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Permit a CITY OF TIGARD ELECTRICAL PERMIT °_ COMMUNITY DEVELOPMENT Permit #: ELC2009 -00152 T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/07/2009 Parcel: 1S136DB00201 Jurisdiction: Tigard Site address: 11565 SW PACIFIC HWY Subdivision: Lot: 0 Project: Chase Project Description: Sign lighting. Owner: FEES FRED MEYER STORES, INC Quantity Description Date Amount BY NICKEL & COMPANY LLC, STORE #375, PO 1 ea Sign or Outline Lighting 04/07/2009 $53.40 BOX 35547 1 ea 12% State Surcharge - 04/07/2009 $6.41 PHONE: Electrical Contractor: EDS SIGNS NORTHWEST P.O. BOX 2376 WILSONVILLE, OR 97070 PHONE: 503 - 582 -9400 FAX: Type of Use: COM Class of Work: ALT 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 work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cen -r. Those rules, -re set forth in OAR 952- 001 -0010 through AR 952 -001 -0100. You may obtain a of the rules or direct questions to OUNC by calling 503.246.6 • • or 1.800.332.2 Issued By: ��0 L NQ g y: Permittee Si nature /� �� �� / ��� fi 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 503.639.4176 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. :d ` _ RECEIVED Electrical Permit Application APR - 7 20 Mk 01-11(1: I S l _ ( ) 1 . 1 - City of Tigard � R �� O t PermitNo.: gild • 1152. S oJ"(.00 17b IIII 13125 SW HaII Blvd., Tigard, OR 97223 CITY OF TIG Other Permit Phone: 503.639.4171 Fax: 503.598.1960 i P:: : TIGARD Inspection Line: 503.639.4175 BUILDING DIVI ' Date Ready/By: June. ® See Page 2 for Internet: www.tigard or.gov Notified/Method: I 1 C- Supplemental Information E 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 ,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 ", "1 - ", ° 1 - ", Job no.: Job site address: //57„5- $4t' PAD PIC. kV 5, 1 P or more. occupancy. ❑ Six Six o or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: 7 6.eitZb , �R , ? 7 3 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: cells e_ ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: S (,u 7/ s.c 7, Description I Qty. I Fee. I Total 1 • 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 75.00 2 DESCRIPTION OF WORK ( with above ft.) HOOK `� A / 1 Limited energy, multi - family 75.00 2 1\ `�i residential (with above sq. H.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: FREj /72E ytg 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 38 5E a?c 2 A.! 6 ,Sr Over 1,000 amps or volts _ 454.65 2 City/State /ZIP: R 3 Llit6 ` OP ` 97,2002- re loom services or feeders installation, alteration, and /or 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 Owner signature: Date: Branch circuits- new, alteration, or extension, Q er panel ! A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: Ebs ,5 /6-A - / B. Fee for branch circuits Contact name: l � 1 k' R L,l� "1_� without service or feeder fee, 46.85 2 first branch circuit Address: 109 in s s _i Cnm,7-2 r:112, Sri Each add'I branch circuit 6.65 _ 2 Miscellaneous (service or feeder not included) City/State /ZIP: a}1 /t ii ti 0 LL.E t � R 9 ?G70 Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: (503 ✓-8a - g y� Fax: : (5 5 - g 5 Reconnect only 66.85 2 E -mail: IS(_J6 si E )S n/CL) e co/72 Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 1 53.40 2 Business name: t. S' j G-A Signal panel, or limited - energy panel, alteration, or Address: /096 6-(A) C.rr)rm9 G/ e. .57' 4. extension. Describe: Page 2 2 City/State /ZIP: 1 .1 J j 1Soi f✓`LL 1 g • 9' 707© Each additional inspection over allowable in any of the above / Per inspection 62.50 Phone: (.6193) 4 - S "S'`ft Fax: (03) 6 -8 a - 840/ Investigation per hour (I hr min) 62.50 CCB Lic.: l? ise*S .a Electrical Lic.: e k5 5 Suprv. Lic.: ) ' 516.. Industrial plant per hour 73.75 //�� jht I n I I l ELECTRICAL PERMIT FEES Suprv. Electrician signature, require�,C� Q� - Subtotal: Print name: KKKK D�at"e� :" Plan review (25% of permit fee): � � �i�� ZQ M p� 59. State surcharge (12% of permit fee): C.(irA Authorized signature: � � / /J_ TOTAL PERMIT FEE: � . $ \ me' T Dat This permit application expires if a permit is not obtained within 180 Print na ^ - •oe� • — . �� - R / 7// )v ,� .,^ , days after it has been accepted as complete. J 7 • Number of inspections allowed per permit. L1.T/1 ,, li//`/1• /ll/C1!