Permit I .. `' CITY OF TIGARD ELECTRICAL PERMIT
I ', II .'. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00205
JIG A R Ti ; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/07/2009
Parcel: 2S 101 AA00101
Jurisdiction: Tigard
Site address: 12000 SW 66TH AVE
Subdivision: Lot: 0
Project: Landmark Ford Lincoln Mercury
Project Description: Sign /Sign outline lighting for (6) signs.
Owner: FEES
CORLISS, JAMES L & CORA K Quantity Description Date Amount
LEASE TO: FORD LEASING, DEVELOPMENT 6 ea Sign or Outline Lighting 05/07/2009 $320.40
CO, PO BOX 23970 1 ea 12% State Surcharge - 05/07/2009 $38.45
PHONE:
Electrical
Contractor:
JAMES F STEIN
P.O. BOX 410
CORBETT, OR 97019
PHONE: 503- 750 -8852
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
•
Total $358.85
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 O' R 952- 00ia0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5• 246.6699 or 1.800.332.2344.
Issued By: LI►�l tr '• � �_ - -1 . . I P ermittee Signature: .l ���� -_
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.
Metrical Permit Application �4= y -- -r , r ''1, FOR OFFICE USE ONLY
City of Tigard d i,' ‘ - r ' . ate/By Daceiv e ��{ d 5 • ? • ( ' I Permit No. ( (0� O
at 13125 SW Hall Blvd., Tigard, OR 97223 'Date/13y:
g Plan Review
M AY 0 7
Phone: 503.639.4171 Fax: 503 - 598.1960 Z0 DateBy: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: kris. 53 See Page 2 for
Internet: www.tigard- or.gov CITY OF T GARD Notified/Method: T J Supplemental Information
TYPE OF WORSl1LDING DIVISION PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
.�ew construction ❑ Addition /alteration /replacement
❑ 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
❑ I- and 2- family dwelling ommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
JQB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
/ J/�� ❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "I - ",
t c 2 ob site address /, ta6 ) 4.761 - ( , . �„ 100HP or more. occupancy.
•- „. / el& ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: "77 j- ,N c --- ❑ Health -care facilities.
0 Supply voltage for more than
,/j
L ,��� ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: i E : ' ❑ Service or feeder 600 amps or more.
��� ((.V// FEE SCHEDULE
Cross street/directions to job site: Description 1 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 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF W ORK (with above sq. ft.) 75.00 2
)a, I 1 Limited energy, multi - family
& (- L-- V r ( kii - L ∎ ` \ ` nn �;, residential (with above sq. R.) 75.00 2
C 1 D V ) C ( J Services or feeders installation, alteration, and /or relocation
( 200 amps or less 80.30 2
❑: PROPERTY O ❑ TENANT 201 amps to 400 amps 106.85 2
�� � ���� 401 amps to 600 amps 160.60 2
Name: tlbt /k 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
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 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: 67Z-S 11 o/ B. Fee for branch circuits
Contact name: F C ,5, / without service or feeder fee, 46.85 2
� J
I'first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: e (....":0__ '1'701 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone ; 731 SG Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting ( 53.40 NO .46 2
Signal circuit(s) or limited -
Business name:
Address: ��' / / energy panel, alteration, or
L extension. Describe: i Page 2 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) rr�� Fax
77, Ol - 11 ,\ 77' l '�i 1 Investigation per hour (I hr min) 62.50
CCB Lic.6i/t /3, Electrical Li� ..-79 Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL' PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date:
Plan review (25% of permit fee):
State surcharge (12% of permit fee): Qr
Authorized signatur:. � ; ; %3 , 1 TOTAL PERMIT FEE: 35p . C5
This permit application expires if a permit is not obtained within 180
Print name: ` I t9 Date !°7l days after it has been accepted as complete.
/{
• Number of inspections allowed per permit.
I: \Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard f Other
Page 2 - Supplemental Information Total number of commercial systems:
LIMITED ENERGY PERMIT FEES: No licenses are required. Licenses are requir
for all other installations
RESIDENTIAL WORK ONLY
Fee for all residential systems $75.00
combined
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n B • urglar Alarm
n G • arage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
l Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
l 1 Outdoor Landscape Lighting
n Protective Signaling
I'. \ Building\Permits\ELC- PermitApp. doc 03/23/06