Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC97 -0499
/u
�n a6p11.* 1 ,'I DATE ISSUED: 07/30/97
!� ' .. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL: 1S136DB -02600
SITE ADDRESS...:11201 SW 72ND AVE
SUBDIVISION • ZONING:C --G
BLOCK . LOT • JURISDICTION: TIG
Pro.j ect Description : Installing a permanent 50 sq. ft. wall sign. Sign must not
project more than 18' from the wall.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- - - - -- MISCELLANEOUS
1000 SF OR LESS....: 0 0 — 200 amp • 0 PUMP /IRRIGATION....: 0
EACH ADD' L 500SF...: 0 201 — 400 amp.......: 0 SIGN /OUT LINE LTG..: 1
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION ° 0
201 — 400 amp • 0 1st W/0 SRVC OR FDR.: 0 PER HOUR : 0
401 — 600 amp : 0 EA ADD'L BRNCH CIRC: 0 IN PLANT 0
601 — 1000 amp : 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS • > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: --- - - --- FEES --
MCDONALDS CORPORATION type amount by date recpt
5000 SW MEADOWS ROAD, SUITE 230 PRMT $ 40.00 JD 07/22/97 97- 297445
LAKE OSWEGO OR 07035 5PCT $ 2.00 JD 07/22/97 97- 297445
Phone #:
Contractor: -- --
YOUNG ELECTRIC SIGN CO $ 42.00 TOTAL
416 EAST 41ST ST
-- - -- - -- REQUIRED INSPECTIONS - - - - --
BOISE ID 83714 Ceiling Cover Elect'1 Service
Phone #: Wall Cover Elect' 1 Final
Reg #..: 000693 •
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - -0010 through OAR 952 -001 -1987. You may obtain a copy
of these rules or direct questions to CUNC by calling (503)246 -1987.
Permittee Signature: 14h/p_ -- Issued By: .1 ?��
OWNER INSTALLATION ONLY
The installation is being made on property I on which is not intended for
sale, lease, or rent..
OWNER'S SIGNATURE: DATE:
• CONTRACTOR INSTALLATION ONLY - --
_0
SIGNATURE OF SUPR. ELEC' N: /7n. It DATE:
LICENSE NO:
+++++++++++++++++++++++++++++++4++++++++++++++++++ + +4 + ++ + + + + ++ ++ ++ + +- 1- ++ + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY:,OFTIGA Electrical Permit Application , Check# `�
:13125 SW HALL BLVD. Rec'd By A. 0 -
TIGARD OR 97223 Date Rec'd ?
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # rIc'1 -O4"17
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
f�
Name of Development MCA O S Number of Inspections per permit allowed
Name (or name of business) ntbanatbs Service included: Items Cost Sum
Address t l ' 20 ( .ta.) "2,Q, i't 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State/Zip Each additional 500 sq. ft. or
Commercial Residential El Limited thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of a current Ii ses / 4b. Services or Feeders
Electrical C ntractor ! - Installation, alteration, or relocation
200 amps or less $60.00 2
Add 201 amps to 400 amps $80.00 2
City .AI. D Slate op.-- Zip 401 amps to 600 amps $120.00 2
Phone No. 27 4,7 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
7 ��/ G� Exp.Date Reconnect only $50.00 2
Elec. Cont. Lice. No. 3
OR State CCB Reg. No.(pgWO Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. otf Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
201 amps to 400 amps 75.00 Signature of Supr. Elec'n 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No.
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
frAl purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
-
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting / $40.00 _1 0 2
3. Plan Review section (if required):* N� Signal circuit(s) or a limited energy
panel, alteration or extension $
Minor Labels (10) $100.00 2
Please check appropriate item and enter fee in sectio 5B
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00 Z * Submit 2 sets of plans with application where any of the above apply. 5. Fees: co
Not required for temporary construction services. 5a. Enter total of above fees $ g • Uv
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY El Trust Account # Od
TIME AFTER WORK IS COMMENCED. a
Total balance Due $
1:\DSTS \ELC96.APP Rev 9/96
A CITYOFa[
_�, ,� DEVELOPMENT '49
'' �. 13125 SW HaII Blvd., Tigard, OR 97223 (503) 6394171
PARCEL: 1S136DB -02600
SITE ADDRESS...:112O1 SW 72ND AVE
SUBDIVISION ZONIN6:C -6
BLOCK LOT • JURISDICTION: TI6
Project Description: Installing a permanent 50 sq. ft. wall sign. Sign must not
project more than 18" from the wall.
- -- RESIDENTIAL UNIT - - -- --- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS-- - - --
1000 SF OR LESS • 0 0 - 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 500SF...: 0 201 - 400 amp.......: 0 SIGN /OUT LINE LTG..: 1
LIMITED ENERGY • 0 401 - 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 - 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION.....: 0
201 - 400 amp • 0 1st W/O SRVC OR FDR.: 0 PER HOUR : 0
401 - 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT : 0
601 - 1000 amp : 0 PLAN REVIEW SECTION
1000+ amp /volt : 0 > =4 RES UNITS • > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: -•- FEES
MCDONALDS CORPORATION type amount by date recpt
5000 SW MEADOWS ROAD, SUITE 230 PRMT $ 40.00 DRA 07/22/97 97- 297445
LAKE OSWEGO OR 07035 5PCT $ 2.00 DRA 07/22/97 97- 297445
Phone #:
Contract or: --
YOUNG ELECTRIC SIGN CO $ 42.00 TOTAL
416 EAST 41ST ST
REQUIRED INSPECTIONS - - - - --
BOISE ID 83714 Ceiling Cover Underground Cove
Phone #: Wall Cover Elect'1 Service
Reg #..: 000693
This permit is issued subject to the regulations contained in the Tigard Plunicipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: e1'Y\ Issued By: j ,' Lam+
-- 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: d1/\ 1 Aff -�IIC �� t DATE:
LICENSE NO:
++±+++++++++++++++++++++++++++++++++++++++++++++ +++ ++ + + + + + + + + ++ ++ + ++ ++++ + + +++++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
"+ r+ rr+ r++ r++++++++++++++++++++ t+++++++++++++++++ ++++ ++ + +++++ + + + + + + + + + +++ + ++ + + ++
CITY OF TIGARD Electrical Permit Application Plan Check I i
1'3125 SW HALL BLVD. Recd By YY
TIGARD OR 97223 Date Recd i',
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # E ' -0 .vi
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development gab .�s Number of Inspections per permit allowed
Name (or name of business) 4G1bS Service included: Items Cost Sum
Address / 1 2,0 .a
1 f/.J t /► � 4a. Residential - per unit
City /State/Zip 1 4 1 1000 sq. ft. or less $110.00 4
1 I V �v « Each additional 500 s q ft. or
portion thereof $25.00 1
Commercial& Residential ❑
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of al current Tice . ses 4b. Services or Feeders
Electrical Contractor ! , iA,' .../ .4. dr . ■ .0 . Installation, alteration, or relocation
200 amps or less $60.00 2
Addre s ... •• j.' D O _ - 4. ' - 201 amps to 400 amps $80.00 2
City 1 • D State �!L- Zip 401 amps to 600 amps $120.00 2
Phone No. Z2.0- a1(O7 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. Exp.Date
OR State CCB Reg. No(oy 3 SO Exp.Date 11 7 4c. Temporary Services or Feeders
COT Business Tax or Metro Nck.f C70 Exp.Date 1 (--1 - V Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Su r. Elec'n 1 -�' 201 amps to 400 amps $75.00 2
9 P /� 401 amps to 600 amps $100.00 2
// Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No.
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
� /� purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
/ Each sign or outline lighting 1 $40.00 O 2
3. Plan Review section (if required):* N/d Signal circuit(s) or a limited energy
/ / � J panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
-
* Submit 2 sets of plans with application where any of the above apply. 5. Fees:
Not required for temporary construction services. 5a. Enter total of above fees
5% Surcharge (.05 X total fees) $ a d
.•
NOTICE • Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY OCR
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # a.
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96