Permit CITY OF TIGARD / - 0F ELECTRICAL PERMIT
PERMIT #: ELC2006 -00620
DEVELOPMENT SERVICES DATE ISSUED: 10/31/2006
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 PARCEL: 2S102BD - 01503
SITE ADDRESS: 12740 SW PACIFIC HWY ZONING: C -
SUBDIVISION: VILLAGE SQUARE LOT : 001 JURISDICTION: TIG
Project Description: (1) 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: 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:
ROSE GOSPODINOVIC MEYER SIGN CO OF OREGON
12770 SW PACIFIC HWY 15205 SW 74TH AVE
TIGARD, OR 97223 TIGARD, OR 97223
Phone: Contact #: PRI 503- 620 -8200
FAX 503 - 620 -7074
FEES
Description Date Amount Reg #: ELE 20- I90CLS
[ELPRMT] ELC Permit 10/31/200( $53.40 LIC 64014
[TAX] 8% State Surcharge 10/31/200( $4.27 SUP 566S1G
Total $57.67 REQUIRED ITEMS AND REPORTS
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 sus•ended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. •ose rule% - - set
forth in O' - • ! 11 -0010 th ough OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC • - a - -669' •
1 -800- .2 -2344.
Issue • By: ■.....L/t � ..i Y .,/ • Permittee Signature: A ell . -dams.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or ren.
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.
Electrical Permit Application FOR OFFICE USE ONLY
Ci o f Ti and Received / EMIDM �' , � i' /p)
tY g o, Permit No.: GGC
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 I Date /B : Other Permit:
Inspection Line: 503.639.4175 ! 14,- e, Date Ready /By: F" ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: ` Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration /replacement Please check all that apply:
1=1 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 I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi-family ❑ Master builder ❑ Other: ❑Buildin 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
Job no.: Job site address: 12750 SW PACIFIC HWY , SUITE 101 ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: TIGARD, OREGON, 97233 The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: CRICKET WIRELESS FEE* SCHEDULE
Description 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. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add] 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
1 WALL SIGN 4' X 8' -1 1/4 dwelling, service and /or feeder 90.90 2
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: CRICKET WIRELESS 601 amps to 1,000 amps 240.60 2
Address: 12750 SW PACIFIC HWY 5-Li t r /O , Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: TIGARD, ORE, 97233 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 I
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
Business name: MEYER SIGN CO OF OREGON branch circuit
B. Fee for branch circuits , I7
Contact name: JERRY RITNER without service or feeder fee,
first branch circuit 46.85 2
Address: SAME
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: ( ) Fax: ( ) Sign or outline lighting 1 53.40 7� Itu 2
E -mail: JRITNER @MEYERSIGNCO.COM Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: MEYER SIGN CO OF OREGON
Address: 15205 SW 74 AVE Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: TIGARD, OR., 97224 Investigation per hour(1 lir tnin) 62.50
Phone: (503) 620 -8200 Fax: (503) 620 -7074 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES, -
CCB Lic.: 64014 Electrical Lic • - : 190C *. try. Lic.: 566 -SIG Subtotal b 3 . ela
Suprv. Electrician signature, require . G Plan review (25% of permit fee) /
Print name: -. L... LvL L .1h i Ar Date: 1 -31 -06 State surcharge (8% of permit fee) �' 7
TOTAL PERMIT FEE 7 . '6
Authorized signatu /�, • O, This permit application expires if a permit is not obtained within 18D
days after it has been accepted as complete
Print name: .,f� 4 / Tu �, Date: 10 - - • Fee methodology set by Tri- County Building Industry Service Board
Number of inspections per pennit allowed.
i:\Building\Permits\ELC- PermitApp.doc 12/03 440.4615T(10 /02/COM/WEB