Permit . CITY OF TIGARD ELECTRICAL PERMIT
r
`• '' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00004
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/13/2012
TIGARD Parcel: 251018800400
Jurisdiction: Tigard
Site address: 11844 SW PACIFIC HWY
Project: Park 217 Business Center Subdivision: TIGARD ROAD GARDENS Lot: 4
Project Description: Sign lighting for a free standing pole sign.
Contractor: COLUMBIA SIGNS INC Owner: WALTON CWOR PARK BC 8 LLC
4700 E FOURTH PLAIN BLVD BY CTMT - WALTON RE TAX
VANCOUVER, WA 98661 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE: 360- 696 -1919 PHONE:
FAX: 360- 696 -9797
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 01/05/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 01/05/2012 $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, o if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C er Those • . -s . re set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a cop of the rules or direct questions to OUNC by calling 503.23.. 9 ir. '!.234
Issued By: . ......,_...s... . 'ermittee Signature: 91/ , 1/
'to A —
4` 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.
tooli [E0E8 ON X8/X17 8C: 1.1. 03i1) ZLOZ /b Oil 0
Electrical Permit Application c � l r,l( t,I l It l: rsl: „Ni.,.
City of Tigard s -� Datnivyd 1 S' I3- r3z -r - '" ° -: ''Lc k i& ct.L t )1
13125 SW Hall Bivd., Tigard.OR 9 ?223 Q 1 a Revi
Phtme: 503.7182439 Fax: 503.548.!960 1...k Q g - �'• i7are/fdy: Other•Permit:
't' iii A14. I') Inspection Line: 503.639.4175 P• ® Lint! ttamlyl6y Yuri, 121 See Page z run
Internet: www.tigatd -orgoV -. ( . y 'fk � .Notifod/Merhed j � j Suppleme.rrallufnrnrat.'on
TYPE OF WOW • `e ,r y r:,'t -' :ELAN AEi1l(.... L ,
0 New construction ❑ Addilionlal unlrc �lrut mein ++ 1 Please check all that apply (submit se of plats widens checked below):
• O revue-100 agN[cc rgr ao0 amps or rnor Building o 0 Building over three sconce.
L
❑ Demolition 'Other: 5. k E t, f ) whit, din available fault current ❑ Marinas and boatyards. .
CATEGORY OF CQNSFRUCTION _ - exceeds lU,UU0 maps at 150 volts or 0 Floating buiJdings• •
• less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling ig Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: In Fire pump. ❑ Installation of 75 KVA or
❑ Emetbr,nuy system. larger disparately derived triton.
YOF SITE INFORMATION AND LOCATION ❑ Addition of new mater lord of ❑' A `F l.2" 1.3
�1
1 100HP or more. occupancy.
Jab no.: I Job site address: 11 a I4t r 5 w (,• ❑ l' L Six or moss residential slits. Cl itecreationa 'vehicle parks.
�
City /State/LIP: , n Pats` ❑ Health -care facilities. 1] Supply voltage for more than .
_ � l a in I fC �� 7.2 ❑14tvatdoss locaticns. 600 volts nominal.
Suite/bldg. /apt_ no.: Project name: pAR 1( 217 ,'- C1N ❑ Service or feeder 600 amps or mare.
FEE SCHEDULE
Cross sweet/directions to job site: S ik) CralaNtt2 4 4 Rwy C( q $ D d rioter I 4hv. 1 ]ter I Taut 1
New residential single- or wniti- family dwelling unit.
C I QLrMe . - Includes attached garage.
Subdivision: I Lot no.: 1,000sq. ft. orfess 165.54 4
• Fa add'! 500 sq. ft. ur portion 33.92 1
'i'ax map /parcel no.: Limited energy, re
DESCRIPTION OF \.VORLC (with above sq. ft.) 75.00 2
Limited energy, multi - family 1 - 75.00 12
Al t.W I i, L N (ArtAz r A q6-is. sr,� nit zpfi . rem residential herbs e. It.) L..
- Servietg or feeders installation, alteration, and/or relocation _
200 amps or less 100,70 2
ISE PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
- - . 401 amps to 600 amps 200.34 2 •
Name: IAill.GY'01J ( »)c t2 A R HI. 601 amps to 1,000 amps 301.04 2 '
Address: I ! -St, COLGLirotI3r10 3 }. ckwa 4, 4S1) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: potty lAN , 012. q 2,1 . . relocation -
59.36 I
.]done; (M3 221 2:13 F ( 200 amps or less
,
r^ s, 201 amps to 400 amps l 2 5.0$
owner installation: This installation is being made on property that I own which is not 401 amps to 549 amps Branch ti$Sd 2
ir t' sa e, , t, r exch e, au CA r dins f0 ORS 447, 449 and 701. Branch circuits - new, alte ration, or extension
err pail]
J Wner signatu •$ / ' �� At D- / 41 0 . 2--- A. Fee for branch cirtuits with
- P:4 APPLICANT ❑ CONTA • • ON above service or feeder fee,
•
ouch branch circuit 7.42 2
Business ,astir B. Fee for branch circuits without
. u f w ., , .. service or feeder fee, first 2
Contact name: f� �i o, branch circuit >6,18
tO 't (��
Each sad') branch circuit 7.42 2
Address: (,f -ion E ( c tr t Abti Iti f i 1141: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2 .
Cit UAvvLf“l/.9() ( e dwelling. service and/or feeder •
Phone: ( u p ) 6 94.. ict 1 ci I lax:: (T6 b ) bqb. q1c47 Reconne t only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: (,Q c lam- C t,(ln.vuh a ti (11A t, roe_ Sign ur Outline lighting ( 67.114 (/7 2
CONTRACTOR Signal circuit(s) orlimited.energy
t� el alteration, or extension. !°u -e2 2
re
Business name: ) 6. tl✓(Gti_' i drit I Each additional inspection over allow hie in any of the above
• j ++ + Additional inspection (1 hr min) 66.25/ hr
Address: F FpU f i k C investigation (1 hr min) 66251 hr
• City /State /ZIP: U cwt �1 eJ f U1 fl. ele ( r Industrial plant (1 hr min) 78.15/hr
Phone: ( ) 61 I q b q I
Z(� , )~ax: ( 3b0 ) G1'6- q 747 Inspections for which no ree is 90.0W hr
specifically listed ('AS hr min) •
CCB Lic.: I 4 Glbd ( I Electrical Lic.: Glt/ts(t'r Suprv. Lic.: ( X5)3 ELECTRICAL PERMIT FEES
Subtotal: /oy7. elf
Supt Electrician signature, required: - Plat review (25%ofpen)* fee) -
` Print name: vvi �� �� . A U Date: +_ Gr .1 Z State surcharge (12u/g of permit Fee): _� (i
TOTAL PERMIT FEE: -1 57, le
Authorized Si ......„•: r .01......1.m. J 'c This permit applLvtiou expires if a permit is not obtained within 150
days after it bus been accepted its cumptete.
Print name: / e/ R { �, ( DaCe: I.- / 'Z ' 'Number of inspections allowed per permit.
- t.aaullditykoctmhaLC.Permithpp -dug 01/01/10 11 11''"" 40.461Sr(1 vo5 /COMiwEa
Z0 /Z0 3Vo'd SN9IS VIElJfl L6L6- 969 -096 ZE :ZZ ZZOZ /170 /i0
•
•