Permit CITY OF TIGARD ELECTRICAL PERMIT
' ' ' 11 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00346
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/23/2011
Parcel: 1 S136DCO2503
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 200
Project: Petsmart/Banfield Subdivision: FRUITLAND ACRES Lot: 17
Project Description: (1) sign lighting (Banfield Hospital)
Contractor: VANCOUVER SIGN COMPANY INC Owner: LURIA, MARK T
2600 NE ANDERSEN RD #50 WHEELES, DOYLE E
VANCOUVER, WA 98661 BY PETSMART INC, PROPERTY MGMT
PHOENIX, AZ 85027
PHONE: 360- 693 -4773 PHONE:
FAX: 360- 693 -2747
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 06/23/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 06/23/2011 $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 '. • ue• • -ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done accordance with - • •roved •1,ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TENTIoN: Oregon la r- Tres you to follow the rules adopted by the Oregon Utility Notification Center. Th•se rules are set forth in OAR
952 -001 0010 thr• gh OAR 952 -00 '091 y obtain a copy of the rules or direct questions to OUNC by calling 503 23 987 or 1.8r 5.33. 44.
/,
Issue. :y: ' / l /Ll / J Permittee Signature: d
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 Applicatio I ,'. FOR OFFICE USE ONLY
Ci ty of Tigard Ju N 2 3 2011 Received / r G � / _ 26
/
- / Permit No.
I N
De : OI / I s 13125 SW Hall Blvd„ Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 OF TIGARD Date /B : Other Permit:
• Inspection Line: 503.639.4175 Date Ready /By: furls: ® See Page 2 for
TIGARD Internet: www.tigard- or.gov BUILDING DIVISION! Notitied/Method: Supplemental Information
r- TYPE - OF WORK PLAN.. ;REVIEW ... ,
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction jaAddition /alteration/replacement
El Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑ Marinas and boatyards.
' _ CA TEGORY' ,QF CQNSTRUCTION • exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El I- and 2- family dwelling Commercial /industrial ❑ 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 .. '. ❑ Addition of new motor load of ❑ "A", "E ", "l -2 ", "1 -3 ",
Job no.: Job site address: 7$o ( 50 0 o 'tnn out\" Aci IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: i `{ r 0 I� tom 7 2.-Z, z ❑ Health -care facilities. ❑ Supply voltage for more than
A l ) ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: o P roject name: Band el 4 , El r = &� l ❑S ervice or feeder 600 amps or more.
Cross street/directions to job site: t f FEE—SCHEDULE—
Description
Qty. Fee. I Total I '
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential
• : DESCRIPTION . WORK,''' •-- (with above sq. ft.) 67.84 2
( i )
6 / i j Limited energy, multi- family
i l l IA nn ‘l IA /) e i S 1 n V adc ( I ct ( sq. HpTi fp� residential (with above s ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
;: ❑ 'PROPERTY ,O. W ' ' J.• TENANT. - ' .' 201 amps to 400 amps 133.56 2
L 401 amps to 600 amps 200.34 2
Name: pe,i tcm act R U l ;ea
601 amps to 1,000 amps 301.04 2
Address: - 7 c )ot .$ A , b la) O� 11" 1 f 6( Over 1,000 amps or volts 552.26 2
City /State /ZIP: ,' , d, (* q7 z z 3 Temporary services or feeders installation, alteration, and/or
1 relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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, . 1. . CONTACT PERSON . above service or feeder fee, 7.42 2
Business name: each branch circuit
�( a.i •ot, j ,'C B. B. Fee for branch circuits
Contact name: without service or feeder fee, 56. l8 2
i -1"t1f ill first branch circuit
Address: 26 100 Ai E' A ‘ e�P n p ' fE so Each add'l branch circuit 7.42 2
r\ Miscellaneous (service or feeder not included)
City /State /ZIP: V Co to v e, r i q .e 66 ( Each manufactured or modular 67.84 2
q dwelling, service and/or feeder
2 ' h
Phone: (360 ) 61 J �•77,-5 I Fax: : S6o ) 673 2 - 7Lt 7 . Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
. '..' - ', CONTRACTOR, , Sign or outline lighting (j) 67.84 697, ge 2
C Signal circuit(s) or limited -
Business name:
VQ11r0IAU , )t CO energy panel, alteration, or
Address: Z 6 0 ^ (E A n/ ie e n Art H,50 ,5 extension. Describe: Page 2 2
City /State/ZIP: vci,nC Ou ve, r LJ A qg 6 6 1 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (340 ) �� u 7 I Fax: La k,o) ??
1 I 7 a �7 Z 71 Investigation per hour (I hr min) 66.25
CCB Lic.: ( ' ' 9 1 Electrical Licia1ak • Suprv. Lie.: 37_ 6 c L5 Industrial plant per hour 78.18 •
Suprv. Electrician signature, required: �/) j 6 -.-',EI;ECTRICAL PERMIT FEES ;- r ././ Subtotal: ‘ gel
Print name: /,2A, / �u Date: 6 •20. `7 Plan review (25% of permit fee):
w State surcharge (12% of permit fee): g.1 y
Authorized signature: � 7 TOTAL PERMIT FEE: '7�. - 9R yv
This permit application expires if a permit is not obtained within 180 •
Print name: e �� 5 ` Date: 4,72 •
/ days fter it has been accepted as complete.
/ * Number of inspections allowed per permit.
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