Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00411
Alk
� � * DEVELOPMENT SERVICES . DATE ISSUED: 6/15/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 639 - 4171
PARCEL: 2 S 112 D D -00300
SITE ADDRESS: 15900 SW 72ND AVE ZONING: I -L
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: 5 sign lighting.
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: 5
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
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:
TIME OIL CO MEYER SIGN CO OF OREGON
PO BOX 24447 15205 SW 74TH AVE
SEATTLE, WA 98124 TIGARD, OR 97223
Phone: Phone: 620 -8200
FEES Reg #: LIC 64014
SUP 566SIG
Description Date Amount ELE 20- 190CLS
[ELPRMT] ELC Permit 6/15/2005 $267.00
[TAX] 8% State Surcharge 6/15/2005 $21.36 REQUIRED ITEMS AND REPORTS
Total $288.36
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 O • r 952- 001 -0010 throng h • ' R 952 - 001 -0100. You may obtain copies of these rules or direct - esti. to OUNC at
503-246-6699 or 1- :332- , .
Issued By: ` . , _ - op., _,1,' , Permittee Signatur .� % �� � ►'_.46/ ,
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 Permit Application . FOR OFFICE USE ONLY
Received // Electrical /� �,,�,'
RECEIVED Date/By: � / i / Permit Nofl�'!� v4 — c2 48
City of .Tigard Planning A ro • Sign A. Date/By: • Permit No.:
13125 SW Hall Blvd. ' �w 2005
Plan Review Othbr
Tigard, Oregon 97223 .. ' - . - Date/By: Permit No.:
Phone: 503- 639-4171 FaxCfp /- $90-r96 RD t Post - Review Land Use
1 ' Date/By: No.:
Internet: www.ci.tigard.or.pjiL) 4 t i
, a Contact Ju ® See Page 2for
-- _"
24 -hour Inspection Request: 503- 639 -4175 Name /Method: % l C Supplemental Information.
TYPE OF WORK • PLAN REVIEW (Please check all that apply) -' *-: ' •
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement Other: 9t j„N S ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
' 'CATEGORY OF- CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ommercial/Industrial ❑ System over 600 volts nominal one structure
I ❑ Building over three stories ❑ Feeders, 400 amps or more
Accesso Buildin M -Famil
❑ ry g y ❑ Occupant load over stories
persons 0 Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
. JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: /5900 ( 77 Gt-.e " • : FEE *. SCHEDULE _ Y.- .
Suite #: • — Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: r / / Descri tion Qty Fee (ea.) Total
New residential- single or multi - family per •
Cross street/Directions to job site: dwelling unit. Includes attached garage.
a,n 7z-,1 Cun. 7 AGPJA -e.0 Service included:
�� 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Limited energy, residential 75.00 2
Subdivision: I Lot #: , Limited energy, non residential 75.00 - 2
Tax map /parcel #: Each manufactured home or modular dwelling
- :; DESCRIPTION OF WORK service and/or feeder 90.90 2
//nn Services or feeders - installation,
.S 7 . l/ /. > a ee . 1 :( /4' a l 7LGyt/ � G Lt„ y alteration or relocation:
c � _ O
� 80.30
( - Lvit ]Z /5 fO � �� 1 ✓ c � ��201 2 00 amps to 400 amps 106.85 2 2
t --au J Q t �, / 401 amps to 600 amps 160.60 2
PROPERTY OWNER 6 1 1 0 T) ANT 601 amps to 1000 amps 240.60 2
1 Over 1000 amps or volts 454.65 2
Name: , - 7- /;n1,e 6 ,7 1 Ce) ' Reconnect only 66.85 2
Addres ,2 7 /IV, .ijyvivodeD,tP Temporary services or feeders - installation,
'' ,,y Qi alteration, or relocation:
City /State /Zip: 2�7`f / 1'Vr . ' 1 ,q 200 amps or less 66.85 1
/ 201 amps to 400 amps 100.30 2
Phone: Fax: 133.75 2 ,
RQO gS 2 D7 ti� 401 to 600 amps
1;1-APPLICANT • ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: - ce extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
CONTRACTOR Each sign or outline lighting ...../.- 53 2
Job No: Signal circuit(s) or a limited energy panel,
1 �" alteration, or extension Page 2 2
Business Name: Attie 5i4 » a `, Dg ., dTh2 Description:
Address: /1 7q, Each additional inspection over the allowable in any o the above:
City /State /Zip: 71671/2_ ) 012_ - q 7 Z Z V Per inspectio (min. 1 hour) 62.50
Phone: !p / 2c Fax: 6 Z0- 7a 7 V Inver . ion fee:
y er:
CCB Lic. #: ,y 'Z
Lic. #: 0 — (Q06 Lc� Electrical Permit Fee .
Supervising electci i� Subtot $ C�7- 00
signature require Plan Revi (25% of Permit Fe e) $
Print Name 0� t L , /- i s -'� plc 5[�(
� � (a _ State Surcharge (8% of Permit Fee) $ ?�o
TOTAL PERMIT FEE $ �rg 8 , ?) :[2
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: �� !� ∎ 1 Date: G i- -os -- 180 days after it has been accepted as complete.
•Fee methodology set by Tri- County Building Industry Service Board.
S/ V 8 l2-p
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
D Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
• Heating, Ventilation and Air Conditioning System
Vacuum Systems
11 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
• Audio and Stereo Systems
• Boiler Controls
n Clock Systems
Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
r 7 Intercom and Paging Systems
D Landscape Irrigation Control
El Medical
El Nurse Calls
El Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD .. _:.
BUILDING DIVISION PERMIT #: ELC2005 -00411
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6!15!2005
Phone: (503) 639 -4171 Alb 11111
Inspection Requests (24 Hrs.): (503) 639 -4175 .. -__..
INSPECTION WORKSHEET FOR DATE: 9/15/2005 TIME: 7 :03AM PAGE: B5
SITE ADDRESS: 15900 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: SHELL
DESCRIPTION: 5 sign lighting.
OWNER: TIME OIL CO, PHONE #:
CONTRACTOR: MEYER SIGN CO OF OREGON PHONE #: 62Q -8240
Inspection Request Scheduled For: Date: 9/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1981 Electrical final 015731 -01 503 -620 -8200 N
Corrections /Comments / Instructions:
i, 1 r\f h ►,I, 1/4 bV 0 -( S o 51,1 16 IN '60 fi k iS 1
C PI (,_ ..I ---C aNC, , tC-b l ° (oR
; b3_e — (7
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: A ' �. l i _ Date: / �'� A... Phone #: (503) 718-