Permit A . CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00466
Ili DEVELOPMENT SERVICES DATE ISSUED: 7/27/2004
13125 SW Hall Blvd.. Tiaard. OR 97223 (503) 639 - 4171
PARCEL: 1 S136CD -01500
SITE ADDRESS: 11660 SW PACIFIC HWY
SUBDIVISION: TIAGARD BOWL ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Sign hook -up.
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:
SCHULZ, DAVID TR SIGNCRAFT LLC
KERR, GLORIA TR 9033 SW BURNHAM
11649 VIA MONTANA TIGARD, OR 97223
YUMA, AZ 85367
Phone: Phone: 503 - 639 - 4910
Reg #: LIC 155420
ELE 34- 674CLS
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/27/2004 $53.40
[TAX] 8% State Surcharge 7/27/2004 $4.28
Total $57.68
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 No'fication 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 questi , s to OUNC at (503)
246 -6699 or 1 -800- 332 -23 I
/// / 1 A�
Issued By: 1 t _ _ � Permit Signature' I % AY //
OWNER INSTALLATION ON Y
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
Date received!I :2_ o Permit no.' € /., i f y �
A i
-"ID': ) I!Iv' City of Tigard Project/appl. no.: al xpire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: !,� (_ ' T GI Bldg. no.: Suite no.: T ax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name ■ , v.. / (...,- I Description and location of work on premises: / c0 lAltr�.,
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: L., Lac Description Qty. (ea.) Total no. insp
�/'� New residential - single or multi- family per
Address: q0 3 , Id` /W s - i dwelling Ina includes attached garage.
City: State:O n I ZIP4`,Z7 7 ' Service included:
Phone�ag:I.A to I FaX -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.:1 s5 *a, V E ec. bus. Ire. no: 3tt 4 014 ccS Limited energy, residential 2
't /metro lic. no.: . "" 9 Limited energy, non - residential 2
,. a Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
elect. name (print) • ` � �S' e„,
Services orfeeders— installation,
Sup. (P ' t+ License no. alteration or relocation:
-.;-_ ... - 1'ROI'ERI:Y_OW NER --, - 200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am is 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps- commercial O Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location Each sign or outline lighting 1 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan ❑ Other. - Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other •
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ , I'd , V 6
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $ ` 6
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
ELECTRICAL PERMIT FEES: UNITED ENERGY PERMIT FEES: -
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 _ 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 _ • 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular Li Service or Feeder $90.90 2 Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System"
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑ ' Vabuum Systems + • •' ; ,
201 amps to 400 amps $106.85 2
401 amps to 600 amps $10.60 2
601 amps to 1000 amps, $240.60 2 ❑ Other '' "' :'•„St -a
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $ 75 . 00
200 amps or less $66.85 2 (SEE DAR $18= 260 -260)° `' ` . • ' }, ti -
201 amps to 400 amps $100.30 2 a. • • ° • , r .
401 amps to 600 amps $133.75 2 , • `Chbck,Type•of Wbrk Involved; : • r • . ., t•'
Over 600 amps to 1000 volts, �--+� + ` • 3 %. e '
see "b" above. I I Audio arfdge Sys erps
4 "/ !'a
Branch Circuits .
ircuits . a . h r• - • ti;� �
New, alteration or extension per panel Lt, oiler Controls r
a) The fee for branch circuits ' •
with purchase of service or 1 '.', „❑ '•• Clock Systems • ,. „zi.,..t y«0t -.4i1. 1 " ` '.1 j .; y e
feeder fee.
Each branch circuit $6.65 2 , a �; ,�❑ Data I�_cgfnrr pic�tiq Ir)stall flop
b) The fee for branch circuits ` ` a r • • T@ 'k .'. - ipi ti 0 . a r
without purchase of service ❑
or feeder fee. Fire Alarm Insiallation
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle
j Each sign or outline lighting $53.4 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00 _
Each additional inspection over El Medical
the allowable in any of the above
Per inspection $62.50 E Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ I I Other,
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms\elc- fees.doc 08/30/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Bustness•Line: (503) 639 -4171 MST
7 BUP
/
Received Date Requested _ J 36 AM PM BUP
Location / / (o o v peLe„ Suite / / MEC
Contact Person -- .'I1�. : —.d At Ph ( ) �o .3 c7 - `T 9/6 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 76O l -
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Alarm
in fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ART FAIL
SITE Please call for reinspection RE: Unable to inspect – no access
Supply Line
Fire S //� /
A Q / � /LG � y �� C� Ext
DA
Fire
Approach/Sidewalk
Su Date c / Inspector /
Other: !!!
Final DO NOT REMOVE this inspection record from a Job site.
PASS PART FAIL