Permit CITY OF TIGARD ELECTRICAL PERMIT
I: COMMUNITY DEVELOPMENT Permit #: ELC2010 -00540
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/01/2010
Parcel: 1S136CD01500
Jurisdiction: Tigard
Site address: 11660 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Tigard Bowl
Project Description: (2) sign Iightings.
Owner: FEES
POWERS PEARL LLC Quantity Description Date Amount
11660 SW PACIFIC HWY
TIGARD, OR 97223 2 ea Sign or Outline Lighting 10/01/2010 $135.68
PHONE: 1 ea 12% State Surcharge - 10/01/2010 $16.28
Electrical
Contractor:
SIGNCRAFT ELECTRICAL LLC
8900 SW BURNHAM
TIGARD, OR 97223
PHONE: 503 - 639 -4910
FAX: 503- 639 -4999
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $151.96
Required Items and Reports (Conditions)
This per •• ' r - • •'-ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be • = e 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 the 180
• - s. ATTENTION: Oregon I- ire• ires you to follow the rules adopted by the Oregon Utility Notification Ce er. Tho rules are set forth in OAR
•52- 001 -0010 rough OAR • • -001 -! • i. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6: •9 or .800 2.2344.
Issued By: `A lfLi Permittee Signature: �>•_ _� _ .�i'
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' Date:
LICENSE NO.
Call 503.839.4175 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.
A - ) 2 0 / 0 - . •
Electrical Permit Application FOR O F F I C E H S U: ()NIA'
Cl of Ti and Received Permit No A
•J g DateB : l0 / //d ELC . 6 ,,0',x) 5- 0 .
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
'' C Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: •
- i t . A It I l Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard -or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
[New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: ( t , _ 0 s1 a� ��`.!x ci(� [ 1 `' t.,_
1 ❑ S Six or more. occupancy.
1 1 Six o or r more residential units. ❑ Recreational vehicle parks.
^ � 1 ❑ Health -care facilities. ❑ Supply voltage for more than
City /State /ZIP:
�� ` , . I- �� p3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: J Project name: 'T \ ❑ Service or feeder 600 amps or more.
r ��' -� FEE SCHEDULE
Cross street/directions to job site: pc. pc., � ;t tA 4 1 1 Description 1 Or.. 1 Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
'�'I MAC Le Fs -e Ico —viS V I un c 1 tt_t,�,.t residential (with above sq. ft.)
✓ Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
�\ 5� - �j tV t ti 601 amps to 1,000 amps 301.04 2
• Address: i L totoc S 1..,, rz>,•� � k-A w17 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: T(S C&. {1 '1 Aa) relocation
Phone: (5 3 ) ipyi t jv j Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: ; •r`('l;;, 4.S 014,7N,--k..)-e B. Fee for branch circuits without
o service or feeder fee, first
Contact name: branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: ( )
Fax: : ( ) Reconnect only 67.84 2
E Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 {3 47 6 2
CONTRACTOR Signal circuit(s) or limited -energy
�1 panel, alteration, or extension. Page 2 _ 2
Business name:
SisVu.4Z._'4- Ek .#rt, a t» t). La— Each additional inspection over allowable in any of the above
Address: P ii, . Lo
Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: � Investigation (1 hr min) 66.25/ hr
T r„L- Do 15 Do - • �'fxil Industrial plant (1 hr min) 78.18 / hr
Phone: (C ,.- ) _ Fax: ( ) Inspections for which no fee is
�t.s 1Q� f. ) y t. tl O �T �F•� L`�Qtg ,
90.00/ hr
specifically listed (/: hr min)
CCB Lic.: 1 s-c-- L12? I Electrical Lic.: 7 4 5+ t • Suprv. Lic.: c 3C, ..627r 5 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 35.(�g
Plan review (25% of permit fee): —e
Print name: k 11 n,) W l Date: /41/ J �i,V State surcharge (12% of permit fee): i lo ^b
tiW---' TOTAL PERMIT FEE: l - 1.90
Authorized signature: i 4 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: iv (.6-4— Date: j G _z ` � • Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11 /05 /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 $75.00
system
(SEE OAR 918- 309 -0000)
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
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10