Permit CITY OF TIGARD ELECTRICAL PERMIT
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PERMIT #: ELC2005 -00893
V I L DEVELOPMENT SERVICES DATE ISSUED: 11/14/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S115AB -01900
SITE ADDRESS: 16200 SW PACIFIC HWY D ZONING: C -G
SUBDIVISION: TIGARD TOWNE SQUARE LOT : JURISDICTION: TIG
Project Description: 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:
BIT HOLDINGS LTD PARTNERSHIP SECURITY SIGNS INC
BY FORUM PROPERTIES INC 436 SE 12TH AVE
FIVE CENTERPOINTE DR STE 290 PORTLAND, OR 97214
LAKE OSWEGO, OR 97035
Phone: Phone: 503 - 232 -4172
FEES Reg #: LIC 122809
ELE 26- 560CLS
Description Date Amount
[ELPRMT] ELC Permit 11/14/200: $53.40
[TAX] 8% State Surcharge 11/14/200: $4.27 REQUIRED ITEMS AND REPORTS
Total $57.67
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 0 R 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -6699 or 1- 332 - 344.
Issued By: -,6€1,(/f Permittee Signature:
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'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.
SGNatxx -oo3sI
Electrical Permit ication l (_llz (.)FI ICE 1 ;SE () I.
Aid :N101in»
V Ti )3 ved
City of Tigard addJll JO �lll0 Dat�e/B . permit No.: ...-0 o. ,
13125 SW Hall Blvd., Plan . , Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 5°3.59 8t b !il ° Date/B ,,. ,- :- Other Permit:
Inspection Line: 503.639.4175 r � ' . Date Ready/By: 65 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method �� Supplemental Information
Q 0 YQ@ EI PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other ❑Service over 225 amps, comm'I ['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
ID Multi family ❑ Master builder ❑Other: [Mudding over three stories [Weeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION RV
❑Egress/lighting plan
Health -care facility ❑der: park
Job no.: Job site address: �2, Cam, J ubmit 2 sets of plans with any of the above.
City/State/ZIP: The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: I Project name: - i .... t - iz A 0 Description I Q I R« Total ••
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: I Lot no.: Ea. add'I 500 sq. It or portion 33.40 I
Tax map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
A t� �t dwelling, service and/or feeder 90.90 2
1`��✓�J � � = �% � x j Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I 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 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 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: • without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: ( ) Sign or outline lighting ` 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business narne : [ ., C — r .— f ' t k. S
. 441 �`�- Each additional inspection over allowable in any of the above
Address: 7 4 'L L PA�` L e a R L JC)
Per inspection 62.50
City/State/Z1P:1 Cp__A a v Q 2 QZ Investigation per hour (I hr min) 62.50
Phone: ( ) 23 2. Li f 7 Z Fax: ( ) 27 d ( 5%( a 1 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.:1Z I Electrical Lic' k uprv. Lic.: es3Si e= Subtotal 52 t
Suprv. Electrician signature, required: Plan review (25 %ofpermit fee)
Date t t I •� State surcharge (8% of permit fee) 7 ` a 7
Print name. �
LLu( ` . C TOTAL PERMIT FEE I S7
_ID
Authorized signature: ` r W This permit application expires if a permit is not obtained within 80
1 days after it has been accepted as complete
Print name: ' wk — k — , �1 1.....0 5244.k t ii)Date:1 I • (,4 • • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
is\ Building \permitsELC- PermitApp.doc 12/03 440.4615T(30/02/COM/WEB
Electrica Permit Application - City of Tigard .
Page 2 - S pplemental Information
LIMITE I ENERGY PERMIT FEES:
RESIDENT WORK ONLY: – — - -
Fee for all rest ential systems combined ... $75.00
Check Type of ork Involved:
El Audio and tereo Systems* • •
❑ Burglar Alar
❑ Garage Door • , ener* °
El Heating, Ventilat..n and Air Conditioning
System* •
El Vacuum Systems*
El Other: •
COMMERCIAL WORK ONLY: �
Fee for each commercial system. 5.00
(SEE OAR 918
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
El Data Telecomm 'cation Installation •
El Fire Al. • nstallation
❑ HV ''
❑ I .trumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control* •
❑ Medical
El Nurse Calls °
-
El Outdoor Landscape Lighting* '
El Protective Signaling
❑ Other °
Total number of commercial systems: - ' , < . -
*No licenses are required. Licenses are required
for all other installations
i: \Building\Pormit \ELC- PamitApp.doc 04/03
CITY OF TIGARD
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BUILDING DIVISION PERMIT #: ELC200 &00893 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2005
Phone: (503) 639 -4171 1 1
Inspection Requests (24 Hrs.): (503) 639 - 4175 "! L.
INSPECTION WORKSHEET F.•R DATE: 12/21/2005 TIME: 7:01AM PAGE: 74
SITE ADDRESS: 16200 SW P' :IFIC HWY D CLASS OF WORK:
SUBDIVISION: TIGARD TOW SQUARE LOT #: TYPE OF USE:
PROJECT NAME: RITE AID
DESCRIPTION: Sign lighting.
OWNER: BIT HOLDINGS LTD PA* NERSHIP, PHONE #:
CONTRACTOR: SECURITY SIGNS INC PHONE #: 503232 -4172
Inspection Request Scheduled For: • : te: 12/21/2005 Pour Time:
Code # Inspection Description Conti # Contact # Message
199 Electrical final 023804- 'I 503-546 -7114 N
Corrections /Comments/ Instructions:
rA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr 0 US (... " Date: 1 Phone #: (503) 718- 2 - 4 14 .