Permit CITY OF TIGARD ELECTRICAL PERMIT
7
° PERM #: El
COMMUNITY DEVELOPMENT DATE ISSUE D:
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136CD-00100
SITE ADDRESS: 11705 SW PACIFIC HWY X ZONING: C -G
SUBDIVISION: PACIFIC CROSSROADS LOT : JURISDICTION: TIG
Project Description: LITTLE CEASARS. (1) 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:
PACIFIC CROSSROADS PROPERTIES, I MULTI - LIGHT SIGN CO.
BY WYSE INVESTMENT SERVICES CO 809 NE LOMBARD ST
200 SW MARKET ST STE 345 PORTLAND, OR 97211
PORTLAND, OR 97201
Phone: Contact #: PRI 503 - 281 -3083
FAX 503 - 280 -9624
FEES
Description Date Amount Reg #: ELE 26 -90CLS
[ELPRMT] ELC Permit 1 1/20/200( $53.40 LIC 64107
[TAX] 8% State Surcharge 11/20/200( $4.27 SUP 343SIG
Total $57.67 REQUIRED ITEMS AND REPORTS
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 Cente . Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questergTo 0 C el /46.6699 or 1.800.332.2344.
J t /
Issued By: _ Zia�' � � Permittee Signature. A
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 503.639.4175 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.
SCNeb04 c'eha1/
A Permit Ap 1"tu� -- tV i Olz OFFICE lci; USI ONLY
City of Tigard
.9Z Received -a( v PermitNo. G . h `
y 1
13125 SW Hall Blvd., Tigard, OR 97223 WV / -% • Plan Re ew
Phone: 503.639.4171 Fax: 503.598.1960 tY V 2000 I' '• D e B Other Permit:
Inspection Line: 503.639.4175 of
,. X 1 1 ' •' � I
� Date Ready/By. See Page 2 for
Internet: www.ci.tigard.or.us CITY Of TI GA Notified/Method �� ®
Supplemental Information
gIVISION
�// PLAN REVIEW
L•'New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: 0 Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling [ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑ Egress/lighting plan RV park
Job no.: Job site address: b ❑Health care facility ❑Other:
A 11 C � SW t�C�� Submit 2 sets of plans with any of the above.
City /State/ZIP: 'T'q A 10 \ The above are not applicable to temporary construction service.
Suite/bldg./apt no.: Project name: � t c+ S FEE* SCHEDULE
� � ' - Lc c,„ Q e A& Description I Qty. I Fee. I Total
• Cross street/directions to job site: 6.W • ? ekcA A, 1 C ' • *71f Au t New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
n l dwelling, service and/or feeder 90.90 2
v_. I. ay L! 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
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
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 600 amps 133.75 2
Owner signatu Date: Branch circuits — new, alteration, or extension, per panel
131 PLICANT I A ❑ CONTACT PERSON A. Fee for branch circuits with
service or
Business name: �k1.r1 i,.� 19 bran h circa feeder fee, each
6.65 2
B. Fee for branch circuits
Contact name: M R� without service or feeder fee,
I� R c� CA/
• Address: p each branch circuit 46.85 2
g � l ®�.p . � t�t� A Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
1\,A i °A
Pump _ X1232
IP Pump or irrigation circle 53.40 2
Phone: (Q,3) 240 . —3 a $ 3 Fax: : ( ) Sign or outline lighting fi 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
• c extension. Describe: Page 2 2
Business name:
hnLAvn k I l►.T Sl9 t/J e t"
Each additional inspection over allowable in any of the above
Address:
S/ cis F 1....n 3 A 1R \� Per inspection 62.50
City/ State/ZIP: % �\ LAJU l d 4.Qe-k Investigation per hour (1 hr min) 62.50
Industrial (80 "i _ 3 Fax: ( ) t ndustrial plant per hour 73.75 ELECTRICAL PERMIT FEES*
CCB Lic.: 641 ) Electrical Lic.: al _ tt Suprv. Lic.: 3 y3g1 et Subtotal
Suprv. Electrician signature, required: \ Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: 1er2.2 / 2 41 Date: 11„2 d( 5 n n
TOTAL PERMIT FE _ / 0
Authorized signature; r■ This permit application expires if a permit is not obtained within 180
(1--) f days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PernitApp.doc 12/03 4404615T(I0/02/COM/WEB
. r
Electrical Permit Application - City of Tigard -
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: • l
Fee for all residential systems combined .. $75.00 •
Check Type of Work Involved: •
❑ Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
•
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
El Other: •
COMMERCIAL WORK ONLY: l •
Fee for each' commercial system. • $75.00
(SEE OAR 918- 260 -260)
•
Check Type of Work.Involved: •
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation • . •
❑ HVAC
❑ Instrumentation •
El Intercom and Paging Systems .
El Landscape Irrigation Control*
•
El Medical
❑ Nurse Calls • • • ,
El Outdoor Landscape Lighting*
•
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
•
for all other installations
is\ Building \ennib\ELC- PefmitApp.doc 09/03
r
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2000.006E8
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/20/2006
Phone: (503) 639 -4171 . �,�� . f
Inspection Requests (24 Hrs.): (503) 639 -4175 ' -_
INSPECTION WORKSHEET FOR DATE: 3/9/2007 TIME: 7:01AM PAGE: 67
SITE ADDRESS: 11705 SW PACIFIC HWY X CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS LOT #: TYPE OF USE:
PROJECT NAME: LITTLE CAESARS PIZZA
DESCRIPTION: (1) sign.
OWNER: PACIFIC CROSSROADS PROPERTIES, I, PHONE #:
CONTRACTOR: MULTI - LIGHT SIGN CO. PHONE #: 503 - 281 - 3083
Inspection Request Scheduled For: Date: 3/9/2007 Pour Time:
Code # Inspection Description • xm # _., Contact # Message
140 Sign installation 044565-01 503.888 -0212 N
Corrections /Comments /Instructions:
•
'" Q Q
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: , Date: 1 Phone #: (503) 718- 2 "1 t l i q
_