Permit CITY F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00118
`�f DEVELOPMENT SERVICES DATE ISSUED: 2/15/2006
`
'' % ° 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S113AD-01700
SITE ADDRESS: 16920 SW 72ND AVE ZONING: C -G
SUBDIVISION: ROSEWOOD ACRE TRACTS LOT : 030 JURISDICTION: TIG
Project Description: 6 ea. 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: 6
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 WIO 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:
BRIDGEPORT LAND LLC MEYER SIGN CO OF OREGON
3939 NW ST HELENS RD 15205 SW 74TH AVE
PORTLAND, OR 97210 TIGARD, OR 97223
Phone: Contact #: PRI 620 -8200
FEES
Description Date Amount Reg #: LIC 64014
[ELPRMT] ELC Permit 2/15/2006 $320.40 ELE 20 - 190CLS
[TAX] 8% State Surcharge 2/15/2006 $25.63
Total $346.03 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 .tification 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 q -sti. s OUNC at
503 - 246 -6699 or 1- 332 -2344.
Permittee Si nature: �_
Issued By: G.� !�.- t-r� -c. g / 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.
i ,7 , FOR OFFICE USE ONLY
Ele ,ieal Permit - i '; Received Electrical
Date/By:V -( q (Oil 0j Permit Nq / Ooll 'ic
�.
City of Tigard Planning Approva Sign
Date/By: Permit No.:.J�) app CO - vta03.2
13125 SW Hall Blvd. �-E 4 6 • Plan Review - Other .
Tigard, Oregon 97223 '' , rr Date/By: Permit Nm
Phone 503- 639 -4171 Fax: 503 - 590- }9 ' ` ■ t Post- Review Land Use .
u.tty I;te\
BUTLDIN Date/By: Case No.:
1
Internet: www.ci.tigard.or.us !La. ' c•_) , I • Contact ,s.:. ® See Page 2 for •
24 -hour Inspection Request: 503 -639 -4175 " -'` Name /Method: `'" 1) Supplemental Information.
. TYPE OF WORK PLAN REVIEW (Please check all that apply) - '
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition /alteration/replacement E _other: S ;G.t/S ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ,-0 Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building n Multi - Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: / 6q 20 5tU 72,1i £ . ' FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: /.5I{/ Sike- Description Qty Fee (ea.) Total i
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
7 ^ C 0 , /t t e� Service included:
Coy rJ �� l` � ` ] LI 1000 sq. ft. or less 145.15 4
(o id 5 6) L� S �Ca/ -- f "« ,-) Uj �t' Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
// //�� — /( Services or feeders - installation,
\.1n5 V ( ) aS�7 C t
6
o � co /S - (lit ` ✓ alteration or relocation:
/r' C 7 200 amps or less 80.30 2
Ic' - 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: )) S cli.61?-s- Reconnect only 66.85 2
Address: 4692 S ., U 72,„,1 `k-. Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 649-8 N - 9 7 ?Y 200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Phone: Fax: 401 to 600 amps 133.75 2
APPLICANT , e O � NTACT PERSON Branch circuits - new, alteration, or
5
Name: t a/ - l c extension per panel:
A. Fee for branch circuits with purchase of
Address.- service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2 -
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
VP
Each pump or irrigation 53.40 2
-
CONTRACTOR Each sign or outline lighting ' 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: ,u Y i,6 G Y oR - 6 6/1 Ca - Description:
Address: /52_0c" Su) 71 L fr.,2
Each additional inspection over the allowable in any of the above:
Cit /State /Zi .: 1 Ai 97 2 Per inspection per hour (min. 1 hour) 62.50
Phone: SD3 k 20-'2[4D Fax: 6 Za- 7o? Investigation fee: _
Other:
CCB Lic. • : & LI n q Lic. #: - 2_(.) - (Q • cc Electrical Permit Fees* _
Supervising electricis 1 Subtotal $ 40
signature required: ' Plan Review (25% of Permit Fee) S
Print Name: 0-f`( 9 , 'N.?I 1M, Lic. # : 5 S 11- State Surcharge (8% of Permit Fee) S ( a3 (03
1 , TOTAL PERMIT FEE $ 30 10 .y 3
Authorized - Notice: This permit application expires if a permit is not obtained ithin
Signature: 1• -.� _ Ir ate: Z — 3 - 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
3 i
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(Please print name)
is \Dsts\Permit Forms\ElcPermitApp.doc 01/03 a U, tib
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
n Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
IT Clock Systems
Data Telecommunication Installation
ri Fire Alarm Installation
n HVAC
1 instrumentation
Intercom and Paging Systems
Landscape Irrigation Control
ri Medical
n Nurse Calls
Outdoor Landscape Lighting
I I Protective Signaling
1 I Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD,
BUILDING DIVISION PERMIT #: / O O D O((g
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
• Phone: (503) 639 -4171 �, . „ i�'�I
Inspection Requests (24 Hrs.): (503) 639 -4175 s' � " .. -..._
INSPECTION WORKSHEET FOR DATE: ,' TIME:9 " ;o t ebeli PAGE:
SITE ADDRESS: /, 9 7 2Y " � e CLASS OF WORK:
SUBDIVISION: ...
LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: (0 PHO NE { P) - `y° Z?-t) °
CONTRACTOR: S t'e \ / - t (,ti eli PHONE #:
Inspection Request Scheduled For: Date: 3 — 0 —v Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 , - 1-t-eS -
• rections Com ' ents/lnstructions:
4
•
PASS fI PARTIAL APPROVAL Ill CANCEL ❑ NO ACCESS
❑ AIL n CALL FOR INSPECTION El FEES ASSESSED
n o' V) e: 3 v� Phone # (503) � '
Inspector: �['i t D at ( ) 718 - 1
CITY OF TIGARD ; ,; y L C-
BUILDING DIVISION PERMIT #:a 6_ bO/ J e
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ,���
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: /6,_ CLASS OF WORK:
SUBDIVISION: / LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 -- -.7 Co Pour Time:
Code # Ins ection Description Confirm # Contact # Message
)9q
Corrections /Comments /Instructions: ■ •
_— _ •
Pt&
VI' c-.4175 1
V(Qzzli) b 8 c.orKec-15 NLL. %As tPti iTANZ•
❑ PASS 1 1 PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t..Z2 1v.‘ Date: � <A, Phone #: (503) 718 - imC?°
CITY OF TIGARD
BUILDING DIVISION PERMIT #: z - 60 11
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / l Z a 7 d CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: q6 ( N 5 PHONE #:
Inspection Request Scheduled For: Date: 3 - 2 (0 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 9 — � - � (moo--
Corrections /Comments/ Instructions:
S Aisne' c-te.2 li csm 5 A5 eeIkMit 266le 1006'O
bat 3 241 Ob
(l PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: G-Atka 1 V ►^moo Date: 2� Phone #: (503) 718 -t