Permit 1 .„ CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00196
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/18/2009
Parcel: 2S112AC00100
Jurisdiction: Tigard
Site address: 14529 S_W. _72ND -AVE
Subdivision: Lot: 0
Project: Save on Tires and Wheels
Project Description: Light (5) signs.
Owner: FEES
DONNELLY, THOMAS J Quantity Description Date Amount
PO BOX 83192
PORTLAND, OR 97283 5 ea Sign or Outline Lighting 06/18/2009 $267.00
1 ea 12% State Surcharge - 06/18/2009 $32.04
PHONE: Electrical
Contractor:
HIGHLIGHT SIGN CORP
18270 SW BELTON RD
TIGARD, OR 97223
PHONE: 503 - 729 -7978
FAX: 503 - 624 -3725
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $299.04
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. hose rules are set forth in OAR
952- 001 -0010 through OA 01 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 4•.6699 0 / A00.332.2344.
Issued By: Perrnittee Signature: / /..►J�
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.
CaII 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.
Electtital Permit Application s . I � " I
II City of Tigard Received 6 /�
g MAY 0 5 2009 Date/By: r J • S Permit No.'e (ei . (301 6 ,
IN • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 CITY Cr,' -IGARD Date Ready/By: urns: ® See Page 2 for
TIGARD ti -
Internet: www.tigard- or.gov ' i °' ., 0 DIVISION Notified/Method: fl c, Supplemental Information
TYPE OF WORK . PLAN REVIEW
xi 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.
• less 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 ", ' 1 -2 ", "I -3 ",
Job no.: Job site address: /ferg? /• 7 44/X 100HP or more. occupancy.
• ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: dQ ❑ Health -care facilities. ❑ Supply voltage for more than
ty IP: �"r • ❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: Project name:/({, 00.3 DIVA* wuJ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
job site: cam/
Cross street/directions to '" �j �i�
J � � � d I,,,e Description 1 Qty. 1 Fee. 1 Total 1 .
S CSI -�rH4. New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
IPITA i.y79T /e4 dei $/alpv :.• residential (with above sq. ft.)
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
Name: apE 4,/A , 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 14' Sa,Q 910. 7.2%, ,.,( * Over 1,000 amps or volts 454.65 2
City /State /ZIP: 11
f'_Q � Temporary services or feeders installation, alteration, and /or
I • relocation
Phone: ( 3') 737.. 148* Fax: ( ) 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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel _
Owner signature: Date: A. Fee for branch circuits with
fg APPLICANT fig CONTACT PERSON • above service or feeder fee, 6.65 2
each branch circuit
Business name: tiirkL Q9r14 dipiep B. Fee for branch circuits
Contact name: L 1.11144,0:440 without service or feeder fee,
�AV first branch circuit 46.85 2
Address: /.Z?Q Sit/, OratarP Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP:. v1115,00,40:70 dr*. i9 7 /4. Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: (SO LAO SACS Fax: : ( ) Reconnect only 66.85 2
E -mail: Teryy 0 b4I pL. t.I7N1f Siggl. Geo.? f Pump or irrigation circle 53.40 2
• CONTRACTOR Sign or outline lighting 5 53.40 a (e 7 05 2
Business name: Signal circuit(s) or limited -
��,� �'stll41, 0 • energy panel, alteration, or
Address: / bg.7f ✓ �i2/ extension. Describe: Page 2 2 Asi
City/State /ZIP: f ,(,/ fV eig, 714'0 Each additional inspection over allowable in any of the above
(5b') tee $4940.5- >) f o�'F -3 P„
Per Investigation 62.50
Phone: Y/*/ Fax: /` ? investigation per hour (1 hr min) 62.50
CCB Lic.: / eftSg/t Electrical Lic.: 5 *SI? Suprv. Lic." S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES .
Suprv. Electrician signature, required: #41seerie Subtotal: a, X7 .00
w - Plan review (25% of permit fee):
Print name: /fir f .• , Date: /� fJ
"( State surcharge (12°/0 of permit fee): 32 .04 �
Authorized signature: ' Qp ,mil
NL
g / i � / TOTAL PE RMIT FEE: a J l
' / This permit application expires if a permit is not obtained within 180
Print name: an t I ll a Date: r/r / O� days after it has been accepted as complete.
"!'� ' Number of inspections allowed per permit.
I: \ Building \Permits\ELC- PermitAppdoc 05/23/06 440-4615T( I I/05/COM/WEB
Electrical Permit Application - City of Tigard ❑ Other -
{ , •
Page 2 - Supplemental Information Total number of commercial systems:
LIMITED ENERGY PERMIT FEES: '*No licenses are required. Licenses are requir
for all other installations
RESIDENTIAL WORK ONLY: •
Fee for all residential systems $75.00
combined
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
❑ Garage Door Opener'
❑ Heating, Ventilation and Air Conditioning
System'
n Vacuum Systems
n 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
n Boiler Controls
❑ Clock Systems
•
❑ Data Telecommunication Installation •
•
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting
❑ Protective Signaling
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06