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Permit CITY OF TIGARD ELECTRICAL PERMIT •• ` �! ' : COMMUNITY DEVELOPMENT Permit #: ELC2010 00418 •T i GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/12/2010 Parcel: 2S102CC00500 Jurisdiction: Tigard Site address: 13500 SW PACIFIC HWY 92 Subdivision: Lot: 0 Project: Fantastic Sams Project Description: Sign lighting. Owner: FEES 13500 PACIFIC CORP Quantity Description Date Amount BY CAPOZZOLI ADVISORY FOR, PENSIONS INC, 21500 HAGGERTY ROAD, SUITE 100 1 ea Sign or Outline Lighting 08/12/2010 $67.84 PHONE: 1 ea 12% State Surcharge - 08/12/2010 $8.14 Electrical Contractor: MEYER SIGN CO OF OREGON 15205 SW 74TH AVE TIGARD, OR 97224 PHONE: 503 - 620 -8200 FAX: 503 - 620 -7074 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: • Total $75.98 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 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 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 • : 952- 001 -0100. You ma obtain a of t - rules or direct questions to OUNC by calling 5'_ mac. •.6699 or 1.800.33 44. Issued By: % /L. •I' �` �GL Permittee Signature: //I /. / 1/ 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. , Electrical Permit App ,: 1 -_, Y L. ? ` q ' 4 FOR OFFICE USE ONLY '' I ` 1t u . ' Received r City of Tigard J Date : �� O I/ Permit No.: ) QQ a . q 13125 SW Hall Blvd., Tigard, OR 97223AUG 1 2 2010 Plan Review Z Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: 6/140 /0-- if Inspection Line: 503.639.4175 ' � r , 1 _ _ _ Date Ready/By: y: Juris: / See Page 2 for TIGAKD Internet: www.tigard- or.gov ;4; �;� Lir' a , _ - 44, - 1 - 5 . ) Notifi (U Supplemental Information �.. r,9 y,;3' PLAN REVIEW TYPE OF WOR ❑ 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 jg Other: 5 i ( 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 ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. A ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: Job site address: ^j�� 1,1%1 lOOHP or more. occupancy. 13S IJV Su) . � C 0 Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: — j . �+ t3$ao ❑ Health -care facilities. ❑ Supply voltage for more than ` v ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name:.}— - ✓l��Il `�'J w' S ❑ Service or feeder 600 amps or more. °� FEE SCHEDULE ' ' Cross street/directions to job site: Description I Qty. 1 Fee. 1 Total 1 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 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 Q w (1 Th,1 A X s l r residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I E TENANT 201 amps to 400 amps 133.56 2 Name: .}-,� _ {� 401 amps to 600 amps 200.34 2 'i�o/l \mil [ �a 1-, v 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City /State /ZIP: relocation Phone: (23) -..11 - e y $ 1 Fax: ( ) 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 1 own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits- new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with Q'APPLICANT I [} �bNTACT PERS above service or feeder fee, each branch circuit 7.42 2 Business name ' Y B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit l Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 tY dwelling, service and/or feeder Phone: Fax: ; Reconnect only 67.84 2 ( Sb3> 3� y - as t (J �' 3 � � ' T 3 S Pump or irrigation circle 67.84 2 E - mail: • • . __ VYi4 r '/1 — / O . C. OW-, 'Sig or outline lighting I 67.84 (, 2 CONTRACTOR •gnal circuit(s) or limited- energy Business name: �/y� ^ panel, alteration, or extension. Page 2 2 / ' L►'. 4� ( �� Each additional inspection over allowable in any of the above Address: 1 Sa os 51 a "1 _ Additional inspection (1 hr min) 66.25/ hr /State /ZIP investigation (1 hr min) 66.25/ hr Ci tQo� t /� , d� 9 a s y Industrial plant (1 hr min) 78.18 / hr Phone: (j 3) 3 (0 4 - a a j I I Fax: ( S1)3) 34o (.t - <43 is— Inspections for which no fee is 90.00 / hr specifically listed (%2 hr min) CCB Lic.: ‘4.4 01 I I Electrical Lic.: ao _ 4 q 0 _,U1 Suprv. Lic.: 96 _ S t o ELECTRICAL PERMIT FEES Subtotal: VI. Vj Suprv. Electrician signature, requires: -- / ,_ _ Plan review (25% of permit fee): Print name:.(11�" r.D l� Date: $, (( / to State surcharge (12% of permit fee): _J, 1`t' ��ll"" TOTAL PERMIT FEE: .75, 48 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: * Number of inspections allowed per permit. I:\Buil dingWermits\ELC -Perm itApp.doc 07/01 /10 440- 4615T(II /05 /COM/WEB 3 d-3 (3, iv