Permit CITY OF TIGARD ELECTRICAL PERMIT
.114 ° PERMIT #: ELC2007 -00040
COMMUNITY DEVELOPMENT
DATE ISSUED: 1/19/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DD-03400
SITE ADDRESS: 11740 SW 68TH PKWY 100 ZONING: MUE
SUBDIVISION: TIGARD TRIANGE COMMONS LOT : 008 JURISDICTION: TIG
Project Description: (1) wall sign & (1) monument sign.
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: SIGNAUPANEL:
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:
PACIFIC NW PROPERTIES SECURITY SIGNS INC
PO BOX 2206 2424 SE HOLGATE BLVD
BEAVERTON, OR 97075 PORTLAND, OR 97214
Phone: 503 - 626 -3500 Contact #: PRI 503 - 232 -4172
FAX 503 - 230 -1861
FEES
Description Date Amount Reg #: ELE 26- 560CLS
[ELPRMT] ELC Permit 1/19/2007 $106.80 LIC 122809
[TAX] 8% State Surcharge 1/19/2007 $8.54
Total $1 15.34 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: � „� 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.
,
Electrical Pe, 0 1, • '
� n
+
t - Date received: j - ja 0 t6 7 Permit no. . pp 7 do 0
,L'.„. City of Tigard g Project/appl. no.: i pure date:
CityofTigard Address: 13125 SW Hall Blvd, Titttit 1 97�7
Phone: (503) 639 -4171 �' C UU I Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 / ' 1' ■ y Case file no.: 1 Payment type:
CI Ur I1.
Land use approval: aprTripaNrc
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi - family 0 Tenant improvement
O New construction r • ddition/alteration/replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: 11'4140 ( / , Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: ` QI ((pck ,D I Description and location of work on premises: (' S(4)1-) -t (T)co. )ry) m- s i Eli
Estimated date of chpletion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no:
Fee Max
Business nam �` S Description Qty. (ea.) Total no. insp
Address: 74Z4 f ( �' /� A New residential - single or multi- family per
�l 1 ` - dwelling unit. Includes attached garage,
City: ` Me - AA0 J I State(}_ i ZIP: q?777 Seniceincluded:
Phone. a t e 5 .7j /. FaxSQ3 Z • /&b E-mail wle '- -i. •,• • , plat t • ft. or less 4
CCB no.: ZZ£SO Elec. bus. lic. no: 2 f d, IL Each a• ditional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. no.: 2 `��I Limited energy, non- residential 2
1//7/07 Each manufactured home or modular dwelling
Signature of supe lectrici (required) Dat Service and/or feeder 2
Sup. elect. name (print):'! i License no: „, 5 A Services or feeders — installation,
PROPERTY OWNER alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps • 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: 1E-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:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am is _ 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: • I State: 'ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) misc. (Service or feeder not included):
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1 &2 0 Hazardous location Each sign or outline lighting f7Y° 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
❑ Occupant Toad over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/Iightingplan 0 Other.
Per inspection 1 1 I
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 $ / 0 Yv
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ .,Sy
Expires accepted as complete. TOTAL $ '1'
Name of cardholder as shown on credit card
$
Cardholder signature Amount
440-4615 (6r00/COM)
'f -
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 4, 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 ❑ 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 Systems
Each sign or outline lighting $53.40
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 ❑ Outdoor Landscape Lighting*
Fees: ❑ Protective Signaling
Enter total of above fees $ ri Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required tor all other installations
front of application.
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
BUILDING DIVISION -' PERMIT #: ELC2007 -00040
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/19/2007
Phone: (503) 639 -4171 400,00it
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/26/2007 TIME: 7:OOAM PAGE: 53
SITE ADDRESS: 11740 SW 68TH PKWY 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 008 TYPE OF USE:
PROJECT NAME: OMA
DESCRIPTION: OMA. (1) wall sign & (1) monument sign.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503.626 -3500
CONTRACTOR: SECURITY SIGNS INC PHONE #: 503-232-4172
Inspection Request Scheduled For: Date: 3/26/2007 Pour Time:
Code # Inspection Description - • m # Contact # Message
199 Electrical final 045344 -01 •03.546-7114 N
Corrections /Comments/ Instructions:
s oti)g. \ft cAN10 J t■ g.0■0) yvx,04
ciP 3 5 Z. 30 (4)
❑ PASS ❑ PARTIAL APPROVAL ❑. CANCEL ❑ NO ACCESS
A FAIL . N CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �S� 0 06 Date: / 314 ' V 1 Phone #: (503) 718- IA