Permit x,.
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00166
DEVELOPMENT SERVICES DATE ISSUED: 4/3/2006
l
, 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S113AD-01700
SITE ADDRESS: 16920 SW 72ND AVE ZONING: C -G
SUBDIVISION: ROSEWOOD ACRE TRACTS LOT : 030. JURISDICTION: TIG
Project Description: 6 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: 6
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:
BRIDGEPORT LAND LLC MEYER SIGN CO OF OREGON
3939 NW ST HELENS RD 15205 SW 74TH AVE
PORTLAND, OR 97210 TIGARD, OR 97223
Phone: Contact #: PRI 620 - 8200
FEES
Description Date Amount Reg #: ELE 20- 190CLS
LIC 64014
Total
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 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: Permittee Signature.�f �5 1
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.
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City of Tigard APR 3 2006 Planning Approval Sign
Date /By: Permit No.: (AN e7l004• /00
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
s^V "
g 1/ R Post - Review Land Use
Phone: 503-639-4171 Fax: ISIO ' i Date/By: Case No.:
Internet: www.ci.tigard.or.us ALL e • it Contact J ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 [''' < , a Name /Method: / / LA Supplemental Information.
2 °r TYPE IFAV,ORK';';i 8 ii *: ' . ,. . ' , PLAN" , REVIEW.(Please c lieckrall that a ';::. - .
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition /alteration/replacement P1- Other: )1( , S ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
O
<.Y �,t;,. t �CATEGORY`QF CQNSTRUCTION.���� 4 0:.:L- : 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ®: Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan . ❑ Other:
�_. Submit _ sets of plans with any of the above.
JOB` SITE :.INEORIGIATION�and;LOCATION ; r '
., ' ,�. The above are not applicable to temporary construction service
Job site address: /6q 20 §() 7 CLI-°JZ- ` _. ; . '" , - .; -FEE* SCHEDULE ! - _; .t 1 "1 r +. ,I.
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Descri Qty Fee (ea.) Total
Project Name: Jl 61..±:. 1rt19 /�P�S 1
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
5w 72-0 0-i--Q ,/ (, o p Service included:
u ( 1000 Service ce ft. included:
or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
• tDESCRIP'PION`OF .t4WORK i r
a service and/or feeder 90.90 2
Services or feeders - installation,
/.,, � a /- � `1. _ „ � en � > (
Iry) (Y\ U..JV? [M alteration or relocation:
e fjy 7!X Ik 200 amps or less 80.30 2
0o
� y.. c C-- ” Y 15 ' P y 1dY1 c(- ■201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
601 amps to 1000 amps 240.60 2
Q'F:OPER Y O WNER i� ®TENANT + Over 1000 amps or volts 454.65 2
Name: ((efrL( P UD p . ( e — Reconnect only 66.85 2
Address: 3c? 39 ,. W IT �-Q 6 S 'eq ( - Temporary services or feeders - installation,
J alteration, or relocation:
City /State /Zip: P 6l, i--�'n � be . ?7 w S— 200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Phone: 1_41 /Z 401 to 600 amps
Fax: 133.75 2
E}AEPLICAN.T : ".CO PERSON a -" ' : Branch circuits - new, alteration, or
Name: V) c i 1 ff /t a C -(e J extension per panel:
A. Fee for branch circuits with purchase of
Address: ( 5,,,,-Kg
- service or feeder fee, each branch circuit 6.65 2
City /State /Zip: 13. 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
Email Misc.(Service or feeder not included):
Each irrigation circle 53.40 2
";� `CONTRACTOR ` e , - :-- Each p sign ump or or outline lighting 6,. 53.40 3 zD. O 2
Job No: Signal circuit(s) or a limited energy panel, 2
^ alteration, or extension Page 2
B usiness Name: �{,( sc&,J �� C�Q �Y / C " Description:
Address: /SZOS 6w 74 A-W- Each additional inspection over the allowable in any of the above:
City /State /Zip: - 776-4- 1 2_b / c - . `t -i 2 -z Per inspection per hour (min. 1 hour) 62.50
Phone: ( zo _g em Fax: 62.0— 707 % Investigation fee:
Lic. #: 7- —1 q L s Other:
CCB Lic. #: 4, y � - � � .: �.: .`=
•a Electiica1; Pei=mlt�Fees
Supervising electr Subtotal $ 31.D 9-D
signature required: \ � \, _ Plan Review (25% of Permit Fee) $
! b St Surcharge (8% of Permit Fee) $ 2..- &
Print Name: p/� �L� t: /1-1&616 Lic. #: StG S TOTAL PERMIT FEE 5 341'`^°
Authorized a ., Notice: This permit application expires if a permit is not obtained within
Signature: �1 il.tAllil Date: 0 — ) . 5 -- "D 6 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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(Please print name) C ?(p ,9 3
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03 J
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:
n Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
I Heating, Ventilation and Air Conditioning System
n Vacuum Systems
T7 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
Boiler Controls
1] Clock Systems
Data Telecommunication Installation
1 1 Fire Alarm Installation
HVAC
I] Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control
I I Medical
r7 Nurse Calls
Outdoor Landscape Lighting
I-I Protective Signaling
I Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03