Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005-00299
�.
� _ �I� DEVELOPMENT SERVICES DATE ISSUED: 5/3/2005
'' I 4 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S134AA-01900
SITE ADDRESS: 10115 SW NIMBUS AVE ZONING: C -
SUBDIVISION: 1 KOLL BUSINESS CENTER TIGARD LOT : 001 JURISDICTION: TIG
Project Description: (2) sign connection.
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: _
TUBEART SIGNS
4243 -A SE INTERNATIONAL WAY
MILWAUKIE, OR 97222
Phone: Phone: 503 - 653 - 1133
FEES Reg #: LIC 70956
Description Date Amount SUP 3
ELE 37-554CLS
[TAX] 8% State Surcharge 5/3/2005 $8.54
[ELPRMT] ELC Permit 5/3/2005 $106.80 REQUIRED ITEMS AND REPORTS
Total $115.34
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 -6699 or
1- 800 - 332 -2344.
Issued By: 0, Ilif 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.
. o, F rp NED
Electrical Permit ji CaLion FOR OFFICE USE ONLY .
City of Tigard 11AI ®3 2005 Received --di )�� Permit No. J 4 1So�..2
13125 SW Hall Blvd., Tigard, OR Yt Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 n � i Date/B : Other Permit:
Inspection Line: 503.639.417 1 I OF' TIGARD e! II Date Ready/By: Juris ® See Page 2 for
Internet: www c1 tigard or us
T!NG DIVISIO 1 Notified/Method: 1 Cr Supplemental Information
i� �•:.s ,: L i� 4 TY4 E OF ,WOR 1 xr sy {.rfr ,:�:- & r .,: .' ' s u t PLAN REV.�IEW
�ew construction dition/alteration/replacement Please check all that apply:
❑ Demolition 12 Other 4 /6-71.1 ['Service rn
Service over 225 amps, com'I ❑Hazardous location
Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
Ya j/ M a GATEGORT O0ONSTRUCTIONP r „ + y y of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- fatnil ❑Building over three stories ❑Feeders, 400 amps or more
y ❑ Master builder ❑ Other
D t OB r S11 INFORMATION A 4J L OCATIO N ;> a� Ar 3 DOccupant load over 99 persons ['Manufactured n tured structures or
-s u ._,, <+ , .,; .' r J .. t ....- t •, , �., -._. ... . . P , -.. ,.t,,.._r. ❑ Egress /lighting plan P
Job no.: Job site address: /Q / Jr k) Adi K13 616 ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: / ( .../ 4 ,-,, q 7 ZZ 3 The above are not applicable to temporary construction service.
/Q , r /6/0y /q-�� -'
/� �y�2-- [�T�� - '- A/6-- A/6-- Desc
�� , � nption Qty. I Fee. �,
Suite/bldg. /apt. no.: Project name: Total
Cross street/directions to job site: S Cti CAL S r Klik 9 New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
' :'1.04';`7'13'''' - } DE CRIP�TIOI WORI{ , a + , f' " " z ; , Each manufactured or modular
dwelling, service and /or feeder 90.90 2
lit' -� r ( 5 / 6-A) i G� Services or feeders installation, alteration, and /or relocation
t ,as r/ / e.. f 200 amps or less 80.30 2
' - . OWNER a = n s r , TENANT s' � t 0.,,-;...14-+ n 201 amps to 400 amps 106.85 2
... .. v J. . . . .. �... . . _ '
.,'. . . , ,. .1..LY., ... _._ . , - �.c _... . _ .
" 401 amps to 600 amps 160.60 2
Name: R � - Zit -, I it s� S u r z ii . / �C5' 601 amps to 1,000 amps 240.60 2
Address: 1 e s-d 1,.-. c f 1 ray Lk( Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: is 1 s e - per_ A * 6 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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
r y r ®`APPLIC T f - �' 1 t - it' Y PERS t. A. Fee for branch circuits with
s
service or feeder fee, each 6.65 2
Business name: ! Vf f Yti't ' branch circuit
B. Fee for branch circuits
Contact name: / v �
IJ 1p j . p k) � / � ) Q < j '' i-L� without service or feeder fee, 46.85 2
Address: /J each branch circuit
Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
( ) c s--3..._ ! i 3 ( ) f 4 , Pump or irrigation circle 53.40 2
Phone: Fax:: S03
,,,s---9____q Sign or outline lighting r .,7--- 0 53.40 /Q6_ yr) 2
E -mail: Signal circuit(s) or limited-
{ 7 : 5' ? `' �' t = energy panel, alteration, or
t . :.. . . _ .. O.V ItACTO12 a H . , : a gY P
extension. Describe: Page 2 2
Business name: / /5 re 4'/ZT
Address: 4 Z l f ?.3 - A 5E I i3 T c u> Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: V( t (_1&'O i . Itjlp On_ Q 7 -Zy Investigation per hour (1 hr min) 62.50
Phone: ( ) 6, c 3 — 1 1 3 3 Fax: ( ) � CJ _ 9/ ?/ Industrial plant per hour 73.75
I Y .t. s t .: E_ LE 10081081.5,PORI FOES* a "" , '
CCB Lic.: 70 cps-4, Electrical Li Lic.: 7 _6/6- Subtotal A /e,31!) Suprv. Electrician signature, required: / �/ Plan review (25% of permit fee)
Print name: 1� S' .jJ� ,�� IIITTTT"' Date:'j — - G� State surcharge (8% of permit fee) 41-TT �,
TOTAL PERMIT FEE $:44,--& Authorized signature: ` % /L7 T his permit application expires if a permit is not obtained within 180
�/ days after it has been accepted as complete / / [ ,7
Print name: / K� S(� �-- t Date:s' - 3 —per— • Fee methodology set by Tri- County Building Industry Service Board •J
•• Number of inspections per pemut allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
rre- r r irxsY^ r 5��',� a.rr�`�"*L'.x. gYR IV
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
CO MkE~WDn ONTtr Mra: _ _.ka
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
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
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \ Permits \ELC- PermitApp.doc 04/03