Permit fIF w,l'I CITY OF TI GA R ® ELECTRICAL PERMIT
PERMIT #: ELC2008 -00485
COMMUNITY DEVELOPMENT DATE ISSUED: 8/21/2008
TIGARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102 B D -00600
SITE ADDRESS: 12725 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT : 050 JURISDICTION: TIG
PROJECT: NEW YORK NEW YORK
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: SIGNALIPANEL:
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:
FARID ADRANGI HIGHLIGHT SIGN CORP
4289 ORCHARD WAY PO BOX 230428
LAKE OSWEGO, OR 97035 PORTLAND, OR 97281
Phone: Contact #: PRI 503 729 - 7978
FAX 971 - 228 -2455
FEES
Description Date Amount Reg #: ELE 517S1G
[ELPRMT] ELC Permit 8/21/2008 $53.40 LIC 104599
[TAX] 12% State Surchar 8/21/2008 $6.41 SUP 517SIG
Total $59.81 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 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 throu•h OAR 952 - 001 -0100. s o• ain • of these rules or direct questions to OUNC at 50 .46.6699 or 1.800.332.2344.
I
Issued By % / — % Permittee Signatur- A /i
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.
k�
Electrical Permit Application . ,. s ^, s ' yT t FORrOFFICE'USEONLY ; - 4 A
-' . ' ;' „ 4" t `
1•, ^
• j' t l � s Received
.
u '� ! ''„ City of Tigard s '' �! , Date /B / % Permit No.:. 1...c � G VS
t ° 13125 SW Hall Blvd., Tigard, OR 972 r„.... t \.`
'> ' 1. Plan Review
. S Ph one: 50 3.639.4171 Fax: 503. +Vf , >• Date/By: • Other Permit:
xT I A' R D Inspection Line: 503.639 ' '`� , ,, .•^ ^O �' Date Ready /By: kris' ® See Page 2 for
.,r. ,, Internet: www.tigard or.gov 1 t. Notified/Method: y 6i Supplemental Information
1 d. PLAN REVIEW . ' ' ,.
❑ New construction Addition /alterati 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 I=1 Other
i a p`�� where the available fault current ❑ Marinas and boatyards.
CATEG OF CON CTION 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 A o
❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3"
Job no.: I Job site address: 1 ‘ 2.72 S st tl , p �IFt i . t Six or or more residential R occupancy. Recreational vehicle parks.
4��� 0 or more residential units. ❑Recreation
City/State /ZIP: .f",9, t . 11 A .� G ❑ Health -care facilities. ❑ Supply voltage for more than
3 ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: �pd(f ��n ❑ Service or feeder 600 amps or more.
j' - ' FEE SCHEDULE . `
Cross street/directions to job site: / , 5 , ()e /444(44/"Airs: )I S 7 ' Description 1 Qty. 1 Fee- 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
/ arcel Ea. add'I 500 sq. ft. or portion 33.40 1
Tax ma no.:
map /parcel Limited energy, residential
- ' DESCRIPTION OF WORK , • • (with above sq. ft.) 75.00 2
� Limited energy, multi - family
4m40 WI, 67/1P 67/1P G tr, ,� 4 ir q ROp 4 � residential (with above sq. 0.) 75.00 2
�/ �7� �� °° q �� � / Services or feeders installation, alteration, and/or relocation
�.,
/ �"^ G'L f # 7 f r. �i1 r. / D 1 �P9 Po St S 200 amps or less 80.30 2
. [PROPERTY OWNER - Ill.-TENANT ' , 201 amps to 400 amps 106.85 2
Name: /'r Jj ei Lg. S d /mg re. 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 1 V T w• ri*CiF /a''' 014)Y • Over 1,000 amps or volts 454.65 2
City/State /ZIP: .1- ' IApo f 7 9 3 Temporary services or feeders installation, alteration, and/or
• relocation
Phone: (5b-9 It 3.. y"a I f' Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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
:: DISOLICANT I ' • SNTACT PERSON , above service or feeder fee, 6.65 2
o l/ � hracircc
Business name: �� f Fee
B. Fee foo ban
r branch circuits
Contact name: L aird* 1 �� p _ fi branch n c h service or feeder fee, 46.85 2
first branch circuit
Address: ipi 1 D 210 . 51/ , Each add] branch circuit 6.65 2
t/ Miscellaneous (service or feeder not included)
City/State /ZIP: . litash , 400 4 i(TD Each manufactured or modular 90.90 2
C1'00 A dwelling, service and /or feeder
O
Phone: - Fax: : ( 10 4' - 318a- Reconnect only 66.85 2
E -mail: 919 0 p �1 Lt® � f y 4e191'1/J Pump or irrigation circle 53.40 2
CONMACTOR Sign or outline lighting ge. 53.40 -- , - 3 - `!v 2
Business name: `9 Q A� ,fin Signal p a ne l, a) e r li or
Mt A � � (w�/ energy panel, alteration, or
Address: / it 10 50, 0a L�� �Q / extension. Describe: Page 2 2
vvv r G�
City/State /ZIP: pitisie-wealoo • 4. 97 / y►(' Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (V) ) 4q , .g Aar I Fax: (Cal to 4' — tf."-.. Investigation per hour (1 hr min) 62.50
CCB Lic.: wire Electrical Lic.: ,IT 5'17 I Suprv. Lic.: 37.. (,( / QG4 , Industrial plant per hour 73.75
MIT "FEES'`
Suprv. Electrician signature, required: *,, 40/ `ELECTRICAL PERMIT
53 .1.-C .
Print name: w nA'/^ (- p ! t , M o Plan review (25% of permit fee):
A � � State surcharge (12% of permit fee): C, • L.
Authorized signature: i . TOTAL PERMIT FEE:
�
/ This permit application expires if a permit is not obtained within 180
Print name: `t ! �,,, c Date: A i days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(I1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
,'RESIDENTIAL; ONLY: ; ... . :
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ 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
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls •
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations •
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06