Permit CITY OF TIGARD ELECTRICAL PERMIT
1111111 ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00363
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/30/2011
Parcel: 2S112DD00300
Jurisdiction: Tigard
Site address: 15900 SW 72ND AVE
Project: 76 /My Goods Subdivision: PACIFIC CORPORATE CENTER Lot:
Project Description: Sign lighting for (2) signs.
Contractor: BEAVERTON SIGNS Owner: PCF ACQUISITION CO LLC
3899 SW HALL BLVD 22026 68TH AVE S
BEAVERTON, OR 97005 KENT, WA 98032
PHONE: 503 - 672 -9037 PHONE:
FAX: 503 - 574 -4741
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 06/30/2011 $135.68
Specifics:
1 ea 12% State Surcharge - 06/30/2011 $16.28
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $151.96
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 • AR 952 -001 -0090. You ma 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:
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 28 11 02:21p R C Ei VED 1- 503 - 574 -4741 p.2
Electrical Permit AnplicatiOH FOR OFFICE I SF ONLY
City of Tigard JUN 2 9 2011 Received .
Dale/8 : / IL , :rte ` � f
• 13125 SW Hall Blvd., Tigard ' , 7 Plan Review
a . Phone: 501718.2439 Fax: ! • 15's o� D nate/Bv: IM
TIGARD TrtspectioiiLiue; 503,G39 . 4 'irJlLDl1�iG DIVISION btteReady /9y: See Page 2for
Internet www.tigard or,gov • Notified/Method: IMI Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ❑ Addition/alteration /replacement
,,�
['Service or feeder 400 amps or more ❑ Building over three stories.
E] �
Demolition Other: S li(c t /a - oP where the available fault current ❑ Marinas and boatyards.
CATEGORj. -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 ommercial /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 "F. ", "t - 2 ", "1 - 3 ",
A yr LOO m or e re ❑ R
Job no.: Job site address: ( 5c100 creational vehicle
�`,Qf ��M f^t i. ❑ Six or more residential traits parks.
Ci ' /State /ZiP: f 4 L .
o R 9 7 r � 2 41 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldglapt. no.: 4 1 Project name: , 'l � 6- S ❑ 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. It. or less 168.54 4
Ea. ttdd' 1500 sq. R. or portion ' 33.92 1
Tax map /parcel no.: Limited energy, residential 75,00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
7-1•PQ - Si (f2 IL) Hook -u P-5 • residential (with above sq. ft.) 75.00 2
Y Services or feeders installation, alteration, and/or relocation
*1 5 ( , J 2 o 61 00052. 0 S(0UZO f 1 Ono S3 200 amps or less 100.70 2
❑ PROPERTY OWNER ,TENANT 201 amps to 400 amps 133.56 2
401 Name: 7 / ,� C O S 2 GAL Ai! z 0 601 am to t 00 m pg 30� as 2
Address: i Sci 00 _s, co L /CJi 4-1.."C G / Over 1,000 amps or volts 1 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP:' l (p,q) C)R 2 2. y relocation
Phone: (tam) ei z - C S 3 s 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 T 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 ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: d 4VE rDr S! roll s B. Fee for branch circuits without
service or feeder fee, first
Contact name: f e h 11.4E 1 1 „ t o L r r- branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: 3 it 9 St.1J Hifs IA is Lvb Miscellaneous (service or feeder not included)
City/State /ZIP: i3 (��n Each manufactured or modular 67.84 2
Q Q � p Q � � dwelling, service and/or feeder
Phone: (5-03) &v`7 2. 9 Fax: : (503) 57.9 7 i/,✓ Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Al t } < k 1j e/ Si / 6 . Co Fr Sign or outline lighting 2 67.84 13S.be 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: d v . 5/64 S panel, alteration, or extension, Page 2 2
Each additional inspection over allowable in any of the above
Address: 3 5 ' / , 6 , ` /� -/ 1 ,0 Additional inspection (1 hr min) 66.25/ hr -
/ Investigation (1 hr min) 66.25/ hr
City/State /ZIP: .t✓ D/t/ -2003 Industrial plant (1 hr min) 78.18! hr
Phone: 5k ) b7 Z „ 9 Fax: ° ) .57.- g7•9(/ inspections for which no fee is 90.00 / hr
�� r ��,
/ specifically listed (.4 hr min)
CCB Lic,: ay�'� , Electrical Lic.: , ' Suprv. Lic.: (S -/7 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 14 515 1l „ Plan review (25 %ofpermit subtotal: 135.(o fee):
Print name: M ti Cl"l txt' . NtrBp70il Date: /- _2 1 , // State surcharge (12% of permit fee): % (p. 2.g
�' � TOTAL PERMIT FEE: (C�1
Authorized signature 4 This permit application expires if a permit is not obtained within 180
days
Print name: ./y//iy,4�-/ �/4/3i Date: -0/•: ions allowed has been p accepted as complete
per 1 ( • Number of inspectLion per permit.