Permit CITY OF TIGARD
BUILDING DIVISION PERMIT #:EL COU/01 9 COS 13
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:10 • 41,(34t
Phone: (503) 639 -4171 . �� I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: I'L• a .t % TIME: PAGE:
SITE ADDRESS: 1 2 %5 0 tja &ftJJ fat"- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: , 0.06
DESCRIPTION: s . - 13p S
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: It.. 3 . Pour Time:
Code # Inspection Description Confirm # Contact # Message
tiq ° ` - - iOM--
Corrections /Comments /Instructions:
b 7-- Wk s- 1 -1 4 - 3 &L-L--f t(\pvl
. i-41/4431 11.13 Cr-U6
r PASS ❑ PARTIAL APPROVAL ❑ CANCEL P1 NO ACCESS
N CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ( Date: 121 u O Phone #: (503) 718 - IL
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CITY OF TIGARD
ELECTRICAL PERMIT
IN
PERMIT #: ELC2008 -00573
COMMUNITY DEVELOPMENT DATE ISSUED: 10/8/2008
TrGAREii 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102C B -00100
SITE ADDRESS: 12850 SW GRANT AVE ZONING: R -12
SUBDIVISION: CF TIGARD ELEMENTARY LOT : 041 JURISDICTION: TIG
PROJECT: BROADWAY
Project Description: Sign lighting for wall signs.
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:
WACO SCHOOL DISTRICT NO. 23 SECURITY SIGNS INC
6960 SW SANDBURG ST 2424 SE HOLGATE BLVD
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Contact #: PRI 503 - 546 -7114
FAX 503 - 230 -1861
FEES
Description Date Amount Reg #: ELE 26- 560CLS
IELPRMT] ELC Permit 10/8/2008 $106.80 LIC 122809
[TAX] 12% State Surchar 10/8/2008 $12.82 SUP 383 SIG
Total $119.62 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may ob -.• • •ies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
i rA 7
Issued By: / i Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
(jei3O240 - ?3 -0• 8'7 -:- O 0/
Electrical Permit Application .1 O12 of I lc l UsI ()Ni , •
.—
City of Tigard Received _
`J g Date /B : Mirmen
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 l a a,,! 1/, Other Permit:
I�I Date /B
Inspection Line: 503.639.4175 % • ".� L Date Ready /13y: t$ See Page 2 for Pei Internet: www.ci.tigard.or.us Notified/Method: ` Su
PE CIF ��� PLAN REVIEW
❑ New construction A AddiatAlteratio' ' n _. . ent Please check all that apply:
❑ Demolition ❑ Ot • ��t' \ ® r ['Service over 225 amps, comm'l ['Hazardous location
® ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. R.,
CATEGO a .`L .:i '• V ON of I - and 2- family dwellings 4 or more new residential
' ,•.I . - to /industrial El Accessory building ['System over 600 volts nominal units in one structure
❑ I- and 2- family dwelling ] 6
❑ Multi- family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more
['Occupant Toad over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lightingplan RV park
Job no.: Job site address: i ['Health-care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project nam . _ 41 Q FEE* SCHEDULE
Description I Qty. I rec. I Total I **
Cross street/directions to job site: / New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. R. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. R. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
\\ dwelling, service and /or feeder 90.90 2 TA ��y / Services or feeders installation, alteration, and /or relocation
Q � -
r �f .1 / i C(4 e 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ T A NT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Sec uirty Signs branch circuit
B. Fee for branch circuits
Contact name: Melissa Hayden without service or feeder fee,
2 424 SE Holgate Blvd first branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/State/ZIP: Portland, OR 97202 Miscellaneous (service or feeder not included)
Phone: ( 503) 546 7114 Fax: : ( 503 )230 1861 Sump or irrigation t incle 53.40 F} 2
Sign or o lighting � 53.40 N9 Z(;) 2
E -mail: Melissa @SecuirtySigns.com _ _ _ V _ Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Security Signs -
Address: 2424 SE Holgate Blvd Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Portland, OR 97202 Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: ( 503 ) 546 7114 I Fax: ( 503)230 1861 ELECTRICAL PERMIT FEES_* _
CCB Lic.:122809 Electrical Lic.:26 ICLS Suprv. Lic.:383 SIG -- - -� ^ Subtotal (C. K � V 7
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ( _ 7a—,
Print name: Marc Lin uist Date:
TOTAL PERMIT FEE (` 61 (y).
Authorized signature: This permit application expires If a permit is not obtained w ithin 180
M elissa Hayden days after It has been accepted as complete
Print name: Y Date: Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits \ELC- PmnitApp.doc 12/03 440- 4615T(10 /02,COMiW