Permit • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00189
DEVELOPMENT SERVICES DATE ISSUED: 4/11/2006
° �I II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S136DA -02600
SITE ADDRESS: 11140 SW 68TH PKWY ZONING: C -G
SUBDIVISION: MLP1999 - 00011 LOT : 002 JURISDICTION: TIG
Project Description: (2) 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: 2
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ 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:
WEBSTAR VI, LLC SECURITY SIGNS INC
610 GLATT CIRCLE 2424 SE HOLGATE BLVD
WOODBURN, OR 97071 PORTLAND, OR 97214
Phone: 503 Contact #: PRI 503 - 232 -4172
FAX 503 - 230 -1861
FEES
Description Date Amount Reg #: ELE 26 - 560CLS
[ELPRMT] ELC Permit 4/11/2006 $106.80 LIC 122809
[TAX] 8% State Surcharge 4/11/2006 $8.54
Total $115.34 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: C� 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.
, .1i i) 2-00 , - (70s
Elec cal Permit �,,; l; l rc►RRorrICt.list:(1Nl.)
, , �
City of Tigard ' Received y. ` ' f a /0(� la- Pe rmitNo.: a. 0 -106,6 ?>z)l S�
13125 SW Hall Blvd, Tigard, OR 97223 2006 Other Permit:
Review/
L - .. _
Phone: 503.639.4171 Fax: 503.598. i%.,rM.;:; Date/By
Inspection Line: 503.639.4175 'I � Date Ready/By: turfs. ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information
BUIm6�O PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ['Bulldog over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder ❑Building over three stories ❑Feeders, 400 amps or more
❑ Other: ❑Occatpant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
❑der:
Job no.: , Job site address:' I S te( ( K� ❑Health - care facility
Submit 2 sets of plans with any of the above.
City / State/ZIP:`' / / ( The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: P roject name: G 'v la Description 1 Qty. I Pee 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: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
A dwelling, service and/or feeder 90.90 2
1 \ i ' e , - / ∎ 1 \ f s . [4rC- ( S1 [rant .1 ` t7� 1( Ml I 41— Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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: ( ) J Fax: ( ) relocation
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 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: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( ) Sign or outline lighting Z 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: L i c..1/4,...i extension. Describe: Page 2 2
Address :2�..� Z 14 - S 1 Each additional inspection over allowable in any of the above
42 Per inspection 62.50
City/ State/ZIP: "pl X L_ r7 ..44 .0 cy` t /ZCSZ Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: (T3 )2 3Z- �f-i7Z 1 Fax: 5 / 8.
ELECTRICAL PERMIT -FEES*
CCB Lic.: (Z.Z`l I Electrical Lic.:7„66&cez - Suprv. Lic.: 30357e5 Subtotal /o(
Suprv. Electrician signature, required: Plan review (25 %ofpermit fee)
- sue State surcharge (8% of permit fee) �/
Print name: � ` _ . G,C1 � � Date: , J /, O S
^� ! TOTAL PERMIT FEE / / 3
Authorized signature: -. This permit application expires if a permit is not obtained within 1 0
days after it has been accepted as complete
Print name: p6 Date: L , / l , Fee methodology set by Tri-County Building Industry Service Board
! Number of inspections per permit allowed
i:\ Building \Permin\ELC- PmmitApp.doc 12/03 440- 4615T(I0/02/COM/WEB 0 /
Electrical Permit Application - City of Tigard 11
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning •
System*
❑ Vacuum Systems*
❑ Other:
[ WORK ONLY: l
Fee for each commercial system. $75.00 '
(SEE OAR 918 - 260 - 260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls •
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations •
i:\ Building\Pmnits\ELC- PcmitApp.doc 04/03
CITY OFTIGARD
BUILDING DIVISION PERMIT #: ELC2000 -00189
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/11/2006
Phone: (503) 639 -4171 /° '�'
Inspection Requests (24 Hrs.): (503) 639 -4175 . ' I I..
INSPECTION WORKSHEET FOR DATE: 6/8/2006 TIME: 7:03AM PAGE: 86
SITE ADDRESS: 11140 SW 68TH PKWY CLASS OF WORK:
SUBDIVISION: MI..P1999- 00011 LOT #: 002 TYPE OF USE:
PROJECT NAME: CASCADE VETERINARY REFERRAL CE
DESCRIPTION: (2) sign lighting.
OWNER: WEBSTAR VI, LLC, PHONE #: 503
CONTRACTOR: SECURITY SIGNS INC PHONE #: 503 - 2324172
Inspection Request Scheduled For: Date: 6/8/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
140 Sign installation 031351 -02 503-232 -4172 Y
Corrections /Comments/ Instructions:
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PASS A PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v • N Date: 6'1`66 Phone #: (503) 718 - ulig?