Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00421
4 41 DEVELOPMENT SERVICES DATE ISSUED: 7/25/00
�� I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6 39 -4171
PARCEL: 25101 BB -00301
SITE ADDRESS: 11834 SW PACIFIC HWY
SUBDIVISION: TIGARD ROAD GARDENS ZONING: C -G
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Installation of one sign lighting. Job No. 20439
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:
TEXACO REFINING & MARKETING BLAZE SIGNS OF OREGON
BY EQUIVA SERVICES LLC PO BOX 23910
PO BOX 4369 PORTLAND, OR 97281 -3910
HOUSTON, TX 77210
Phone: Phone:
639 -3262
Reg #: SUP 524SIG
LIC 64325
ELE 26380CLS
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT BLD 7/25/00 $42.75 0002631 Elect'I Final
5PCT BLD 7/25/00 $3.42 0002631
Total $46.17
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 -.:: - _ . the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain ••'res of these les or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE ki 0 4 n ISSU . ' BY:
NER INSTALLATION ONLY
The installation is being made on property I own ich is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
1 CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: /4 DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check#
13125.6W HALL BLVD. Rec'd By 6 CO
Date Rec'd (0 / / /0:D
TIGARD OR 97223 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # eleSeev- 05(4
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development " re - i. . 4--4.1 Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum
R�
Address I 3 `� 11 5 (4) `P ' 4a. Residential - per unit
U 1000 sq. ft. or less $ 117.75 4
City /State /Zip / l- tRlLftt ( Each additional 500 sq. ft. or
(( JJ portion thereof $ 2615 1
Commercial ill Residential ❑ Limited Energy $ 60.00
Each Manurd Home or Modular
• 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation
Electrical Coonntractor ,-4 200 amps or less $ 64.25 2
t
Addres O Pa6-L3 9 f Q 201 amps to 400 amps $ 85.50 2
City State 0-1 • Zip q'� J 401 amps to 600 amps $ 128.50 2
601 amps to 1000 amps $ 192.50 2
Phone No. 63 �� . 3 .,, 26 2 Over 1000 amps or volts $ 363.75 2
Job No. aO```r3 7 Reconnect only $ 53.50 2
Elec. Cont. Lice. No. D -1 ROCESExp.Date 2- D7 - 0 .4c. Temporary Services or Feeders
OR State CCB Reg. No. & Lis? S Exp.Date 7 -2 O m Installation, alteration, or relocation
COT Business Tax or Metro No. a. O 13 Exp.Date I-3 0 -0/ 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
License No. / 5 5 I C, Exp.Dat i 0 -1 - p Z see "b " above.
Phone No. b 4' 4,6'3.'7 4d. Branch Circuits
New, alteration.or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous .
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting . / $ 42.75 t.! /7 5
Signal circuit(s) or a limited energy
• (if required):* panL alteration or extension $ 60.00
3. Plan Review section
( Minor Labels (10) $ 10D.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $ 4- / -
* Submit 2 sets of plans with application where any of the above apply. ° Q / Asib Surcharge (95 total fees) $ '3 ki
Not required for temporary construction services. Subtotal G $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED W1THIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 414.1'7
is \dsts \forms \electric.doc
8/22/00 Activities for Case #: ELC2000 -00421
3:33:30 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
•
ELCC001 Application received 7/25/00 DEB DONE No Hold BLD 7/25/00
ELCC003 Permit created 7/25/00 DEB DONE No Hold BLD 7/25/00
ELCC730 Elect'I Service No Hold BLD 7/25/00
•
ELCC799 Elect" Final No Hold BLD 7/25/00 ' , -
•
ELCC500 (F)Issue permit 7/25/00 DEB DONE No Hold BLD 7/25/00
1 �
ELCA510 (F) Reprint permit 8/15/00 ZZZ DONE No Hold ZZZ 8/15/00
•
a
Page 1 of 1
IIII OF TIGARD BUILDING INSPECTION DIVISION MST
2 I nspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested f �- Z 7 AM PM BL 13
R ACI ,w,, (7'x Suite MEC
Contact Person Ph 5 7- Z Y- F'J Zc PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC je,va - V Z-(
Retaining Wall ELR
Footing Access:
Foundation J 0 -0 : 2 � ? FPS
Ftg Drain �F- SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear � - L — A -�-
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler - _� ' /
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
FAIL
OW" - '
ervice
Rough In 57
UG /Slab
Low Voltage
Fir -
° ART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other Date !Z? �
� ') Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •