Permit CITY OF TI GARD '' ELECTRICAL PERMIT
PERMIT #: ELC1999 -00475
`" - DEVELOPMENT SERVICES P DATE ISSUED: 7/30/99
443 f 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639- ��
PARCEL: 1S136CD-00100
SITE ADDRESS: 11705 SW PACIFIC HWY M
SUBDIVISION: • ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of lighting for one wall sign. Job No. AFF -99.
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 PROSIGN INC
BY WYSE INVESTMENT SERVICES PO BOX 1354
200 SW MARKET ST STE 345 CLACKAMAS, OR 97015
PORTLAND, OR 97201
Phone: Phone: 656 -1354
Reg #: LIC 00079230
SUP 557SIG
ELE 3- 315CLS
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Final
PRMT DEB 7/30/99 $60.00 99- 316815
5PCT DEB 7/30/99 $4.20 99- 316815
Total $64.20
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 Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain ies o se rules or direct questions to OUNC at (503)
246 -1987. fJ
•
Permit Signature: . )0 Q = r �-4-t „G� / � Issue B y : p � GZ/1�t,a.
N� zJ/
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
CITY OF TIGARD
T Electrical Permit Application Plan Ch:
1312 SW HALL BLVD. Rec'd By i, aw
Date Rec'd t 2 ,
TIGARD OR 97223 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Permit #
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: , Q 4. Complete Fee Schedule Below:
Name of Development fi ' ,� f (r C r,o yA& 45 Number of Inspections per permit allowed
Name (or n of mess) okay ?ofer Service included: Items Cost Sum
Address 11 ?Ad' rG KW , , iC l fVl �f 4a. Residential - per unit ..
I 1000 sq. ft. or less $110.00 4
City /State /Zip f.qa rd- pr -i23 Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial Residential ❑
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of .11 current licenses) 4b. Services or Feeders
Electrical ontractor do ■ ♦ i L Installation, alteration, or relocation
200 amps or less $60.00 2
Addre s /y : Z 201 amps to 400 amps $80.00 2
City . i.. . .A 0.' State Or Zip (2 401 amps to 600 amps $120.00 2
Phone No. . i13 S� g A- 601 amps to 1000 amps $180.00 2
Job No. A F ` , " Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. - Exp.Date /D Dl
OR State CCB Reg. No. 1 0 Exp.Date . EMO 4c. Temporary Services or Feeders
COT Business Tax or Metro No. i'- Exp.Date j Installation, alteration, or relocation
200 amps or less $50.00 2
SI Signature of Su r Elec'n t 201 amps to 400 amps $75.00 2
g p �� -����L 401 amps to 600 amps $100.00 2
1� / Over 600 amps to 1000 volts,
License No. 7 l ✓ �� Exp.Date I ! �� see "b" above.
Phone No. 74j) (owl -t
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
- b) The fee for branch circuits
City State p without purchase of
Phone No. service or feeder fee. •
First branch circuit $35.00 2
The installation is bein e on property I own which is not Each additional branch circ $5.00 2
intended for sale, I e or rent. 4e. Miscellaneous 6 , pp
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting % $4.11,00--- 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 am mor the allowable in any of the above
System over 600 volts nomi Per inspection $35.00
Classified area or strut containing special occupancy Per hour $55.00
as described in N. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: 60'
O
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) 7e , $ 7 7'�
NOTICE Subtotal $
5b. Enter 25% of line 5a for -a--- PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due 4 � /7 , �O
I: \DSTS \ELC96.APP Rev 9/96