Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00296
1 0I� DEVELOPMENT SERVICES DATE ISSUED: 5/27/2004
, 1I II 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 - 4171
PARCEL: 1S136CD-00101
SITE ADDRESS: 11675 SW PACIFIC HWY
ZONING: C -G
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of sign lighting for (3) wall signs.
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: 3
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:
MILLAR, TED L TRUSTEE SECURITY SIGNS INC
834 SW ST CLAIR 436 SE 12TH AVE
PORTLAND, OR 97205 PORTLAND, OR 97214
Phone: Phone: 503 - 232 - 4172
Reg #: LIC 122809
ELE 26- 560CLS
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/27/2004 $160.20
[TAX] 8% State Surcharge 5/27/2004 $12.82 Rough -
Elect'l Final
Total $173.02
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 a - = • - 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 •99 or 1 -800- 332 -23
I - ued By: _r_;;,..4174111111_/..„/ I / Permit Signature
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 Received FOR OFFICE USE ONLY
[ Electrical Q `/
-4 - - • Date/By: ‘91 act PermitNo.:`�f0a - 419 A 9 1 6
Planning Approval SigNo. n
City of Tigard Date/By: Permit . 7
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
/�aa�d ' ( �
Internet: www.ci.tigard.or.us a e! I l Date/By: Case No.:
� Contact J ® See Page 2 for
`^ -
24 -hour Inspection Request: 503- 639 -4175 " Name/Method: p Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply) .
❑ New construction I ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement Other: Skx+ f ❑ 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
❑ 1 & 2- Family dwelling Eg Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ 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: 1k (orj5- 4 ?AC ► A c, .14uw"1 _ FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: w is •i c c.A.- . 3 Ic Description I Qty I Fee (ea.) Total
New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: I Lot #: 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
Services or feeders - Installation,
ll.l P...."1 wAre.4.. S I 1_10./.1 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 I [TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts I 454.65 2
Name: k/v cepisr r 13. AM (t Reconnect only 66.85 2
Address: h! 1 u Q. 'fib L F . 8.34 ', ,sr services or feeders - installation,
JJ� aall a eration, or relocation:
City/State/Zip: • G 7.7 9•e ' 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to Branch amps 133.75 2
V] APPLICANT [a CONTACT PERSON B
/� Br circuits - new, alteration, or
Name: s C. c iV 0.1 V (la X. A f/ extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit I 6.65 2
E -mail: Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
CONTRACTOR
Each sign or outline lighting 3 53.40 106 a� 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name:
C t_.),z. L --r-7 St &l S Description:
Address: 4.C'3C C l"Z.T!� ifss- .
City/ State/Zip: Each additional inspection over the allowable in any of the above:
Cit
Y p: lPoce.-rr_ oz. . ..17 Z I Per inspection per hour (min. 1 hour) 1 62.50
Phone: L pi • Z-31., LI 111J 1.1 Fax: 503 2701 ei / lnvesti ation fee: I
Other:
CCB Lic. #: 12,2,,i104::‘ Lic. #: Z . • 4. 5 Electrical Permit Fees*
Supervising electrician Subtotal $ /66 • 2 4)
signature required: Plan Review (25% of Permit Fee) $
Print_Name: L . Lic. #: _ State Surchar a 8% of Permit Fee $ • SL
TOTAL PERMIT FEE $ 7 • D A.
Authorized l ,- ---- Notice: This permit application expires if a permit is not obtained within
Signature: .- - - Date: 5 27• e.1 180 days after it has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
C-e
141C. O1 13 17---147(.40
(Please print name)
i :\Dsts\Permit Forms \ElcPetnvtApp.doc 01/03
ti
. Electrical Permit Application - City of Tigard �.
••Page 2 = •Supplemental Information , --..
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORKONLY:
Fee for all systems - ' ' $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems
▪ Burglar Alarm '
Garage Door Opener
o Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
▪ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls • , • - • • • • . . -
Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
A
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems •
❑ Landscape Irrigation Control
❑ Medical
a Nurse Calls
El Outdoor Landscape Lighting
El Protective Signaling . ,
Other •
Number of Systems • ' •
a
* No licenses are required. Licenses are required for all
,. other installations
• •• .
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03