Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00359
,T f GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/20/2010
Parcel: 2S101BB00401
Jurisdiction: Tigard
Site address: 11880 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Russ Chevrolet
Project Description: Sign lighting for relocated pole sign.
Owner: FEES
KNAUSS, WAYNE ET AL Quantity Description Date Amount
C/O HUMBERSTON, RUSSELL D, REVOCABLE
TRUST, PO BOX 4300 1 ea Sign or Outline Lighting 07/20/2010 $67.84
PHONE: 1 ea 12% State Surcharge - 07/20/2010 $8.14
Electrical
Contractor:
YESCO LLC
20100 SW 112TH AVE
TUALATIN, OR 97062
PHONE: 503 - 612 -6672
FAX: 503 - 612 -0914
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes an. -II other applicabl - law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, ork is suspe• •ed for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C. - e Those rul- - are set forth in OAR
952- 001 -0010 through 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503. • :6' • •r 1.800.3 -. X 44.
Issued By: mo t. _ d Permittee Signature: l /
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' 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 NA� I OR (F I Ic I:;(itil ci, I
City of Ti and �C Received
`.1 g ci !\)....v Datelan B Rev : 7 Q LO II, / Permit No.: 7 , D .��3g
13125 SW Hall Blvd., Tigard, OR 9
°' ' 1 Phone: 503.639.4171 Fax: 503.598.1960 % DPateB : iew Other Permit:
-1:1 , n It i. Inspection Line: 503.639.4175 a� 1Gr‘ V. Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov �� Notified/Method: Supplemental Information
TYPE OF WORIs , (� \ PLAN REVIEW
❑ New construction "Addition/alteratioi lac'ement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling .:®•'Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
• . • • JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: gyp S •� 1 t.i / / IOO or more re sidential units. ❑ Recreational occupancy. residential vehicle parks.
' '1
City/State /ZIP: ' ,f I '� O . C1, a '3 / ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: k Cjte j( -1 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
. ' DESCRIPTION OF WORK " . (with above sq. ft.) 67.84 2
(�
n r' I. /' u f Limited energy, multi - family 67.84 2
D � [oc� +P
f� �)IS�t Pa St ' residential (with above sq. ft.)
l U3%. 1 5r 1)3,c-le \ ` Services or feeders installation, alteration, and/or relocation
b u e + p� t v a c2.0 LA) 200 amps or less 100.70 2
20 1 amps to 400 am
PROPERTY OWNER. • s 133.56 2 0 P P
401 amps to 600 amps 200.34 2
Name: N.--c C,hGQ r n. - o I P. it L 1 601 amps to 1,000 amps 301.04 2
Address: , S 1, {) •, L ; t- f Over 1,000 amps or volts 552.26 2
City/State /ZIP: �;� r � f _ / 1 . L / Temporary services or feeders installation, alteration, and/or
"�- rd relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps [0 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
IR APPLICANT I CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: yc V B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: 1 f „ . p . - � I ■S branch circuit
Each add'I branch circuit 7.42 2
Address: 7,0 1 OD S 1� 11) 111 4V e- • Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State /ZIP: �( �Ia k ; r. 0 9 0(.1 3- dwelling, service and/or feeder 67.84 2
Phone: (5,D3 )/ _j - (Jt � ( Fax:: (So3) ( . 63 / 4 Reconnect only 67.84 2
lD Pump or irrigation circle 67.84 2
E - mail: *S ' . I if‘ 5� yeSG 0 t 030 Sign or outline lighting . , 67.84 V.V./ 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: ) (, � panel, alteration, or extension. Page 2 2
1 Each additional inspection over allowable in any of the above
Address: 20 ‘ Do ` 1a T A 4 e , . Additional inspection (1 hr min) 66.25/ hr
( v Investigation (1 hr min) 66.25/ hr
City/State /ZIP: 1 UCZ 1 I Y � �� Industrial plant (1 hr min) 78.18/ hr
Phone: (C 1 ., �� Z ' Fax: (933) Doi ) 11 Inspections for which no fee is 90.00/ hr
specifical listed (t/: hr min)
CCB Lic.: t 6 C D 61 Electrical Lic. :37.51 �$ Suprv. Lic.: `P -6 c ELECTRICAL PERMIT FEES :
/ Subtotal: GT Tq
Suprv. Electrician signature, required :
Lf2. � Plan review (25% of permit fee):
Print name: .E� f • i,
� e Date: 7/9 I /0 State surcharge (12% of permit fee): V . 1
/ TOTAL PERMIT FEE: 15
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ' N �' f r '� s Date: - 7/1/ g> • Number of inspections allowed per permit.
1: \Building\Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /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 .. $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other: •
COMMERCIAL WORK ONLY: • i
Fee for each commercial $67.84
system •
(SEE OAR 918- 309 -0000) •
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
Fl 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
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09