Permit CITY OF TIGARD ELECTRICAL PERMIT
111 a , COMMUNITY DEVELOPMENT Permit #: ELC2011 -00024
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/07/2011
Parcel: 2S110AA00600
Jurisdiction: Tigard
Site address: 10650 SW MCDONALD ST
Project: 7 -11 Subdivision: Lot: 0
Project Description: (3) branch circuits for outside LED lighting.
Contractor: NOMAD SIGN INSTALLATIONS INC Owner: TEXLAND PROPERTIES CORP
418 45TH AVE NE TAX DEPT #16394
SALEM, OR 97301 PO BOX 711
DALLAS, TX 75221
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 perm' issue• - bject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance wi • approve• . ans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TTENTION: Oregon a equire •u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 -0010 thr gh OAR 95 01 -0 1 ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 0 1.800.332.2344. /
Issue y: � . .� -4! � � 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.
Call 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 Recei
City of Tigard D ate/B d 6 / 74.11.-- Permit No.: 13125 SW Hall Blvd., Tigard, OR E C E V FD Pla n Review
' C ' Phone: 503.639.4171 Fax: 503.598.196� Date/B : Other Permit:
I'l(AI:I)
Inspection Line: 503.639.4175 JHN 2011 Date Ready/By: Juris: ® See Page 2 for
Internet: -www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF W t TICARD
r
uv l
El New construction g Addition/alter to replacement PLAN REVIEW
i'J L hhyC DI1�1�'IC�1. Please check all that apply (submit 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 1:1 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 ", "l -2 ", "l -3 ",
Job no.: Job site address: � � , ' M I D f --� 100HP or more. occupancy.
10 so .5 f e NO(n J ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Q R. 9 10 a4 ❑ Health-are a d fcation ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: — 1 — I I ❑ 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
/ /n� DESCRIPTION TION OF WORK (with above sq. ft.) 75.00 2
'JELL) OCa t % A s , 1 % �� 75.00 2
t ,L, Limited energy, multi- family
S residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ 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
h 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 .
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: . Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder 7 42 2
` each branch circuit
Business name: 0 6M An S l 1 � NS - t - Q+11 o,4-4ONS 1 • B Fee for branch circuits without
S I service or feeder fee, first ; 2
� � n y v . F' branch circuit j �i,
Contact name: I t . \
A .' �t Each add'I branch circuit -aj1 2
[ / s
Address: y/B 17" ,4
) -V ( Miscellaneous (service or feeder not included)
s' 4 // .i I q 7 0 / Each manufactured and/or d/ r modular
City/State /ZIP:
t / - 3
q 7 dwelling, service and/or feeder 67.84 2
Phone: (507) 3 3 5' - ‘ 47 II Fax: : ( ) Reconnect only 67.84 2
J' Pump or irrigation circle 67.84 2
E - mail: 1� „. u 415 & YItiAIL r C O1l'i
Sign or outline lighting 3. 67.84 AO3, 6
CONTRACTOR Signal circuit(s) or limited- energy .
panel, alteration, or extension. Page 2 2
Business name:
/ Y01h/4n S 1 /J LN /f O/ / Each additional inspection over allowable in any of the above
Address: `// ? y 5 719 AI/C Vie Additional inspection (1 hr. min) 66.25/ hr
City/State /ZIP: .5/1 t a / Investigation (I hr min) • 66.25/ hr
/ Un 97 3 Industrial plant (1 hr min) 78.18 / hr
Phone: (So3 ) 3 3 5' - 6 7 `� Fax ( ) Inspections for which no fee is 90.00 / hr
specifically listed (% hr min)
CCB Lic.: � 33 Electrical Lic.: etS'. /4 Suprv. Lic.: a '7 C ,
,' T ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee): =--�
' Print name:
( S tate surcharge 12% of permit fee): r
CO � � � l 1 _- Date: (._'7 � � ( P )� 1.
.. -- -- --oo TOTAL PERMIT FEE: �/"�rl
Authorized signature: (.t `` 1 y/ This permit application expires if a permit is not obtained within 180
^ days after it has been accepted as complete.
Print name: to ' C r �f zCock Date: I _ 1 — 11 • Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 4404615T(I1/05/C0M/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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n 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
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 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
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10