Permit CITY OF TIGARD ELECTRICAL PERMIT
Permit
a COMMUNITY DEVELOPMENT #: ELC2012 -00177
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2012
Parcel: 2511 ODCO2200
Jurisdiction: Tigard
Site address: 15660 SW PACIFIC HWY A -1
Project: Petco Subdivision: 1997 -016 PARTITION PLAT Lot: 2
Project Description: Sign lighting for (4) signs.
Contractor: INTEGRITY SIGNS OREGON Owner: TRC MM LLC
PO BOX 88 5973 AVENIDA ENCINAS STE 300
HUBBARD, OR 97032 CARLSBAD, CA 92008
PHONE: 503 - 981 -3743 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 ea Sign or Outline Lighting 03/29/2012 $271.36
Specifics:
1 ea 12% State Surcharge - 03/29/2012 $32.56
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $303.92
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 Notficatio enter. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0090. You may r' • . co • of the rules or direct questions to OUNC by callin 3.232.19;7 or 1.801
-71". Issued By: .. Permittee Signature: 1 (
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.
o noo cl �� >�
Electrical Permit Application �4 FOR OFFICE USE ONLY
City of Tigard O ` Received
1 114 ° 13125 SW Hall Blvd., Ti!. 4.6' 91. Z3 +^ B Date : �- Permit No.: '�LG �-- -0 \y Plan Review
C Phone: 503.718.2439 0, •t! • :.1960 1 G DateB Other Permit: 564201.1 Of
T I G A l D Inspection Line: 503.63' I ` AO ^Q _` _ Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gry r` `V G .` \�? `�V�` Notified/Method: Supplemental Information
TYPE OF WO 0 PLAN REVIEW
acement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ❑ Addition/altera
1
13 Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition [her: _ . i 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 atcmmercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", ° E", "I -2 ", "l -3 ",
IOOHP or more. occupancy.
Job no.: Job site address: 6 `
1.1 �� SeJ L t 7 ❑ Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: t l 13 Health-care facilities. ❑ Supply voltage for more than
� p ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: � Cz )
❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ?-/ 4d. rri 4 Q � Description 14ty. I Fee. I Total I •
19,5 New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or les 168.54 4
Ea. add' 1500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
T ) Li fell S ,' "c _ " -h+ residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: • tP YYt2 tv.Li[s.r.... . ll n.___, 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
y relocation
Phone: (/15 Ro _ (36 Fax: ( ) 200 amps or less 59.36 I • 1 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not -
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT IONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: ICJ _ .n -t`_1. c-IJ ,-` �J - �t S 0 `�' _ w�� B. Fee for branch circuits without
C service or feeder fee, first
56.18 2
Contact name: ` n branch circuit
`J E a ch add' I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each City /State /ZIP: dwelling, servic and/or feeder 67.84 2
Phone: (5b3) el f/ _3 7143 Fax: ) g Qa , s/s3 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: jai/FAA ,Q n.{,Q r h
S CS � s-,-, , s.� CCD.r outline lighting 67.84 ,271 3! 2
C RA OR ignal circuit(s) or limited- energy
Business name: - n A . panel, alteration, or extension. Page 2 2
7 J Pi S S� Each additional inspection over allowable in any of the above
Address: t o . 6. Rex 8, Additional inspection (1 hr min) 66.25/ hr
,t Investigation (I hr min) 66.25/ hr
City /State /ZIP: „� /� / / � / /r�/ 9742.2 Industrial plant (I hr min) 78.18/ hr
Phone: (R') �) � I Y �,/ 1_� � ��/� I Fax:3) �� a . ��� Inspections for which no fee is 90.00/ hr
:]1.I specifically listed ('/ hr min)
CCB Lic.: 143 .E 4 Electrical Lie.: Ci.,•S e10 Suprv. Lic.:379 ELECTRICAL PERMIT FEES `
Subtotal: .a 7/. 3 „..---,
Suprv. Electrician signature, required Plan review (25% of permit fee):
Print name: D eD . 741 .4 L I, .S Date: 3A 8 / State surcharge (12% of permit fee): , �
/ TOTAL PERMIT FEE: 30 3. e ta
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I : \Building \Permits \ELC- Permit 07/01/10 440- 4615T( 1 I /05 /COM/WEB