVISION:
BLOCK: JURISDICTION: TIG
Project Description: Installation of sign lighting for 2 wall sign additions to the East & West walls.
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+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
HAZEL INTERNATIONAL INC HEATH + COMPANY LLC
HIGASHIYAMA HIGHLANDS CO LTD 4644 SE 17TH AVE
BY NORRIS & STEVENS REALTY PORTLAND, OR 97202
PORTLAND, OR 97204
Phone: Phone: 232 -2620
Reg #: SUP 618sig
LIC 127870
ELE 26 -998c1
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT DEB 9/10/99 $42.75 99- 318835 Elect'l Final
PRMT DEB 9/20/99 $42.75 99- 318467
5PCT DEB 9/10/99 $3.00 99- 318835
(additional fees not listed here)
Total $91.49
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 ado ted bye Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain co s of these ruiekordirect questions to OUNC at (503)
246 - 1987.
PERMITTEE'S SIGNATURE ' - .. ISS ED BY:
OWNER INSTALLATION 0
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: s � - E'< c Z2 '- /\ DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Cre'CITI TIGARD ' Electrical Permit Application • PlanChe%
13125 SW HALL BLVD. i Recd B AO .
Date Rec'd /D V
TIGARD OR 97223 r
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST '
Inspection (503) 639=4175 Print or Type Permit # Elct 9 99 _oc544
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
•
Name of Development Doc-tn t-S FAre•iy C I t i., t c.. Number of Inspections per permit allowed
Name (or name of business) Do cl as GgiFili - Family el. •:,, c Service included: Items Cost Sum
Address g73t S !/// S/tiocfy Lowe . • 4a. Residential - per unit
/ 1000 sq. ft. or less $110.00 4
City /State /Zip / t q Ami OR C Each additional 500 sq. ft. or
• Limited portion Energy $25.00 1
Commercial, Residential ❑
Limited Energy $25.00
Eacti Manufd Home or Modular
• Dwelling Service or Feeder $68.00 2
2a. Contractor installation only: ' •
(Attach copy of all cu nt licenses 4b. Services or Feeders
Electrical Contractor A7 tt Om pm at, 1-LC Installation, alteration, or relocation
200 amps or less
$60.00 2
Address /e) 2 / 3 Al E / 7 A s f 201 amps to 400 amps $80.00 2
City nof f State n Q e Zip (772 2 0 401 amps to 600 amps $120.00 2
Phorlfr No. A - 0 3.. L/Dcg -- 5 / D 601 amps to 1000 amps - $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only - $50.00 2
Elec. Cont. Lice. No. ° cam. 9c7$C /S Exp.Date /0 / 9 q
OR State, CCB Reg. No. /97:70 Exp.Date I. 2q- O u 4c. Temporary Services or Feeders • . •
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation ,
200 amps or less . $50.00 2
nature of Su r. Elecn 201 amps to 400 amps $75.00
Si '
2
9 P °���r`�� 401 amps to 600 amps $100.00 2
r Over 600 amps to 1000 volts,
License No. 44/ s, q Exp.Date see "b" above.
Phone No. sD 3 - 40 ac 4n6)-' ' S1 b 4d: Branch Circuits .
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit - $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
' Phone No. service or feeder fee.
First branch circuit $35.00 2
Each additional branch circuit - $5.00 2
The installation is being made on property I own which is not -
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 ‘a 2
Each sign or outline lighting -aft- -gg-e0 2
• 3. Plan Review section (if required):* '�a S 8 5
Please check appropriate item and enter fee in 5B. • 4f. Each additional inspection over '
4 or more residential units in one structure . - the allowable in any of the above '
.. Service and feeder 225 amps or more Per inspection $35.00
' System over 600 volts nominal Per hour $55.00 -
Classified area or structure containing special occupancy ' In Plant $55.00
•
as described in N.E.C. Chapter 5
5. Fees: ' • • . So
* Submit 2 sets of plans with application where any of the above apply. 5a. Enter total of above fees $ r= 99.
Not required for temporary construction services. ° rchargeJtal fees) 7 $ :� "
Subtotal . $
NOTICE 5 b. Enter 25% of line 5a for
Plan Review if required (Sec.3) $ ' •
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS • Subtotal $ '
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY ❑ Trust Account # _ 9/i • TIME AFTER WORK IS COMMENCED. Total balance Due , I $ •
�7L
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