Permit - CITY O F TIGARD GARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00826
- A i I, DEVELOPMENT SERVICES DATE ISSUED: 12/30/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110DC 02400
SITE ADDRESS: 11565 SW DURHAM RD 120
SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: (2) sign lighting.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 2
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BUILDING SIX ASSOCIATES LLC HIGHLIGHT SIGN CORP
BYCRL MARKS +CO INC 8200 SWHUNZIKER
135 EAST 57TH ST TIGARD, OR 97223
NEWYORK, NY 10022
Phone: Phone: 503 620 - 8205
Reg #: LIC 104599
SUP 517SIG
FEES ELE 37- 660CLS
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/30/200' $106.80
[TAX] 8% State Surcharge 12/30/200' $8.54 Elect'I Final
Total $115.34
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Speaalty Codes and all other applicable laws
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 than 180 days ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain copies of these ru es or direct qu -: long to OUNC at (503)
246 -6699 or 1 -800- 332 -2344
Issued By: ,/ Permit Si nat �
y� .���a ALT _��lti� / g �./�iL�,i L /ILi.zA
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'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
RECEIVES
Electrical Permit Application r t � , = °,,t , ',FOR OFF O $ ` '� ,11„'
F ' V '
City of Tigard IDEC J 0 2004 Receive.
Permit No
Date B �� " - Permit `1,
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone: 503.639.4171 �/9 i 9 VI' IIGARD I IY' +� • Date /Re Other Permit
Inspection Line. 503 .63 i Vl 1 V i�LJ .'a, Date Ready /B• Tuns Q See Page 2 for
Internet www ci hgaB TIDING DIVISION Notified/Method N \ CS Supplemental Information
TYPE OF WORK PLAN REVIEW
Erg; -- construction ❑ Addition/alteration/replacement Please check all that apply
❑Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition El Other:
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq ft,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling L o /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
III Multi - family ❑ Master builder ❑Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address ) I S c CW pi2e RA,yy( AP-
El Health-care of play ❑above:
Submit ? sets of plans with any of the above
City/State /ZIP: -j' I &Mo. /) 409 t; S7 1 a0 The above are not applicable to temporary construction service.
Suite/bldg./apt. no: I Proj ect name. - rwtri 12 . i...✓ f FEE* SCHEDULE ** -
Description Qty. Fee. Total
Cross street /directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion • 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
' 1,57-41,t_.- a Z! � �, �� ` o p - z pe'x dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER 1 ErrENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Tl9v - t CL(J0 601 amps to 1,000 amps 240.60 2
Address: 11 S(o S SW • PtJ24ff4 ti D. S7' /ap Over 1,000 amps or volts 454 65 2
Reconnect only 66 85 2
City/State /ZIP: - 6 ,,4 - OA t Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) g '+ 4-.- &g 1 3 I Fax: (.1 ) d 9.-4 -- 7'? y3 200 amps or less 66 85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date Branch circuits - new, alteration, or extension, per panel
g-- APPLICANT I R CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name. )...i) loHNAsir paw civet° branch circuit
B Fee for branch circuits
Contact name: c174 By w7 without service or feeder fee,
each branch circuit 46 85 2
Address: g. � ( , 0 #1j/0
Each add'l branch circuit 6.65 2
City /State /ZIP: T/ b an L'ii , Miscellaneous (service or feeder not included)
( r ) 4 d t� - 'Pam (.S�3) 4. Li 3 Pump or irrigation circle 53.40 2
Phone. Fax: Sign or outline lighting 53.40
g g g � la 0 , VU 2
E -mail: 51 rWR oP y I Y('La,-/t $ /tty(] , ertc,P14 . Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe Page 2 2
Business name: /, f /6,,,yy GNT f'/ 1 djg,.
f at) �uv��kei� Each additional inspection over allowable in any of the above
Address: L(J • 0? � Per inspection 62.50 _
City/State /ZIP -(" 4f 2_ 4 4 2' / � f Investigation per hour (1 hr min) 62 50
Phone: (la) opag - 8 1-6 -j Fax: ( JV3) 6 a +..?7 j Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: i if, 1 G Electrical Lic.: $//y 3 )-, Suprv. Lic.: 77-6'4i Subtotal I of
Suprv. Electrician signature, required: 4/i` l Plan review (25% of permit fee)
'"i State surcharge (8% of permit fee) g 6 . , 1
Print name: (i(Fz [ Date: /a r�� /
TOTAL PERMIT FEE f / 5/ 34
Authorized signature: This permit application expires if a permit is n obtained within 180
days after it has been accepted as complete
Print name Date: * Fee methodology set by Tn- County Building Industry Service Board
** Number of inspections per permit allowed
i \Building\rem its\ELC- PemutApp doc 12/03 440- 4615T(10 /02 /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:
I Audio and Stereo Systems*
I Burglar Alarm
Garage Door Opener*
Heating, Ventilation and Air Conditioning
System*
Vacuum Systems*
Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
I Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
Medical
Nurse Calls
❑ Outdoor Landscape Lighting*
I I Protective Signaling
Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
r\Buildmg\Pertmts\ELC- PermitApp doc 04/03