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Permit p CITY OF TIGAR® ELECTRICAL PERMIT F 1 COMMUNITY DEVELOPMENT Permit #: ELC201000384 T f Gl� R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/27/2010 Parcel: 2S102AA00602 Jurisdiction: Tigard Site address: 11960 SW PACIFIC HWY Subdivision: Lot: 0 Project: Kaufman Streamborn Project Description: Sign lighting for relocated pole sign. Owner: FEES AMAN, WALTER Quantity Description Date Amount PO BOX 2990 TUALATIN, OR 97062 1 ea Sign or Outline Lighting 07/27/2010 $67.84 PHONE: 503 692 -9182 1 ea 12% State Surcharge - 07/27/2010 $8.14 Electrical Contractor: GARRETT SIGN CO INC 811 HARNEY ST VANCOUVER, WA 98660 PHONE: 360 - 693 -9081 FAX: Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $75.98 Required Items and Reports (Conditions) This permit i • subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other appl' able law. All work will be don- n accordance • approved plans. This permit will expire if work is not started within 180 ys of issuance, or if work is s pended for more the 180 days. ATTENTION: Oregon law req ' _ you to follow the rules adopted by the Oregon Utility tification Center. Those r es are set forth in OAR 952 .01 -0010 thro h OAR 952 -00 -0 D0. ou. obtain a copy of the rules or direct questions to OUNC by calling 3.246.6699 or 1.800.3 .2344. /I k I - - uedBy: ` - 6 1,4 PermitteeSignature: 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' . _: I -1 4.‘ � Date: LICENSE NO. CaII 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. Electrical Permit Application . ., ° ; FOR OFFICE USE:ON Y Received Et e' 0 20 /0 - 6D 3 City of Tigard Retell 7 A7 0 / PermitNo.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C " Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: - T PG A R D. Inspection Line: 503.639.4175 Date Ready /By: Juris: la See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information TYPE OF WORK .. PLAN REVIEW Vf 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 stories. .❑ Demolition ❑ Other: 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 ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder R Other: S /6--.1✓ ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFOItINATION • AND,-LOCATION ❑ Emergency system. larger separately derived system. ❑Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: Job site address: / �J r �/ 100HP or more. occupancy. / 6d XIV / //' C 17 ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: �. ' 9 7 ' 7 ❑ Health-care facilities. . ❑ ❑ Ha Hazardous Supply voltage for more than 7 rdous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. Cross street/directions to job site: FEE SCHEDULE J Description I Qty. 1 Fee. 1 Total I" New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 67.84 2 . DESCRIPTION OF WORK (with above sq. ft.) 1//6(1,/ © Limited energy, multi- family 67.84 2 / � � XY6'- g - residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 [PROPERTY. OWNER " - ❑ TENANT. 201 amps to 400 amps 133.56 2 Name: /� - 401 amps to 600 amps 200.34 2 �L i- ,i,N 601 amps to 1,000 amps 301.04 2 Address: fie2 6 p '2- . 4� Over 1,000 amps or volts 552.26 2 • / Temporary services or feeders installation, alteration, and /or City /State /ZIP: ni t� (J�- 9 � U � Z relocation Phone: (173 ) 0 f' Z ._ 77/?...___ Fax: ( ) 9 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 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 7.42 2 / each branch circuit Business name: / , m « t E a B. Fee for branch circuits without 11 Pit service or feeder fee, first Contact name: \ �,/h 0 branch circuit 56.18 2 'V Each add'I branch circuit 7.42 2 Address: Nt ' " ,, e , r Miscellaneous (service or feeder not included) W' Each manufactured or modular ^ A City/State /ZIP: , U/1 ��° dwelling, service and/or feeder 67.84 2 • Phone: ( ) , 7. ) 6(>../...p i ` 0 VVV .5q1.4. 1) Fax :•: () O `3 Reconnect only 67.84 2 1 Pump or irrigation circle 67.84 2 E -mail: O ''���� '/ ��j tA �1 Sign or outl l ighting / 67.84 7, gT 2 CONTRA TOR Signal circuit(s) or limited- energy Business name: C,1/.Z/2 �— 5 26 --ys panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: (( v4 , ( t Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: ��4 /� i.-' ,,Y3/60 Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: (uj/ 0 � r 0V , I Fax: ( W) (A - S II:b Inspections for which no fee is 90.00 / hr ^'l/ r specifically listed (%z hr min) CCB Lic.: r 2 Electrica Lic • G I' ) E ,. ii I uprv. Lic.: 7th ,1t 0 ELECTRICAL PERMIT FEES I Subtotal: (p 7. Suprv. Electricia signature, required: l , / h iI P Plan review (25% of permit fee): --e Print name: / f, , 4 / ) I' : 7(171/0 State surcharge (12% of permit fee): : 1 y TOTAL PERMIT FEE: 75 .9 IS Authorized signatur • This perm it application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: - _ °` Date: 7 4.. * Number of inspections allowed per permit. • 1:\ BuildingWermits TLC-Permit •- .p.doc 10/01/09 440 -4615T(II /05 /COM/WEB