Permit
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2009-00615
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/13/2009
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9659 SW WASHINGTON SQUARE RD M06
Subdivision: Lot: 0
Project: Spencer's
Project Description: Sign lighting for (1) sign.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 1 ea Sign or Outline Lighting 11/13/2009 $67.84
1 ea 12% State Surcharge - 11/13/2009 $8.14
PHONE: Electrical
Contractor:
VANCOUVER SIGN COMPANY INC
6615 SW HWY 99
VANCOUVER, WA 98665
PHONE: 360-693-4773
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permi ' issued subject the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done n accordance with appr a lans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TTENTION: Oregon law qui you to follow the rules adopted by the Oregon Utility Not!' enter. Those rules are set forth in OAR
952-00 -0010 thr ugh OAR 952-0 1-0 Yo may obtain a cop of the rules or direct questions to OUNC by ca 246.6699 or 1.800.332.2344. ^ 1
t
Issue PermitteeSignat e: lCJ
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 FOR OFFICE USE ONLY
Receivd
City of Tigard Date/Be : I i /07 Permit No.: &1 `J
0--alp 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
hm Inspection Line: 503.639.4175 Date Ready/By: Ind" EZ See Page 2 for
Internet: www.tigard-or.gov Notified/Method: t Supplemental Information
TYPE OF WORK 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 OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ l- and 2-family dwelling ELCommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pomp. ❑ 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: - ' ' IOOHP or more. occupancy.
el41ib tort. S R~ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 7 Z Z 7 ❑ Health-care facilities. ❑ Supply voltage for more than
I; AOL -CA J ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description Qty. Fee. Total
New residential single- or multi-family dwelling unit.
(A) a G , 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.)
Limited energy, multi-family 75.00 2
1 t 61'A 11 residential with above sq. ft.)
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: 401 amps to 600 amps 160.60 2
C 5 601 amps to 1,000 amps 240.60 2
Address: 5 t Over 1,000 amps or volts 454.65 2
City/State/ZIP: -'t 2 3 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: Vancouver Sign Cc B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: first branch circuit
Address: 6 615 NE HWY 99 Each add'1 branch circuit 6.65 2
Miscellaneous service or feeder not included
City/State/ZIP: Vancouver WA 9 8 6 6 5 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( 3 6 q 6 9 3 4 7 7 3 Fax:: (360) 6 9 3 2 7 4 7 Reconnect only 66.85 2
E-mail: 5i C.ot Pump or irrigation circle 53.40 2
CONTRACTOR - Sign or outline lighting • 2
name: Signal circuit(s) or limited-
Business Sign Co energy panel, alteration, or
Address: 6 615 NE HWY 99 extension. Describe: Page 2 2
4 City/State/ZIP: Vancouver WA 9 8 6 6 5 Each additional inspection over allowable in an of the above
Phone:( 3 6 0 6 9 3 4 7 7 3 Fax: (360) 6 9 3 2 7 4 7 Per inspection 62.50
Investigation per hour (I hr min) 62.50
\hJ• CCB Lic.: 6 3 9 51 Electrical Lic.3 7 - 4 6 CLS Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 4A4e Subtotal:
Print name: "0• L-11 I Date: /iii q Plan review (25% of permit fee):
State surcharge (8% of permit fee): t
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not ob fined within 180
Print name: O Dale: days after it has been accepted as complete.
Number of inspections allowed per permit.
l:\Building\Pcmiits\ELC-PennitApp.doc 05/23/06 410-4615T(I1/05/COM/WEB