Permit CITY OF TIGARD ELECTRICAL PERMIT
I
Y ° PERMIT #: ELC2008 - 00003
COMMUNITY DEVELOPMENT DATE ISSUED: 1/2/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 115A B -01900
SITE ADDRESS: 16200 SW PACIFIC HWY SIGN ZONING: C -G
SUBDIVISION: TIGARD TOWNE SQUARE LOT : JURISDICTION: TIG
PROJECT: TIGARD TOWN SQUARE
Project Description: (2) electrical sign lightings. Job No. 109617/1
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: 2
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:
HARSCH INVESTMENTS CORP TUBEART SIGNS
851 SW 6TH AVE SUITE 55 4243 -A SE INTERNATIONAL WAY
PORTLAND, OR 97204 MILWAUKIE, OR 97222
•
Phone: Contact #: PRI 503 - 653 - 1133
FAX 503 - 659 -9191
FEES
Description Date Amount Reg #: ELE 37 554CLS
[ELPRMT] ELC Permit 1/2/2008 $106.80 LIC 70956
[TAX] 12% State Surchar 1/2/2008 $12.82 SUP 366SIG
Total $119.62 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 suspended for
more than 180 • - • TTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 -' : -0010 throu • ' OA ° 901 -0100. You may obtain copies of these rules or direct questions to OUNC at at 5� .669• • s • '. 14.
Issued By: di % ` �_ 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:
-eONTRACTOR 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.
Eleetrieill Permit EIVED FOR O
A lic C I' OFFICE USE ONLY
City of Tigard ��// Received Permit No.: ^,, g �Sy.
y g DateB : / 0 ��Oeod a-C.r/i
9
q 13125 SW Hall Blvd., Tigard, OR 97 2008 Plan Review
Phone: 503.639.4171 Fax: 503.59 t t V fi DateB : Other Permit:
TI G A R D Inspection Line: 503.639.4175 ,,T O F TIGAAD Date Ready/By: Ju ls' el See Page 2 for
InterneInternet: www.tigard- or.gov LI' ! e Notified/Method. �' Supplemental Information
TYPE PLAN RE VIEW
Please check all that apply (submit 2 sets of plans w(m
tes checked below):
® New construction ❑ Addition/alteration/replacement
❑ 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 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling tf 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
El Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: log L / l i Job site address: � (,�-a W `� -� � w IOO or more occupancy.
�! ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: — r , �' ' '' ;) tJ ❑ Health -care t i es. 0 Supply voltage for more than
V 10'rt f ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
Ti 4�t..� To r Sp 4.-A"-C._ FEE SCHEDULE
Cross street/directions to job site: [ Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
C r) Y i( ('(t, 141-., 4 .f ( T‘,4-ex-,m, I y residential (with above sq. ft.) _ 75.00 2
Services or feeders installation, alteration, and/or relocation
t II te r "'^'+"`'c` "FPf-J2_. S� S S r 200 amps or less 80.30 2
gi PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: ga i�t. /'_ 401 amps to 600 amps 160.60 2
c w ,{ 601 amps to 1,000 amps 240.60 2
Address: gs I J 6 i 4 o f S r ; j s S ' Over 1,000 amps or volts 454.65 2
City /State /ZIP: rPo,t 1- (,_._1. t o 9 -�_. i f Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I Di CONTACT PERSON above service or feeder fee,
Lys each branch circuit 6.65 2
Business name: -r, t 4N+ 'D- `�-c SP S B. Fee for branch circuits
without service or feeder fee,
Contact name: R ��� ( A( �� � first branch circuit 46.85 2
Address: L - A S E �„ ,4_,,... L Each add'I branch circuit 6.65 2
/ Miscellaneous (service or feeder not included) _
City /State/ZIP: ; (, wt� 0e - ei 7-')-):D- Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( 5 0 3 ) c S 3 _ ((33 Fax: : (S-o3 ) 6 sq -qf q tl Reconnect only 66.85 2
E -mail: Pump or irrigation circle ! _ 53.40 2
CONTRACTOR Sign or outline lighting I V 53.40 /e)
53.40 k 2
Business name: L T Signal circuit(s) or limited -
4 /� + V t S � b-y S energy panel, alteration, or
Address: / extension. Describe: Page 2 2
S -.... -2
City /State/ZIP: S c4_ w - Q Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) S � Fax: ( ) S c .t-4 -e Investigation per hour (1 hr min) 62.50
CCB Lic.: --- 4.0.16 - 1 0 Electrical Lic.:3 _ yea Suprv. Lic.:'366 -.S' U r. Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 4 e � I , Subtotal: / �ft�
Plan review (45% of rmit fee): 'e9'
Print name:
` Date: k 1 e J g
�" Stl�4 .74111, .74111, ��0I
Statesurclidf't f permit fee): / . 51p,,, Authorized signature: /��� TOTAL PERMIT FEE:
li ` lya
This permit application expires if a permit is not obtained within 180
Print name: l � � Date: `�� J days after it has been accepted as complete. •
' f • Number of inspections allowed per permit.
I:'. BuildingPermitsiELC- permnApp.doc 05/23/06 440- 4615T(It /05 /COM/WEB