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Permit 7 CITY OF TIGARD y ELECTRICAL PERMIT PERMIT #: ELC2003 -00525 u I� DEVELOPMENT SERVICES DATE ISSUED: •8/21/03 J II 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136AD-04000 SITE ADDRESS: 11505 SW PACIFIC HWY B SUBDIVISION: VILLA RIDGE ZONING. C -G BLOCK: LOT : 007 JURISDICTION: TIG Project Description: Wall sign 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: 1 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: RAMSAY SIGNS 9160 SE 74TH AVE PORTLAND, OR 97206 Phone: Phone: 777 - 4555 Reg #: LIC 63422 ELE 26- 106CLS FEES SUP 493S1G Description Date Amount Required Inspections [TAX] 8% State Tax 8/21/03 $4.27 [ELPRMT] ELC Permit 8/21/03 $53.40 Elect'I Final Total $57.67 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty 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 rules or direct questions to OUNC at (503) 246 -6699 or 1- 800 - 332 -2344. Issued By: Permit Signature: --G 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 • • • Electrical Permit Application FOR OFFICE USE ONLY Received Electrical l ate/By: gra 1 ( Permit No.:E- 'C,.203 - er) CRS - City f Ti and Planning Approval Sign y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use M aim diy I t Date/By: Case No.: Internet: www.ci.tigard.or.us ,..' I I Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -417.5 Name/Method: Supplemental Information. / J . 7 - 1 ) 0 3 - 00 TYPE OF WORK PLAN REVIEW (Please check all that apply) I New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location ❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet, CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in — ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park p Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address: j i ' j 0 - tS St AJ Pate L-�t C_ 01)3 t _ j FEE* SCHEDULE Suite #: Bldg. /Apt. #: f Number of inspections per permit allowed Project Name: C o,n OL.c1C&�t i C � S.p r t 11 e e e Qty Fee (ea.) Total 1 Cross Street/l�l ChOriS to Ob site' New residential - single or multi- family per J ��r dwelling unit. Includes attached garage. S ( peAel ,� Q (Zn Sl. i Alf& Service Included: C1." SU-) (.128.m` payKW ' 1000 sq. ft. or less 145.15 4 {' Each additional 500 sq. ft. or portion thereof 33.40 1 Lot #: Limited energy, residential 75.00 2 Subdivision: Limited energy, non residential 75.00 2 Tax map /parcel #: • Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or feeder 90.90 2 ELL ry LOCLOA S 19n Services or feeders - installation, Z'f1S� C � alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 ❑ PROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: Reconnect only 66.85 2 Address: Temporary services or feeders - installation, alteration, or relocation: City/State /Zip: 200 amps or less 66.85 1 Phone: Fax: 201 amps to 400 amps 100.30 2 [� APPLICANT ® CONTACT PERSON Branch n to h circuits amps 133.75 2 Branch circuits -new, alteration, or Name: "'ant e c-_*:)t_rt,.on extension per panel: A. Fee for branch circuits with purchase of Address: 9 i to o SC. - 7 Lit `` P e._ service or feeder fee, each branch circuit 6.65 2 City/State /Zip: Pot 1 . OR. 9 7a o10 B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: i a - 7 7 7 - (I S 1 Fax: SO 3- 7 - n - tea O Each additional branch circuit 6.65 2 E -mail: S . ,ri Q €X IZ• e,ufrts.cuf $1 8r/5 , C Om Misc.(Service or feeder not included): Each pump or irrigation circle 53.40 2 CONTRACTOR Each sign or outline lighting ( _ 53.40 5 , C/O 2 Job No: - Signal circuit(s) or a limited energy panel, Business Name: Q � i Description: tion: or extension _Pie 2 2 Name: f 14LUYl5Lt_ `r 97 Description Address : 91 S E 7 ere Each additional inspection over the allowable in an of the above: City/State /Zip: ?ca. O . q7aoLp Per inspection per hour (min. 1 hour) 62.50 Phone:5013 7'17- 1 -15SN - Fax:553' MM7 -Oa a Investigation fee: a Lie. # 1:0- b10 L' LS other: CCB LiC. #: (p 3zf a 0 Electrical Permit Fees* Supervising electrici Subtotal $ 5 3 .L/ 0 signature required: Plan Review (25% of Permit Fee) $ Print Name: Chri S . he_ o Lic. #: 5 5 1'G- State Surcharge (8% of Permit Fee) $ 4 -I, a 7 TOTAL PERMIT FEE $ 5 7, 1,7 Authorized f� Q (6?,,E � + Notice: This permit application expires if a permit is not obtained within Signature: l� e Date: O l 03 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. - ?::orulce._ A .'i c to n (Please print name) i:\Dsts\Permit Fotms\ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard 1 Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: Audio and Stereo Systems 0 Burglar Alarm n Garage Door Opener n Heating, Ventilation and Air Conditioning System ID Vacuum Systems 0 Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems El Boiler Controls El Clock Systems 0 Data Telecommunication Installation ❑ Fire Alarm Installation HVAC 0 Instrumentation ❑ Intercom and Paging Systems Landscape Irrigation Control Medical EI Nurse Calls Outdoor Landscape Lighting Protective Signaling • n Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Fomu\ElcPermitAppPg2.doc 01/03