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Permit CITY OF TIGARD ELECTRICAL PERMIT Per COMMUNITY DEVELOPMENT Permit #: ELC2009 -00244 T [ G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/27/2009 Parcel: 2S102AB03600 Jurisdiction: Tigard Site address 12289 SW MAIN ST Subdivision: Lot: 0 Project: Portland PC Repair Project Description: (1) sign outline /lighting. Owner: FEES JOHNSON FAMILY TRUST & Quantity Description Date Amount JOHNSON, REES C TRUST &, JOHNSON, 1 ea Sign or Outline Lighting 05/27/2009 $53.40 MARYANNE G TRUST, 3112 SW SANTA 1 ea 12% State Surcharge - 05/27/2009 $6.41 PHONE: Electrical Contractor: HIGHLIGHT SIGN CORP 18270 SW BELTON RD TIGARD, OR 97,223 PHONE: 503 - 729 -7978 FAX: 503- 624 -3725 Type of Use: Class of Work: Type of Const: Occupancy Grp: Total $59.81 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 . - is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifica'••n Center. • os- rules are -et forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5y 246.6. • • • • ;06 2.2344. Issued By: y at. LQ c-4(? 1,( Z� Permittee Signal • > / / ' 'Si / //� 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 503.639.4175 by 7:00 a.m. for an Inspection that business day. 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 Application RECEIVED FOR OFFICE USE ONLY Received - t City of Tigard Date/By: Perm No.: �e . 0r� q i- lig 13125 SW Hall Blvd., Tigard, OR 97223 MA 2 7 2 009 Pl an R �J Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: V7009 . T I G 1 R D Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: Juris: Page 2 for Internet: www.tigard- or.gov Notified/Method: 1 j �, Supplemental Information BUILDING DIVISION TYPE OF WORK PLAN REVIEW 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 ❑ Other: 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 re CommerciaUindustrial ❑ 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 ", "E ", "l -2 ", "l -3 ", / n 1 8? sal , Six or or more. occupancy. Job no.: Job site address: ITT �/� �,� ry7 ❑ Six or more residential units. 0 Recreational vehicle parks. City/State /ZIP: 'y' q. f 9 7 ‘9. 3• ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: Fba pC w /Q ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: 54J. Now 4 igL 1 . 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. ft. or less 145.15 4 Ea. add'I 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above 'sq. ft.) 75.00 2 Limited energy, multi - family 75.00 2 /0••U PO/ 4- a- )411) ale Urt C /IAA residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER 1 llg TENANT 201 amps to 400 amps 106.85 2 Name: 1/11,4 0/c jp g L` / ildg'r - dO pt. ApAsix 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 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 599 amps 133.75 2 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with 0 APPLICANT I fiej CONTACT PERSON above service or feeder fee, 6.65 2 f j• y / , ar �P • Fee for circuit Business name: � �.�, � A/9,0 B . Fee for branch circuits wiihoui service or feeder fee, Contact name: SOWN— 4,444.4W14 D ' first branch circuit 46.85 2 Address: / a, $7Q C.U. s 104-70u Each add'l branch circuit 6.65 _ 2 ^'_. Miscellaneous (service or feeder not included) City/State/ZIP: 7 Web C)A' • Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: () ) (p sin $' ,2471.. Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting r‹ 53.40 2 Signal circuit(s) or limited - Business name: 1.+1,A kip y 5944 Qin „ x energy panel, alteration, or Address: 1 Pir7t7 PA). �jfi.kra� extension. Describe: Page 2 2 City/State /ZIP: c i4,(n ce Each additional inspection over allowable in any of the above Phone: ( a)) (.Port gOr Fax: ( ) Per inspection 62.50 S Investigation per hour (1 hr min) 62.50 CCB Lic.: 041-91 Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: / Plan review (25% of permit fee): Print name: in l /'/ I Date: ; a 7/� ' State surcharge (12% of permit fee): Authorized sign. �, -.000 TOTAL PERMIT FEE: D ate: ,T .. This permit application expires if a permit is not obtained within 180 • Print name: • 11It , V / A ._ ! ... , i -/ v 0 7 days after it has been accepted as complete. • Number of inspections allowed per permit. I: \Building'Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(I I /05 /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: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 • system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems • ❑ Landscape Irrigation Control* ❑ Medical • ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling • ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1: \ Building \Permits\ELC- PennitApp.doc 03/23/06