Permit ELECTRICAL PERMIT
CITY OF TIGARD
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COMMUNITY DEVELOPMENT PERMIT #: ELC2007-00682
DATE ISSUED: 10/3/2007
-TIGARD-' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102C B -01802
SITE ADDRESS: 13405 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: STEEL HORSE BAR & GRILL
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: SIGNAUPANEL:
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:
CLARK SIGNS
PO BOX 1113
ST HELENS, OR 97051
Phone: Contact #: PRI 781 -4236
FAX NA
FEES
Description Date Amount Reg #: ELE 389S1G
IELPRMTI ELC Permit 10/3/2007 $53.40 LIC 64933
TAX] 8% State Surcharge 10/3/2007 $4.27 SUP 5-I8CLS
Total $57.67 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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.669 .800.332.2344.
Issued By: � 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.
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1) _al Permit Applicatio> :y � � . ' FOR OFFICE USE ONLY,1 i ' X irtsi, , reN ��r ;
R eceived i p
` City of Tigard / 1 Permit N ��
ti "� ° 13125 SW Hall Blvd., Tigard, OR 97223 (1 � 1 4,� ;� 2007 Plan Re view O 67 ` O� ��
'. In / Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date /By:
T I G tt D Inspection Line: 503.639.4175 GIP( O F TIGARD Date Ready /By: Juris,,/ ® See Page 2 for
g g / Supplemental Information
Internet: www.ti ard -or. ov BUILDING pILDING la DIVI IO iv N Notified/Method:
TYPE OF WORK PLAN REVIEW-
❑ New construction Addition /alteration/replace ent 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: 9 / \ 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
❑ 1- and 2- family dwelling at 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 ", "I -2 ", "1 -3 ",
n 100HP or more. occupancy.
Job no.: Job site address:
13 yc, S C k r y ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: - Q04. / � � 0 Health-care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal
Suite /bldg. /apt. no.: Project name: S-Aeel Az S c , „ ❑ Service or feeder 600 amps or more.
i FEE SCHEDULE
Cross street/directions to job site: D escription 1 Qty. 1 Fee I 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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK • (with above sq. ft.)
Limited energy, multi - family
/Q G 9 e�! ‹ -k S .9 GI residential (with above sq. ft.) 75.00 2
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
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, 6.65 2
each branch
s
Business name: G f et Y- t p p 0_5 B. Fee for branch circuit
circuits
Contact name: , Fah l C es< fir st branch nch circuit or feeder fee,
� a first branch circui t 46.85 2
Address:
Each add] branch circuit 6.65 2
/113 Miscellaneous (service or feeder not included)
City/State /ZIP: Sf #e /gas 01L 9 7v3 7 Each manufactured or modular 90.90 2
973 _g/ / dwelling, service and/or feeder
Phone: (5o)) 7B(_ y� Fax: : 03) (_ Y Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
_ CONTRACTOR - Sign or outline lighting
/ 53.40 53 2
Business name: / / Signal circuit(s) or limited-
! a( /' K - , 7 4f energy panel, alteration, or
Address: to 6 ii / 3
/ of) extension. Describe: Page 2 2
City /State /ZIP: s Mete OK 4—)as---/ t 0t/ Each additional inspection over allowable in any of the above • lo . ■ Per inspection 62.50
P( Phone: ( �e 3 ?8 , - .t� G Fax ( .11 I / d� ..s
y Investigation per hour (1 hr min) 62.50 11 L. CCB Lic.: Electrical Lic. :-• r,3/ -.0 L5 Suprv. Lic.: ` SBA � / Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES -
Suprv. Electri an s sa e, required: Subtotal: 5.3 "-,
Print name: � /_ a �.� Date: /rj_3, Plan review(25 %of permit fee):
�+ State surcharge (8% of permit fee): 4. a
Authorized signature: TOTAL PERMIT FEE: 5 7 ,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
" Number of inspections allowed per permit. � •
I \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
9 /J
Electrical Permit Application - City of Tigard
Page 2 -. Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL-WORK
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
H Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls •
❑ Outdoor Landscape Lighting*
H 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
CITY OF TIGARD
BUILDING DIVISION PERMIT #: f=t.C2007- 006132
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/3/2007
Phone: (503) 639 -4171 d..
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/12J2007 TIME: 7:01AM PAGE: 45
SITE ADDRESS: 13405 SW PACIFIC I CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: STEEL HORSE BAR & GRILL
DESCRIPTION: Sign fighting.
OWNER: PHONE #:
CONTRACTOR: CLARK SIGNS PHONE #: 781-4236
Inspection Request Scheduled For: Date: 10J17J2007 Pour Time:
C..- nspec io : cription Confirm # Contact # Message
199 Elecf.rical final 057516.02 503-781-4236 N
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W ASS PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
FAIL I I CALL FOR INSPECTION _ ADDITIONAL FEES ASSESSED
Inspector: Iv 1.(6 LE Date: /Gl `1401 Phone #: (503) 718 -1 $4
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