Permit •
CITY OF TIGARD ELECTRICAL PERMIT
0 . COMMUNITY DEVELOPMENT
Permit #: ELC2009 -00361
Date Issued: 07/21/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY W2
Subdivision: Lot: 0
Project: Taekwondo
Project Description: Sign /outline lighting for one sign.
Owner: FEES
SN PROPERTIES PARTNERSHIP Quantity Description Date Amount
1121 SW SALMON ST
PORTLAND, OR 97205 1 ea Sign or Outline Lighting 07/21/2009 $53.40
PHONE: 1 ea 12% State Surcharge - 07/21/2009 $6.41
Electrical
Contractor:
GRAPHIC D SIGNS LLC
2255 SE 122ND AVE
PORTLAND, OR 97223
PHONE: 503 - 256 -2064
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.81
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable 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, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 3.246.6699 or 1.8 .
/l/ U✓l
Issued By: y�Q _ t7 e � n � 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' 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 RECEIV FOR OFFICE USE OLY
illlil City of Tigard ved I Permit o.: •
13125 SW Hall Blvd., Tigard, OR 97223 t Plan Review
Phone: 503.639.4171 Fax: 503 598.1960 JUL 21 200 DateB : Other Permi : iii Al ` y. • i
'F I G A R D Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGA s' I otified/Method: Supplemental Information
TYPE OF WORK BUILDING DIVISION . . PLAN REVIEW .
❑ New construction ❑ Addition /alteration /replacement 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 OP 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 y 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: r (, , o (r 100HP or more. occupancy.
l Cpp . v �\ V S"V I�(� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 'j t J ❑ Health -care facilities. ❑ Supply voltage for more than
1 t 9� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: w _ Project name: 1 E KW 0 N n/1 ❑ Service or feeder 600 amps or more.
v 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
75.00 2
DESCRIPTION OF WORK (with above sq. ft)
/� L ' ' \ e�Q} p (it)
Limited energy, multi - family 75.00 2
. `ci4,A in l v L Sri- 1 residential (with above sq. ft.)
66 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
Name: `;' 'I " pctm,Q 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: 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 ' ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: L - (1 L B. Fee for branch circuits
G C � Q. �i L` without service or feeder fee,
Contact name: first branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 90.90 2
^ f dwelling, service and /or feeder
Phone: (IJI
(�) a D� F ax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR . - , . Sign or outline lighting 53.40 Sl, 4f) 2
�/� / Signal circuit(s) or limited -
Business name:
GC JCL��� s `�� S l energy panel, alteration, or
Address: , J S c c5€ 1222^ ¢CV f' • extension. Describe: Page 2 2
• City/State /ZIP: po iu- Il, U 0) 22 3 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (� �--/ ) ^ Fax: 7
to — W(.4 ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: ( c 2:-- Electrical Lic.:16_1 j� SC uprv. Lic.: 7'f_ S - �6 r Industrial plant per hour 73.75
required: ELECTRICAL PERMIT FEES A
Suprv. Electrician signature, uired: ��� Subtotal: ¢s3 40
Plan review (25% of permit fee):
ur e:
Print name: i,. C x Dater_ ` 01
State surcharge of permit fee):
Authorized signature: `V n V '� TOTAL TAL PERMIT FEE: S ,8 __.> This permit application expires if a permit is not obtained within 18
Print name: L� ( Jam/ Date: .��I — OG days after it has been accepted as complete.
1 • Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(I I /05 /COM/WEB
t O '
Electrical Permit Application - City of Tigard ❑ Other
Page 2 - Supplemental Information Total number of commercial systems:
LIMITED ENERGY PERMIT FEES: '-No licenses are required. Licenses are requir
for all other installations
RESIDENTIAL WORK ONLY
Fee for all residential systems $75.00
combined
Check Type of Work Involved:
❑ Audio and Stereo Systems"'
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
H Other:
COMMERCIAL WORK ONLY: .
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control'
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting"'
❑ Protective Signaling
I: \ Building \PermitsWLC- PermitApp.doc 03/23/06