Permit 14, CITY OF TIGARD
ELECTRICAL PERMIT
PERMIT #: ELC2008 00311
COMMUNITY DEVELOPMENT
DATE ISSUED: 6/3/2008
TCGnKD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S1 12 D D -00300
SITE ADDRESS: 15900 SW 72ND AVE ZONING: I -L
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: CONOCO PHILLIPS /76
Project Description: Installation of (3) sign lightings.
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: 3
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/0 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:
PACIFIC ENVIRONMENTAL SERVICE CO MEYER SIGN CO OF OREGON
PO BOX 2049 15205 SW 74TH AVE
PORT TOWNSEND, WA 98368 TIGARD, OR 97223
Phone: 425 - 478 -7489 Contact #: PRI 503 - 620 -8200
FAX 503 - 620 -7074
FEES
Description Date Amount Reg #: ELE 20 190CLS
[ELPRMT] ELC Permit 6/3/2008 $160.20 LIC 64014
[TAX] 12% State Surchar 6/3/2008 $19.22 SUP 566S1G
Total $179.42 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 • • • : ' • - ccordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more th- • 80 days. • ' ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR • 2- 001 -0010 throu• h •. - 452 -■ • 1 -0100. You may obtain copies of these rules or direct questions to OUNC at 503. • 6.6699 or 1.800.332.2344.
Iss ed By: , / / ` l� i / ' 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.
, ' .5c, ,u2 - cry l a
Electrical Permit Application • FOR OFFICE USE ONLY .
,
ry >�
11111 City of Tigard Received 3 D D P er mi t No / 57 "XS/
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 . Phone: 503.639.4171 Fax: 503.598.1960 Date /Bv: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard - or.gov Notified /Method: 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 stones
❑ Demolition tier: �, ' 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
El � 1- and 2- family dwelling mercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A °E "I -2", "I -3'
/5 � €v' rz4Q� I OOoP o e residential Recreational Job no.: Job site address
JJ p y ❑ Six or more residential mots ❑Recreational vehicle parks
City/State/ZIP: P� � �4 /CA 7 Z Z. cf. / ❑ Health -care ca ❑ Supply voltage for more than
_ ❑ Hazardous locations 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Mocto .PA(1 Cf S 74, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: eaf, MIA) A / 7 / Description 1 Qty. 1 Fee. 1 Total l "
� New residential single - or multi - family dwelling unit.
�p r�p� 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 I
Tax map /parcel no.: Limited energy. residential
DESCRIPTION OF WORK (with 75.00
wt above s q. 0 )
nry / Limited energy. multi - family 75.00 2
L o 1 12a # i V i t) , LL t 'p I . CM � � residential (with above sq. ft.)
111 Services or feeders installation, alteration, and /or relocation
(.;e) 16 Ca ill 0 t"( 200 amps or less 80.30 2
ROPERTY OWNER l 9 Cj t - EN T 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: i 0 0 o DM ✓n � m
U i ry` & (,.P►Q GI - 601 amps to 1.000 amps 240.60 2
Address: J p ' 0 ` - � z' - 4 2010 Over 1.000 amps or volts 454.65 2
City/State/ZIP: Q Temporary services or feeders installation, alteration, and /or
T b�- �� _ � I • relocation
Phone: (L 2 )) sl 18 - -7 t,.,48 ( Fax: ( ) 200 amps or less 66.85 I
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 1 CONTACT PERSON above service or feeder fee.
6.65 2
each branch circuit
Business name: � _ do � �� Q ' 13. Fee for branch circuits
p ' without service or feeder fee, 46 85
Contact name: first branch circuit
Address: Each addll branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) I Fax:: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 3 53.40 2
Signal circuit(s) or limited- j
Business name: AI o L er 6(6 a, eh op , e- energy panel. alteration. or 1
Address: / 5010 C r6 �5' '. 4-uR v extension. Describe: Page 2 2
City /State /LIP: '/ ('G 1), ` 1 q 7 z z lF- Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) 6 2 0 I Fax: ( ,)?) b 2,0-7 07 V Investigation per hour (1 hr min) 62.50
CCB Lic.: 6 p Electrical Lic.: zo_n ()C L5 Suprv. Lic.: 6 Industrial plant per hour 73.75
( /U ` s' ELECTRICAL PERMIT FEES
_ Suprv. Electrician signature, required: _ Subtotal: /7a, �O
(1 ` Da te: Plan review (2' % of permit fee): O
Print name: : I t L D ►� S� It? State surcharge (12 %ofpermit fee): /9..0 --
Authorized signatur . ' —` T � = .. +` TOTAL PERMIT FEE: /7,. y y
This permit application expires if a permit is not obtained within 180
Print name: iS�,p, P \; Date: S og days after it has been accepted as complete.
• Number of inspections allowed per permit
I \ Building \Permits \ELC- PermitApp doc 05 /23/06 440 -461 ST(1 I /O5 /COM/WEB