Permit . CITY O TIGARD y ;:
S CCTRI ;�L�',�'ERi9iIT
iw , DEVELOPMENT SERVICES PERMIT L -0 aL :
� il' DATE I SS ]E 15 2 1 1. / 1 i / 97 ' ' .
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171 •
PARCEL ; 2:51 0X13- -' 02;0,,3.
SITE ADDRESS. . . 2 131 G5 . SW PACIFIC HWY .
3LJBDIVI SION.... ;NORTH TI,GARDVILLE ADDITION ' ,. `ONINGaC. -.G . '
BLOCK .... , . •
,, ,, L_OT...,.e ...... . °0133. • JtJRI.SDICTION TIG ,
Project De scr i pt i on g Burger.ttir!g signs .
- ... -•-RESIDENTIAL UNIT - - - -•- - -- :_,- TEMP SRVC /FLEDCRS -•.__- , _.- _ -MISCELLANEOUS _._.' :-
1000. SF OR L_`= S>.... 0 '. • 0: -- E00 'amp.. o ICI,', • , PUI'iPtIRRIGPTIEN..... .O
EACH Ai?D' I._ ' 'a1Z 0SF, .... 173. . ,201 40121 a m p. : :, . 0 SIGN /OUT L_ I NE T•O.• . , 5 : :
L..Ti1ITED' ENERGY.. ... :.. 2 iZ' 4111 _ £ I0 arop.' e . 2 Ill SIGNAL.. /PANEL..,... . e.,.;r, -
h1Ahlt- HM, SVC /FDR;. 2 0 " 611a-ainps- •- 100I41' volts:: 2 12' 1 LABEL ;10 ) . _ v,. 0.
•--- SERVI'C.E /FEEDER -_:' - -= - BRANCH •.Ci ?CUITS,- - - - -•- - -ADD' L - iNSPECTIONS -;-. :. ,
121: - 200 a iii p .... .... .,,.. „1Zi. , 'W /SERVICE OR FEEDE:Ro 11 PER INSPECTION.. a''
201 - .' +I00,, .amp.. 6 .. = 0. 1st W ;'0 SR VC'. OR �TDR. ; 0 PER. ,HOt1R.,.o .. . , , ILA'. .
- :t, ' h L� C , ,
-��O11 - G,c',L: an; ...... 0� F =A ADD L_ L� :�haCn � :Ii -ti.,. I?t � .1.14 PLANT • . k1 . •
6 01 -- 1. NA amp. . . . . o IZi _' =-• -•- - ":---- -,- •-------- •-- •f='L..AN • REV REVIEW SECT 101\17 _ _ =- . '.. �_.:...._ :- _
1 amp/ yol:c .. 01 > ='4 RES Uhl]: T 8'..; .... . o a > 600 VOL i ..Ni._MINAL. , ,. -
Reconnect only o 0 '• SVC /FDR ' > == E.25 AMPS. e e . CLASS AREA /SPEC, OCC. e
' ,,.DINT - !Q• i � _._._---._._.__.__._-..------•--•--•----- __._._...--- ..._-- _.____- - -••-- i"�E .
',STEI•N,.SIGN : type . amount by date. . 1.-e cpt •
' 39810 CROWN POINT HWY • PRM•i $ 120.00 'J'SD' i 1 /04/ 97
.6':0R BE -r- nR. g7c;_i9 ----- _ - - F - -P-__rnrr__ sr3 1 ip •4i -a7 � gi,-,F .•'-_ - -
-- - - - - 1 '`fir - .
Phone #a. •
Cont rapt or. a - - - -- - -- _ - - -- : • .
J I M: STI= I N• STEIN SIGN COMPANY, • . ' $ 1 2G o :,1730 TOTAL' , •
3941B • CLOWN POINT HWY . . ' ' ' . • ' - .. -' .. , . • • • . ,
REDU I RED ASPECT 1 CNS -- -- --
CO! BE. OR 9701:3 ' ' Elect' ). Final • '
'Ph on e #2,695-3220 . •
.
Tsi4 pernit is issued subject to the regulations contained' in the Tigard Municipal Code, State o Ore Specialty. Codes and ail ,other '
applicable laiis. All ,,ork rill be done in accordance ,with approved plans... This wait will, expire if• work is�;not Start;.ed within 18Z,
days of issuance,, or if 'cork is suspended for 'gore than 180 days. . ATTENTION: Oregon law requires ;you to fo lo,l,the rPles adopted, by .
the Oregon • Utility Nptificat ion. Center. Those rules are Set forth in CAR' 9t2-001-N10 through GAR 952- 091- 1S37.. Ynl,nay attain a,cocv'
of these rules ar. direct .ouestidnt t.o.OU11C by. calling i50246-1987. . ,
E'ermittep :=,i is Dyo
_- .- •- • -__ -- - _ :._ :_. -- ' --- -•• -OWNER I NSTPI LAT ION. ONLY- •--- ..- .- -- ___ -._ - . _-- _�..._._-- ._- ..- . - -.-__ __, •
The i'nstallat.ion is being' made an 131 open' y I O ;r.f'I aahi.c:il 3.5 rIn% • intended frIr
Sale, lease,. or•rent. .: -,' . " . ..• . . . .
OWNER'. S 'SIGNFT'JRE2 = - -. �_____ 1)ATF.
. _.__._._..__ ____.._.___ _ _.....___CONTRACTOR INSTALLATION I ON ONLY - - _. -.. - -_:
_: _. .__ ____.- . _._.--_.._.. -.._::-_ ; .- : -_.__..-:__.._-,.- 1 -. ; .,-
S :1 GNAT.L.IRF. OF SUER. .F_LEC" N .1 , .,�.._ �.__._..__� DATE. e _ ' . •
L, ).. Ci_' J'ii ?:SE ,I1 . _.._�_ -- - - - - -- -
-'- 1.--.+ j....1.4 1 .. - -. �� 4. 4...1.4.4 tiL 1..- }..1.-t- -1- i I•'-•I- +-F... a:a....,- .•1-'i--h -I:. I - f -1- l-'•• C--I"i, :.;....1_..I...I...}..1- ..x.1.:..1:..1 .4-- I_ I .._ } + . : { .... ; ... } .: { -. 4 - .I:•..{.• ;-.F..“
Ca1.1 ... 39'-..4i73 'h'J /,`I 101 ;.3.411. .' pr, cx•il,''1'(l 'per 1-r ee'ded ih :? ,, - next 'b4lsine._=.s day.
.... s:_' r..;-• irji.-}.:' r.. i.- 1-- i--,••- F+ ±. ++_I.+.+-- 1-- I- +++±+ 1 - - 1 ± . + ...- a *.::4. 1... I--S-•i'. rl4,.- 1-=}..{.. q...+•#- h•. i-- i• ti-. A._,•_' rri•+44. F.... 1..• i4_ I-- h-• r-i°- F4:'-F..i...-+1--F•:F•-I-+-I-
•
CITY O Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By CI.Y
TIGARD OR 97223 Date Rec'd //e 5
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # t: `.0 9? ` DAB
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) 8 Je.5 /1 A ^`f Service included: Items Cost Sum
Address /3/ GS -SW '1 Cr f � C f7 y 4a. Residential - per unit
Ci ty p /S /Zi f Art- 0 9 7a 1000 sq. ft. or less $110.00 4
J Each ad 500 sq. ft. or
1=1 Limited thereof $25.00 1
Commercial El Residential
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor .s7 - £: a 5i, Ai Installation, amn, alteration, Stio or relocation $60.00 2
Address 3 ! /0 C/L l ; N /- 14w 201 amps to 400 amps $80.00 2
City Co Q B g T7" State O Zip 9 7 70/ 9 401 amps to 600 amps $120.00 2
Phone No. C,5"'b 3_) 69s" - 3-. g 0 601 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. Exp.Date
OR State CCB Reg. No. 6 74 Exp.Date? MT: 4c. Temporary Services or Feeders
COT Business Tax or Metro No. d Sly Exp.Date 5 ; Installation, alteration, or relocation
C \ IL� > 9- 200 amps or less $50.00 2
Signature of Supr. Elec'n V i� V - 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No 35�) 1:1-6i Exp.Date iC 9 f see "b" above.
Phone No 6q c ;7.- 7-
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
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 / C 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional Inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
•
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: ' O
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $ l ,
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $
I \DSTS \ELC96 APP Roy 9/96