Permit CITY OF TIGARD ELECTRICAL PERMIT
C q
a .a. COMMUNITY DEVELOPMENT Permit #: ELC2010 -00399
:1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 08/03/2010
Parcel: 2S102AA00602
Jurisdiction: Tigard
Site address: 11960 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Kaufman Streamborn
Project Description: (2) branch circuits for outside sign.
Owner: FEES
AMAN, WALTER Quantity Description Date Amount
PO BOX 2990
TUALATIN, OR 97062 2 crt Branch Circuits 08/03/2010 $63.60
wo /Purchase Service or
PHONE: 503 - 692 -9182 Feeder
1 ea 12% State Surcharge - 08/03/2010 $7.63
Electrical
Contractor:
EA MARTIN LLC
4233 SE 182 #202
GRESHAM, OR 97030
PHONE: 503 - 310 -9745
FAX: 503- 658 -1935
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work wit
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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through 0' : 952- 001 -0100. You i - _ - - • es or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
1110 r
Issued 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' 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.
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Electrical permILAmpjkla Iew ceived Permit No.: i�i',�c.,�• —
City of Tigard � �� 2 9 Other Permit: a (A to _00 the available fault current ❑ Marinas and boatyards.
(Ya-
l Vt TIGA DatedBy: _ s�raceafor
Phone: 5 Lire: 5O3 Sax: 5(1.61181)9,00-. Date ReadyBy: Sappre 2 information
inspection Line: 503.639.41 Notified/Method:
r 1 G:� r. Internet: www,tigard- or.goY UILDING DIV ISION _ �`C
fi y,rr,'' 1:Jr :�,.3 ^ ::I ;i "i'u-: %�'t :t { ° ..,` ;..,.
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,, i�. ., ,.•,. '''-•'••:‘••• t f lans " .... ..:.......:.
r .v ; t, .a ,. :, • •• „' ::.: '* '•k`• • . 7 . : •' ''. ''' ._.li:_r.,S�.. . . . .
1g ... wlnerniamciceribelow):
. e . ' r nC r' ,L'..;c; +�,, '" . a� ^ i � • " :-. PlC7r,9c he ck all that setso plans
Additi0n/l3]teratian /replacement ❑ Service or feeder 400 amts or more i n Building
[] Demo over three stories.
New Demolition ,>,ho+r
W .g la �. t l l , , "° ' i"r; ,tg: exceeds amps at 150 molts or C7 Floating buildings,
lltton ❑"` t : :
i f 11� . 1i Yr . .�•'° 1u pRe yl'.o . 1 :f r t w' .,`S0,Krr z,t; �' ... :r ; * ,-` 1x to ground, 10,000 amps 150 ❑ Floati gbutdIn agricultural ' " ' S ' ,,•. � buildings.
0 1- and 2- family dwelling r'! Commcrctal /industrial ❑ Accessory building amps for all other installations.
pump ❑ b ui ldi ngs . nf 15 KVA
0 j 741.4",:4-'-t burger separately derived system.
Q Multi faintly ❑ aster budder ❑ Other: El Emergency system lead 2 1 3 - .
j ' ' ' F nr r, i� S t da 4 , T :I t �i "J 40 g t, ❑ Additive anew f ❑
. �3 ls'
h x 4 q f ' J tbl r : WF_* ��i r I OOIII' or mgr.. occu
❑ Recrotional vemcie pew
Job nor: Job site address: t � I � r -'1..,.. ❑Six or more residential units. more than
❑ u
gppsow) voltage Rtr
❑ } 0cetthtarc Facilities. s ow volts 1tagC f r
CAW/State/ZIP: t CC\ ❑ Service locations.
0 $CiviCC Or feeder 600 amps or more- y .
no.: Project name: k mit * - L— =u a .a idli fir ..; , 1`� .. ` r
Suite/bldg./apt. � 0 DeseriOtkm
Cross street /directions to job bite; - �_ New residential single- yr multi- family dwelling unit
Includes attached garage. _..
_
ICI
1,000 sq. R. or toss 168,5 - 4
Subdiv ision: Lot no.: Ea- add'l500 sq. It or portion 33 54 —
Limited energy, residential 75.00
Tax
map /parcel no.. Wi�,pj� 4ry6 .1 �qW ^:.a " , �;;xlt:,,, C.Vii (with above a. •
J1�1! � + ^ "alt:,l'ky"ii`i „i ?Si,Y� zP " ;� d � f {� r. m � s . � + 1. 1��� ^ u�D„ . ... � Limitwi crwrgz•, mum //wit,/ 75.00
residentialwlth above sq ft,1 _
u � a • " ' 20 smut nr less Services or feeders installation alteration and/or relocation
70
+ ' ' ” ` .°8 . ' • .1 .;•i 1 amps amps
20 m 400 133.56 Ig
� R s�.i,a 2
�`;r�� Rcci�`�. '' ° .,:,r x ". ���`�= " `�tt '� (nfi� * ..,. 401 amps t0 600 atnPs — 200.34
601 maps co 1.000 amps 301.04 . 2
Name: _ 2
Over 1,000 amps or volts
Address: Temporary services or feeders Installation, alteration, and /or
City/State /ZJP: _ relocation
( 200 amps or less 59.36 gg
Phone: ( ) I F ( ) 201 amps to 400 amps 175.08 El
to ORS 447. 449, and 70] . on property
l int 1 ovrn which is not 4ol�amps to 400
amps �_ 125 .54 2
O installation: This installation is being ma
intended for sale, lease, rent, or exchange, according Breech circuits — new, alteration or extension r er ° duel Date: A, Feu for
Owner 3t grtatUra: : ,.,� .< l x b e s or 1.42
,i., f .. i :'! r ....q i �,. - . .i.:V: .:,�i:'r,Y,: ;',q: ' ` ... ,,, :, branch or feeder circuits
y p
•,,,,,,,,,,° t' �. '�enru: � '..:a��.f „ .r. .. Y(,Ad'!�
' I fee
,.,.,: -' -., "• .1' 'ti a >''��,'
n ' B. Fee for branch circuits without
Business name' service or feeder fee, first , 56,18 5G.18
ef
or branch circuit
AiJdr et name: Each add'I branch circuit
Miscellaneoosiservice oeder not included)
AIJ3reaa: Each manufactured Or modular 67.84 2
CCity/State/ZIP: _ dwellin_, service and/or feeder � 67.84 2
E-mail: ( ) Fax: ( ) Pump or irr Reconnect only igation circle 67.84 7
67.84
E -mar Sign or outline lighting
,...,..,.: ;';
:. 44. . ;pn. na.., R ireai s or lirrtited energy
, ::Wl��. ,�.t.�. �� Ny i , - Jl.r .�rt�Y. �:ir�w.:�7�;, r t�lp " I .w�:���;��,,•,.�;. t:[ C
,;,,,,,, ;; ,, e , , me . , a; ,_ P ;
Business name: (�r�l(\ �,�,4.4 ,duet, alteration or extvtwton, 1 Each additional inspection over allowable In any of the above
Address_ ( `� Additional inspc lion (1 hr min) 66 hr
�y� investigation (I in min) 66.75/ hr
City /State/ZIP: Cn t(''e 1c �, �� _ 1. e3D industrial plant (I ht min) 78,18 / hr
�' SD� ` _ _ Inspections for which no foe is 90.00f hr
C to. G�'� �, Fax: ( 'taut listed h hr min
Electrical Lic.: aL\Li Suprv. Lic.: �•: . •" ..:r.'.:
CC Lic.: t �o2�� Subtotal: ul j , up
Suprv. Electrician signature, required: — tun review (25 %urpermit coo:
W Date: °`t " a �' . ` (" State surcharge (12% of permit fee: ''k •
UkS
Print name: r r; ■1i(1 ii I. TOTAL PERMIT FEE: 44 k k , ,a3
Authorized signature: T is permit applimtlon expires if a permit is not obtained within no
- - days after it has been accept as complete
Print name. Date: • Number of inspections allowed per Penna.
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