Permit CITYCI OF TIGARD RD ELECTRICAL PERMIT
r[ PERMIT #: ELC2007 -00866
° COMMUNITY DEVELOPMENT DATE ISSUED: 12/27/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DD-04100
SITE ADDRESS: 11850 SW 67TH AVE ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT : 007 JURISDICTION: TIG
PROJECT: AMERICAN FAMILY INSURANCE
Project Description: (1) sign lighting
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: 1
LIMITED ENERGY: • 401 - 600 amp: SIGNAUPANEL:
MANF HMI 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:
LEISER, ANNE TRUSTEE SECURITY SIGNS INC
6009 SW PENDLETON CT 2424 SE HOLGATE BLVD
PORTLAND, OR 97221 PORTLAND, OR 97214
Phone: Contact #: PRI 503 546 - 7114
FAX 503 - 230 -1861
FEES
Description Date Amount Reg #: ELE 26- 560CLS
[ELPRMTj ELC Permit 12/27/200' $53.40 LIC 122809
[TAX] 8% State Surcharge 12/27/200' $4.27 SUP 383 SIG
Total $57.67 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 obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: CA /4r./t 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.
*. i � �
7\/ ,D-06 9 — oo a 3 3
Electrical Pe � � ' .pit 1. r > t i ' , 0 � - 1 (► C)1 l I I: usE °NI Y.
City of Tigard ~ n: Al / a ' 62
Plan Review Permit No.��i �� _ r ✓�
13125 SW Hall Blvd., Tigard, OR 9 (+ 1
Phone: 503.639.4171 Fax: 503
At /t, Date/B : Other Permit:
Inspection Line: 503.639.4175 , y I. itj . �! �+ , I . Date Ready /By: ® See Page 2 for
Internet: www.ci.tigard.or.4 , X' i v IS ., `� Notified/Method: Supplemental 1C ILIIK PLAN REVIEW
❑ New construction `i Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling g Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi- family 0 Master builder 0 Other:
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑ Egress/lighting plan RV park
Job no.: ) site address: 1 1� n1 (I/7\4 j p ❑Health -care facility [Other:
1 l J t(,) W 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.: I Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I *`
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
)N1 1 dwelling, service and /or feeder 90.90 2
l( \( 1 Services or feeders installation, alteration, and /or relocation
V 200 amps or less 80.30 2
❑ PROPERTY OWNER , ❑ TENANT 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
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
Owner Installation: This installation is being made on property that 1 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 1 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Secuirty 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'1 branch circuit 6.65 2
City/State /ZIP: Portland, OR 97202 Miscellaneous (service or feeder not included)
( 5 03) 546 7114
Pump or irrigation ne ig circle 53.40 2
Phone: Fax: : ( 503 )230
Sign or outline lighting 1 53.40 2
E -mail: Melissa@SecuirtySignS.COm ^ _ __ ___ 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
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
503 )546 7114 503 2301861 ELECTRICAL PERMIT FEES*
CCB Lic.:122809 Electrical Lic.: --- - --- -_ __- . ___.--.--.__--._._--
26520CLS suprv. Lic.:383 SIG Subtotal /-3 t../L)
Suprv. Electrician signature, required: Plan review (25 %ofpermit fee)
Print name: Date: State surcharge (8% of permit fee) c., 7
Marc Lin u1St TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit Is not obtained within 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 \Pcrmits\ELC- PemtitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: ELC2007•00865
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/21/2007
Phone: (503) 639 -4171 � ���,�
Inspection Requests (24 Hrs.): (503) 639 -4175 . ' 1 `'IL.
INSPECTION WORKSHEET FOR DATE: 3/12/2008 TIME: 7:OOAM PAGE: 37
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
• SUBDIVISION: 'TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME AMERICAN FAMILY INSURANCE
DESCRIPTION: (1) sign lightincg
OWNER: LEISER, ANNE TRUSTEE, • PHONE #:
CONTRACTOR: SECURITY SIGNS INC PHONE #: !:03-641 -7111
Inspection Request Scheduled For: Date: 3/1272008 Pour Time:
Code # • Inspection Description Contact # Message
1139 • Electrical final 066554 - 01 503-5467114 7114 N
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Corrections /Comments /Instructions:
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ASS n PAR TIAL APPROVAL ❑ CANCEL _ NO ACCESS
r FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: G ---, 1v L Date: 1 IV v v Phone #: (503) 718- A%