Permit C ITY O F TIGARD ELECTRICAL PERMIT
'' PERMIT #: ELC2005 -00623
,,,j4,144-9441111 DEVELOPMENT SERVICES DATE ISSUED: 8/29/2005
°' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 1 S136CD -00100
SITE ADDRESS: 11705 SW PACIFIC HWY K ZONING: C -G
SUBDIVISION: PACIFIC CROSSROADS LOT : JURISDICTION: TIG
Project Description: Sign lighting.
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 HIGHLIGHT SIGN CORP
BY WYSE INVESTMENT SERVICES CO PO BOX 23667
200 SW MARKET ST STE 345 TIGARD, OR 97281 -3667
PORTLAND, OR 97201
Phone: Phone: 503 - 620 -8205
FEES Reg #: LIC 104599
SUP 517S1G
Description Date Amount ELE 37- 660CLS
[ELPRMT] ELC Permit 8/29/2005 $53.40
[TAX] 8% State Surcharge 8/29/2005 $4.27 REQUIRED ITEMS AND REPORTS
Total $57.67
•
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon UtiIiVNaiftcation Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copi,„pf these rule • questions to OUN
503- 246 -6699 or 1 -8 32 -2344. i /
Issued By: Permittee Signature's
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
Cit of Ti and PermitNo
Y g E LEIVED Date/By: //i ?'S � i$ f1.L�..005- 00 ). , : / . 3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.196 2 3 2005 /Ir�, Date/By: y: Other Permit:
Inspection Line: 503.639.4175 �' ,, Date Ready/By: Juris: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
CITY or rto_ARD
,IR IN Ori PLAN REVIEW
❑ New construction A ddition/alteration/replacement Please check all that apply: •
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEG RY OF CONSTRUCTION of 1- 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 0 Master builder 0 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: ` /1-05 S () Aie kid./ ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: 1-'1&1412. Z) , 0,2_ et z is The above are not applicable to temporary construction service.
Suite ldg. /apt. no.: 1' Project name: pipe' � ca FEE* SCHEDULE
Description I Qty. I Fee. I Total I "
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
[,, Includes attached garage.
Y't 79 SO 8' 5i T 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
l ,,,� t " "' [ mil/ �j� / /) , dwelling, service and/or feeder 90.90 2
J/ v," Services or feeders installation, alteration, and /or relocation
Ii o.. 200 amps or less . 80.30 2
❑ PROPERTY OWNER TENANT 201 amps to 400 amps 106.85 2
s « 1,000 am 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: IE Q f 'A i Li f/j V` Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: 7 ' lc � C Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) 1 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 signature: Date: Branch circuits - new, alteration, or extension, per panel
7 APPLICANT I CONTACT PERSON A. Fee for branch circuits with
$ ,6 ( �~ ( branch circuor fu fee, each
Business name: 6.65 2
4'2 .J . branch it
Contact name: ! V � B. Fee for service circuits
es
without service or feeder fee, 46.85 2
�,.r each branch circuit
Address:
Pe /3 00'. Z, , Co 4 Each add'I branch circuit 6.65 2
City/State /ZIP: ^ri x..44-12.0 (Y4 q 7 ` 2- R ..........„ Miscellaneous (service or feeder not included)
Phone: ( ) 02 ' Fax: : ( ) �/ / � Pump or irrigation circle 53.40 2
Sign or outline lighting ' 53.40 2
E -mail: • f Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Pa ge 2 2
Business name:
Address:
City/State /ZIP:
Each additional inspection over allowable i any of the above
Per inspection 62.50
Investigation per hour (I hr min) 6 2.50
Phone: ( ) N r Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 1 0t1'57:1 Electrical Lic.: S 1 51 1. Suprv. Lic.: Subtotal
53 .40
-
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: L,1) at � ,�'pf Date: Z/2,,, Or State surcharge (8% of permit fee)
r" lJa • ` I TOTAL PERMIT FEE 5=7 ,7
Authorized signature: This permit application expires if a permit is not obtained within 1 0
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 \Pennits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
,Page 2 - Supplemental Information
• • LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
. ❑ Audio and Stereo Systems* •
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
• ❑ Vacuum Systems*
•
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 91 260 -260) •
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling
1 ❑ Other
-Total number of commercial systems:
•
*No licenses are required. Licenses are required •
for all other installations
i:\ Building \Permits\EL.C- PennitApp.da 04/03
CITY OF TIGARD `
_,, BUILDING DIVISION PERMIT #: ELC2005 -00623
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/29/2005
Phone: (503) 639 -4171 � . �
I Requests (24 Hrs.): (503) 639 -4175 `
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 77
SITE ADDRESS: 11705 SW PACIFIC HWY K CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS LOT #: TYPE OF USE:
PROJECT NAME: H & R BLOCK C -
DESCRIPTION: Sign lighting.
OWNER: PACIFIC CROSSROADS PROPERTIES, I, PHONE #:
CONTRACTOR: HIGHLIGHT SIGN CORP PHONE #: 503.620 -8205
Inspection Request Scheduled For: Date: 10/31/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 019752 -01 503 - 957 -3887 N
Corrections /Comments/ Instructions:
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:
i„
Date: L 3 I `(s Phone #: (503) 718-