Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00849
COMMUNITY DEVELOPMENT DATE ISSUED: 12/17/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 101 DA - 00100
SITE ADDRESS: 13010 SW 68TH PKWY 140 ZONING: C - P
SUBDIVISION: TRIANGLE CORPORATE PARK LOT : 007 JURISDICTION: TIG
PROJECT: PACIFIC SOURCE HEALTH
Project Description: Sign lighting.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS 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/ SVCI 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 HIGHLIGHT SIGN CORP
6600 SW 105TH, STE. 175 PO BOX 23667
BEAVERTON, OR 97008 TIGARD, OR 97281 -3667
Phone: 503 - 626 - 3500 Contact #: PRI 503 - 620 -8205
FAX 503 - 624 -3725
FEES
Description Date Amount Reg #: ELE 37- 660CLS
[ELPRMT] ELC Permit 12/17/2W $53.40 LIC 104599
[TAX] 8% State Surcharge 12/17/200" $4.27 SUP 517SIG
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 • .•69. 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.
Slow a-o o l - vti a-a-
'Electrical Permit t TVED I(1)l( ()l I Ic,'I.1 1 oN I_y
City of Tigard " . f , , ; Permit No
' /' —OD
13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
Phone: 503.639.4171 Fax: 503.598.1 kt, 1 . i ' 2007 ii; ' %' ",, i ‘. Date/B • Other Permit:
Inspection Line: 503.639.4175 „AN".
..x 1. ,'. , Date ReadyBy: ® See Page 2 for
Internet: www.ci.tigard.or.us UI1 YO �/ F OF Notified/Method: �, Supplemental Information
BU �� WitYttON PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
El Demolition ❑ Other: ❑Service over 225 amps, comm'I ['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 ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi- family ❑ Master builder Other: S / lP N ❑Building over three stories ❑Feeders 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address:/ /} ❑Health -care facility ['Other: 3 D / D S ►� G PA tia y rs+0 Submit 2 sets of plans with any of the above.
City/ State/ZIP: 77 b m D 2, q 7 Z2 c f The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: / i 0 J 1 Project name:/94 , L 5 0 "ft - L e He aft mu
Description FEE* SC Q,' i . E Fm 1 Total I •• • Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. fl. or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 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
_ L �� + • ( � dwelling, service and/or feeder 90.90 2
� 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: [• �g va glob ..- PA FiG cb t, g c.t_ gegc 601 amps to 1,000 amps 240.60 2
Address: • a -re si amps or volts 454.65 2
SN_ p S A f3 t7 � e_ t. .. • • / - '• econnect only 66.85 2
City/ State/ZIP: j'• /CO Temporary services or feeders installation, alteration, and/or
Phone: ($'t//) 6 y_ 5-3-g I Fax: ( ) To x 9724 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 [r CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: S mk (e S I b Nt S ' K1 L branch circuit
B. Fee for branch circuits
Contact name:
Dt9 V 1; C d oom =O /Zio without service or feeder fee,
each branch circuit 46.85 2
Address: (, 7 y Z S W 1 7t;/ tfl, 1 r~e., Each add'I branch circuit 6.65 2
City / State/ZIP: 0 L p HAI o 2, C
-7 Do 7 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( or ) ( y —pis Fax: : ( ) Sign or outline lighting ��l 53.40 57 2
E -mail: Signal circuit(s) or limited - �-�
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: ki .9 kit 1.9191_ cite N S - M t It!.2_ (Leh iz
Address: Each additional inspection over allowable in any of the above
Z() (� S IA.) H UN z I kA � R I) Per inspection 62.50
City/State/ZIP: T(6 A 'L t Q R Ci 7 Z Z 3 Investigation per hour (1 hr min) 62.50
Phone: (SW) 20 pat) S Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: / O(15'1 q Electrical Lic.: �6- B88-US Suprv. Lic.: S k 5 1 7 Subtotal j r s 3 y-D
•
Suprv. Electrician signature, required :..7/ /� () g Plan review (25 %ofpermit fee)
- i-o-p—
Print name: hce_ Ci A it. i , ! Date) z / y b 7 State surcharge (8% of permit fee) 4 .
e
TOTAL PERMIT FEE s' /► • 4
-
Authorized signatu1 .L1 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: 5 .., F r _ p Date: I Z/ 1 7/t 7 • Fee methodology set by Tri- County Building Industry Service Board
/ • • Number of inspections per permit allowed.
i:\Buildmg\Permits\ELC -Pe mitApp.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard • •
• Page 2 - Supplemental Information .
LIMITED ENERGY PERMIT FEES:
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:
COMMERCIAL WORK ONLY:
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 \Petmits\ELC- PamitApp.doc 04/03
CITY OF TIGARD
A .
BUILDING DIVISION PERMIT #: ELC2007- 00819
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/17/2007
Phone: (503) 639 -4171 P el f •Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/20/2008 TIME: 7:OOAM PAGE: 27
I
SITE ADDRESS: 13010 SW 68TH PKW( 140 CLASS OF WORK:
SUBDIVISION: TRIANGLE' CORPORATE F'ARK LOT #: 007 TYPE OF USE:
PROJECT NAME: PACIFIC SOURCE HEALTH
DESCRIPTION: sign lighting.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503-626-3E00
CONTRACTOR: HIGHLIGHT SIGN CORP PHONE #: 503
Inspection Request Scheduled For: Date: 2/20/2008 Pour Time:
Code # . • - • I escription Confirm # Contact # Message
199 Electrical final 065279 -01 503.291 -G986 Y
Corrections /Comments/lnstructions: 1
1
I I
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED I
Inspector: 'Zr' .` N 68 Date: i-10- 01 Phone #: (503) 718- l llit'