Permit CITY OF TIGARD ELECTRICAL PERMIT
' = COMMUNITY DEVELOPMENT Permit #: ELC2011 -00301
Date Issued: 06/03/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S104BB08100
Jurisdiction: Tigard
Site address: 14250 SW BARROWS RD 001
Project: Ultimate Tan Subdivision: RUSSELL'S SCHOLLS FERRY Lot: 3
Project Description:
Contractor: BEAVERTON SIGNS Owner: ALULI REAL ESTATE HOLDINGS LLC
3899 SW HALL BLVD 415 -C ULUNIU ST
BEAVERTON, OR 97005 KAILUA
OAHU, HI 96734
PHONE: 503 - 672 -9037 PHONE.
FAX: 503 - 574 -4741
•
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 06/03/2011 $67.84
Specifics: 1 ea 12% State Surcharge - 06/03/2011 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952.0. Y•u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / Permittee Signature: //V /97
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.
Jun 01 11 03:20p 1- 503 - 574 - 4741 p.1
Electrical Permit Applicati �a'�'CEIVED FOR OFFICE USE ONLY
City of Tigard JUN 2 2011 Received X0,3/// (/ Permit No.6 // - DO 301
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1; Phone: 563.718.2439 Fax: 503. Date /By: Other Permit5g-'� /// dods6
Inspection Line: 503.639.4175 OF T Date Rcady/By: lens: PI See Page 2 for
l 1GAR17 Internet: www.tigard or.gov BUILDING DIVISION Notified/Method: /` supplemental Information
. TYPE OF WORK PLAN REVIEW
ID 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 A Other: AJjart/ , I &A) 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 0 Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION O Addition of new motor load of ❑ "A ", "E ", "l -2 ", "1 -3 ",
I00HP or more. occupancy.
Job no.: Job site address: I4z c 0 s4, bp, Ram e() 001 ❑ Six or more residential units. ❑ Recreational vehicle parks.
❑ Health -care facilities. [3 Supply voltage for more than
City /State /ZIP: -�� &A (Z Q fl.. Z a ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 0 0 I Project name: -TA.A. 4 m 5 Pior ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: neses_pi don i Qty. I Fee. I Total I
New residential single- or multi- family dwelling unit,
f IA2 (31,•- «p S t 4"' Se-e--hc)QIS Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
(w ith above sq. It)
75.00 2
DESCRIPTION OF WORK •
Limited energy, multi - family 75.00 2
residential (with above sq. ft.) 1
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: D diZib IE C (Ltcl l,✓-Fp -t 601 amps to 1,000 amps 301.04 2
Address: 6I z5,0 S L. , lk, t.0s go do I Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: it o tvlivo a it, "'"-) Z �3 relocation
Phone: (563) gect — 3 0 d 5 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
to APPLICANT El CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: f3 mu k- --TO P) SI0 5 B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: m ate, EG 0 /- - branch circuit
Each add' I branch circuit 7.42 2
Address: 3 g, q 7 S e t) SIR // (/✓(/I® Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State/ZIP: 13E, ��h 6 % 9 f 7 v 05 dwelling, service and/or feeder
/� Reconnect only 67.84 2
Phone: ( 563) 1tv 72_4 (�3 F ( ) Pump or irrigation circle 67.84 2
E -mail: /YJ kC ' �R»7 5/ (0 { � '7 Sign or outline lighting i 67.84 4i 7. r'( 2
P CONTRACTOR %9'!V Signal circuit(s) or limited -energy
,panel, alteration, or extension. Page 2 2
Business name: A/41. Each additional inspection over allowable in any of the above
Address: Pr 1 ,ctl, / /5� Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.251 hr
City /State /ZIP: A LrJ Gfi 7D w 1 O 5 ➢ f Industrial plant (1 hr min) - 78.18 / hr
Phone: (5Q'j) 7 2 -9'a 7 Fax: ( 3 / ' f� a / 7/ 4 / /5i 6 Inspections for which no fee is 90.00 / hr
/ specifical listed (%s hr min)
�/ CCB Lie,: /3 99 f . Electrical Lie.: C+` '3 �'7 Suprv. Lie.: ELECTRICAL PERMIT FEES
I1 � C Subtotal:
Suprv. Electrician signatu e, r quired: 7///// / o� OA Plan review (25% of permit fee):
Print name: IaYt �a' Q % a)0 Date: 69 / State surcharge (12% of permit fee): g . t q
`_, TOTAL PERMIT FEE: -7 5 .9$
Authorized signatu ` This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name : Date: (s � j � ) � /. �- /1 ' Number of inspections allowed per permit.