Permit A 7 _ __ `^ ,,y(„9.5/61.-
' '� ° (�i a/ yl /i v r ELECTRICAL PERMIT
= TY UV
TIGA D
PERMIT #: ELC2004 -00098
DEVELOPMENT SERVICES DATE ISSUED: 3/1/04
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135BD-01200
SITE ADDRESS: 09802 SW SHADY LN
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install (2) ea. sign lighting.\ /15/04, adding (1) additional - sign tigtitin or interior neon sign.
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: 3
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:
FORBES, DONALD CAROLYN SIGNCRAFT LLC
BURDICK, DONALD LINDA 9033 SW BURNHAM
434 RIDGEWAY RD TIGARD, OR 97223
LAKE OSWEGO, OR 97034
Phone: Phone: 503 - 639 - 4910
Reg #: LIC 155420
ELE 34- 674CLS
FEES
Description Date Amount
Required Inspections
[ ELPRMT] ELC Permit 3/1/04 $106.80
[TAX] 8% State Surcharge 3/1/04 $8.55 Rough -
[ELPRMT] ELC Permit 3/15/04 $53.40 ElectI Final
(additional fees not listed here)
Total $173.02
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 -8 =0 10 through OAR 952- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-6699 or
1 -80 32 -2344.
/
Is ued By: �� �
/ �' Permit Si nature' ' ' �� �
OWNER INSTALLATION ONL'
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 639 -4175 by 7:00pm for an inspection the next business day
4 -
EltriQal - -Nrmi
�. t Application FOR OFFICE USE ONLY
City of TigQard Received
b Date/By: 0 / 3 Permit No.: EL, , ,, i - j.'
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 1 0 f J Date/By: Other Permit:
Inspection Line: 503.639.4175 IL, Date Ready /By: laris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
TKNew construction ❑ Addition/alteration /replacement Please check all that apply:
El Demolition ❑ Other: El Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1 - and 2- family dwelling itg Commercial /industrial ❑ Accessory building ❑System 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 DEgress/lighting plan RV park
Job no.: Job site address'502.SW . 00 ❑ Health -care facility ❑Other:
Vt� Submit 2 sets of plans with any of the above.
City /State/ZIP: -n r ak C � 'j2-- The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
�� �y� Description I Qty. I Fee. I Total I •'
C %�/ Cross street/directions to job site: 2�Jl.//-E�► New residential single- or multi - family dwelling unit.
�( Includes attached garage.
IT0�, 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
( ,Q
1 C /? 1 N � k fCJ \ dwelling, service and/or feeder 90.90 2
Cr Y I �, / �J Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
� 401 amps to 600 amps 160.60 2
Name: Ng'(.1� —.- ce S ( Jt2 n 601 amps to 1,000 amps 240.60 2
Address: �� l ( ! r Over 1,000 amps or volts 454.65 2
V/`�� Reconnect only 66.85 2
City /ZIP: e � �Oe I-7 20 \ Temporary services or feeders installation, alteration, and /or
Phone: (6)2} 2 )._,1 6 3 Fax: ( ) relocation
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 as to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
PPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: 1 (( j,., r • branch circuit
^ �j� B. Fee for branch circuits
Contact name: J [J �++� 111 without service or feeder fee, 46.85 2
Address: O el �j 1� /1i10r�� \ each branch circuit
�� I v r - Each add'I branch circuit 6.65 2
City / State/ZIP: , G'7 3 Miscellaneous (service or feeder not included)
Phone: (53 6 ci 4." 1 ( 0 Fax: : ( A 6 y1 1419 Pump or irrigation circle 53.40 2
f Sign or outline lighting (y 53.40 MO 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: S IC r „/�, - L extension. Describe: Page 2 2
Cif* J t
Address:
f Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: l4 j Electrical Lic.: - -16sV Suprv. Lic.: Subtotal 5D 4C)
Suprv. Electrician signature, required: n �� i V • Plan review (25% of permit fee) /4 2'y
ue�►� �o State surcharge (8% of permit fee) •
Print name: t,�
���� , ` kt �' � 17. 4 r TOTAL PERMIT FEE S 7 b —1 AUthOrlZed Signature: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete
Print name
�� � Date: 5-1 _0 • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
is\ Building \Perndts\ELC- PemtApp.doe 12103 440- 4615T(10 /02/COM/WEB
•
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
•
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Pertnits\ELC-PennitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection, Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
t� BUP `
Received 3 -1 - o "1 Date Requested 3 ") ( °L (0 PM
Location SO • S1 C LA L-N - Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) - - - SWR
BUILDING Tenant/Owner ELC too i`
Footing
Foundation C
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
C___ f
Fire Sprinkler
•
Fire Alarm
Susp'd Ceiling
Roof
Other: / �- /'
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
RT FAIL
ECTRICA
Service
Rough -In
UG /Slab @ N. Low Voltage 1.
,' Fire Alarm Qb
1155 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI PART FAIL
❑ Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA II �1
Approach/Sidewalk Date % - lb - Inspector G •.. _ � tiS L Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL