Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00023
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/07/2011
Parcel: 1 S135BC00201
Jurisdiction: Tigard
Site address: 10765 SW GREENBURG RD
Project: 7 -11 Subdivision: Lot: 0
Project Description: (3) branch circuits for outside LED lighting.
Contractor: NOMAD SIGN INSTALLATIONS INC Owner: BELANICH, ROGER M
418 45TH AVE NE 22020 17TH AVE SE #200
SALEM, OR 97301 BOTHELL, WA 98021
PHONE: 503 - 339 -6674 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 01/07/2011 $203.52
Specifics: 1 ea 12% State Surcharge - 01/07/2011 $24.42
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $227.94
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, dr if work is suspended for more the 180
days. ATTENTI. = - :•n law • uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 rough OAR 9' -I -0090. of may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: I . ' Permittee Signature:
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.
can 503.639.4175 by 7:00 a.m. for the next available Inspection date.
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
,� qq
•City of Tigard Dateiv R eceived 7 // Permit No.: / -oo 3
13125 SW Hall Blvd., Tigard, OR 9 B EC EVE D Plan Review
Phone: 503.639.4171 Fax: 503.598.196A Date/B : Other Permit:
TIGARD
Inspection Line: 503.639.4175 JAN 7 2011 Date Ready/By: Juris: H See Page 2 for
Internet:. www.tigard- or:gov ((' ��� Notified/Method: Supplemental Information
TYPE OF WOR kj S �r�� PLAN REVIEW
e pt
� fi�,gg'' `` t ttiilStO. - Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction IAl Addition/alteN acement
❑ 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 IV CommerciaUindustrial • ❑ Accessory building amps for all other installations, buildings.
❑ Multi - family ❑ Master builder ❑ Other: 1 ❑ 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 - ", "1 - ",
Job no.: Job site address: /0 7 6 S c R---n L ( Six or more residential units. or more. occupancy.
❑ Six or 0 Recreational vehicle parks.
City/State /ZIP: ,1 1 5 a r d 0 {Z '9 7 22.3 ❑ Health -care facilities. ❑ Supply voltage for more than
J ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: "— / / ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
. • 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
sq. 75.00 2
DESCRIPTION OF WORK ( with above q• ft. )
Limited energy, multi - family 75:00 2
• rve 0, } 5 t cie L G ( Z ;5.0, 'la 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
401 amps to 600 amps 200.34 •2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 . amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 ' 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447,449, 670, and 701.
Branch circuits — new, alteration, or extension,-per panel
Owner signature: Date: A. Fee for, branch circuits with
❑ APPLICANT above service or feeder fee,
❑ CONTACT PERSON each branch circuit 7.42 2
Business name: Sj B. Fee for branch circuits w ithout -
1 /1Skt((afi Hoe/ r..) � .4
p y yl (
service or feeder fee, first �6 2
Contact name: Z.7 j, i.e�GA branch circuit 56.18 •
� d 1 Each add'I branch 7 Al ! (/ g' ,2
`1
" Address: ) 0 L/ - �.,- IV-e- Miscellaneous (service or feeder not included)
City/State/ZIP: S C( 1 ? O I ? Each manufactured or modular 67.84 2
/ 1 J dwelling, service and/or feeder '
Phone: ( s' 3 ) 3 34 6 67 Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
" E - mail: /e.g. , r y . ifOJ roci-c( S +9 ( y" 4, / . Coon Sign or outline lighting . 5 67.84 ;45.5' 2
CONTRACTOR Signal circuit(s) or limited- energy -•
• v panel, alteration, or extension. Page 2 2
Business name: 0 0»74 ( S,y,„ :T s �i 4.4P r .3 , el c-
Each additional inspection over allowable in any of the above
Address: 2 / 0 11 S t'^ ,.,,,.;e /.)-e . Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: 5 4, 93-30i Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr •
Phone: (D3 ) 33g 6 c 9 Fax ( 0 Inspections for which no fee is •
I , specifically list (%: hr min) 90.00 / hr
CCB Lic.: 993 3) 43lectrical Lic.: as ( Suprv. Lic.: 2./76 43 ELECTRICAL PERMIT FEES
(k k \ Subtotal: i T ® 6
Z
Suprv. Electrician signature, required: °
Plan review (25% of permit fee): .
Print name: r o ) / Date: / — Z p ] State surcharge (12% of permit fee):. .1.1.
I TOTAL PERMIT FEE: ' f .
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: • Date: • 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:
n 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
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PerniitApp.doc 07/01/10