Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00013
DEVELOPMENT SERVICES DATE ISSUED: 1/10/01
'f �! 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 1 S136DA -00100
SITE ADDRESS: 11308 SW 68TH PKWY
SUBDIVISION: ZONING: MUE
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of sign lighting for one sign. Job No. 19 -0021
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: 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+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
SISTERS OF PROVIDENCE VANCOUVER SIGN COMPANY, INC
4805 NE GLISAN 6615 SW HWY 99
PORTLAND, OR 97213 VANCOUVER, WA 98665
Phone: Phone: 360 - 693 -4773
Reg #: ELE 37 -46CLS
LIC 000006
SUP 525SIG
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FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT DLH 1/10/01 $53.40 2720010000( Elect'I Final
5PCT DLH 1/10/01 $4.27 2720010000(
Total $57.67
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 -0080. You may obtain copies- ofthese-rules or direct questions to OUNC at (503)
246 -1987.
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PERMITTEE'S SIGNATURE ISSUED BY � AC tv Z
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 INSTA LATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: 594 . /G)
Call 639 -4175 by 7:OOpm for an inspection the next business day
- A Electrical Permit Application
Date received: / / _27 Permit no.: Zte, —
•
4 >� ..1 1 ! City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERM Ft
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration /replacement Ether: 51 ❑ Partial
JOB SITE 1NFORi11ATlON
Job address: 1 ('o ir S,.. 6V P•4 z i.4 1 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: Ptzov r..0 rn.x is rr.G,e -rz ) I Description and location of work on premises: E1.. g .a t. C 'x6 r../
Estimated date of completion/inspection: 3 '-t K .
CONTRACTOR APPLICATION FEE SCHFINILE
Job no: (q - 06 2 ( Fee Max
Business name: VA to (A-vc Pe- SZ6 a! Co Description Qty. (ea.) Total no. insp
New resident - single or multi- family per
Address: ( A./E t/t✓`( 2°f dwelling wit. Includes attached garage.
City: V, Lou 1/61(— I State:1.44 - I ZIP: 1,(54,4 Service included:
Phone: 16m ,q3'f X 13 [Fax: ac fZi'( E -mail: aitt 1 ' ,,,,e . t 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 6 3 qs-f I Elec. bus. lic. no: 71 - 46 LL S Limited energy, residential 2
City /metro lic. no.: (5 • • p 2 0 2 2— Limited energy, non residential 2
L. i Each manufactured home or modular dwelling
Signature of supervising electrician ( -. uired) Date Service and/or feeder _ 2
Sup. elect. name (print): : (Zl/(-m Ho 1,T License no: Services or feeders — installation,
alteration or relocation:
PROPI:RIYOWNER 200 amps or less 2
Name (print): <I 5 O F rR O v l ae ICE 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: yFos pe 66 Z ShN 601 amps to 1000 amps 2
City: ?01Z1-1,64ir I Statet I ZIP: Q '?"Z / 3 Over 1000 amps or volts 2
Phone: 221 2.1 z ( I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN BEN IE'V (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each sign or outline lighting / . 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other: Per inspection 1 1 1 1
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 5
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
credit card number: / / within 180 days after it has been State surcharge (8%) $ 'a 7 •
Expires accepted as complete. TOTAL $ 7 - 7
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440.4615 (6/00/COM)
Electrical Permit Fees: Limited Energy Fees: - -
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 1, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular 111 Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑ Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918- 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls •
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging in Systems
Each sign or outline lighting i $53.40 y
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection • $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ 5" q•497 n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all,other installations
front of application.
,(07
Fees:
Total Balance Due - $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts\forms\elc- fees.doc 10/09/00
CITY OF TIGARD Plan Check #
73125 SW HALL BLVD. Electrical Permit Application
Recd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 - 4171, x304
Date to DST
Inspection (503) 639 -4175 Print of Type Permit #
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Com Fee Schedule Below:
t�
Name of Development `rovi9 f Tic, era b Flo szwes Number of Inspections per permit allowed
Name (or name of business) LE Ere Service included: Items Cost Sum '1'
Address U 30Fr Sc. 6j5 ` PAta ev f•f 4a. Residential - per unit
City /State /Zip 1 ht+- c D R R f.22 1000 sq. ft. or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial Er Residential ❑ Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data Installation, alteration, or relocation ,
Electrical Contractor VAN CO u�vEV- 51-Ca 1.1 Co • 200 amps or less $ 64.25 2
Address 6643 wE tfW 1 f 201 amps to 400 amps $ 85.50 2
City t / q11 cow State V`' Zip b�66L" 401 amps to 600 amps $ 128.50 2
ty V p 601 amps to 1000 amps $ 192.50 2
Phone No. 3CO 6 't 1 Over 1000 amps or volts $ 363.75 2
Job No. 14 - 66 Z I Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 3 7 - N'CL 5 Exp.Date /0/0 i /o i 4c. Temporary Services or Feeders
OR State CCB Reg. No. 639.1 " ' Exp.Date t/z- ea Z Installation, alteration, or relocation
COT Business Tax or Metro No. coon zoz t Exp.Date D l/o /4 Z 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n x mod e 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
see "b" above.
License No. aC.5 71Z Exp.Date
4d. Branch Circuits
Phone No. 3bo CI? q1-1`3 New, alteration.or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
panel, alteration or extension $ 60.00
3. Plan Review section (if required):* Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $
* Submit 2 sets of plans with application where any of the above apply. 1 Ob..6lo Surcharge (.05 X total fees) $
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $
is \dsts \forms \electric.doc