Permit IJ
j CITY OF TIGARD ELECTRICAL PERMIT
°O PERMIT #: ELC2007 -00542
COMMUNITY DEVELOPMENT DATE ISSUED: 8/6/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 208 ZONING: C -G
SUBDIVISION: TIGARD PLAZA LOT : 002 JURISDICTION: TIG
PROJECT: DOLLAR TREE
Project Description: Install (1) illuminated 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:
TIGARD PROPERTIES INC MEYER SIGN CO OF OREGON
2106 SE OCHOCO ST 15205 SW 74TH AVE
MILWAUKIE, OR 97222 TIGARD, OR 97223
Phone: Contact #: PRI 503- 620 -8200
FAX 503 - 620 -7074
FEES
Description Date Amount Reg #: ELE 20- I90CLS
[ELPRMT] ELC Permit 8/6/2007 $53.40 LIC 64014
[TAX] 8% State Surcharge 8/6/2007 $4.27 SUP 566SIG
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 Center. • ose rules are set forth in
OAR 952 - 001 -0010 through OAR 952-001-0110. You may obtain copies of these rules or direct questions to OUNC at 50.. 46.6699 or 1.800.332.2344.
•
Issued B /j ���� j 'Z ' Permittee Signature: %Rei
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.
. SC7 y-o • - • i •
Electrical Permit Application FOR OFFICE USE ONLY
' ' Received
yyf City of Tigard ♦ qii
i J Permit No.•5/ od e) - • •
q 13125 SW Hall Blvd., Tigard, OR 97223 DateB : Plan Review
C : Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Ju l ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
)2 construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
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Job no.: Job site address: I (q y S S W QAK t c t L N y
W I or more. occupancy.
1 _ El Six x o or r more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: T i GA r - 0 R. 91 -2.2.3 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 2 O$ Project name: Doll QR.. 1-17-E 6 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
• New residential single- or multi - family dwelling unit.
3 tic, Pae r'F tc Htwy 5 w 4- A•(4.. F.AN D. Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'! 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. R.)
• Limited energy, multi - family 75.00 2
/N S/74-1-1- Ca) OAF i I (uer► W z f e e / 5/6A) residential (with above sq. R.)
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
Name: 6,q.. -( � 19L —2,4 i I d 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 _ 2
Address: in 2 J IV E +-(1,J ' 9 Over 1,000 amps or volts 454.65 2
City/State /ZIP: t/AFp)C. u E7'Z- t- 1t `' F14, r- Temporary services or feeders installation, alteration, and /or
relocation
Phone: ('31,0 ) 5-6 b^ c.-02... . 1 C ei 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 599 amps 133.75 _ 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit _
Business name:
(6A-Ni e— A-5 i1 -c_-r i+-) B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
�i�jr 1fz ti first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included) •
City/ State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: eenti,,c54r e Gt e s!c ,wee • G Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting $ 53.40 g $ . /0 2
Signal circuit(s) or limited -
Business name:
ME-Y eta 1 C o/ w en r• y of OR , .S energy panel, alteration, or
a1 r extension. Describe: Page 2 2
Address: (SZ °S St.) 7y ct.„P._
City/State/ZIP: - G',q- c12_ ell 2.2-4 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5b 3 ) 62a - ? 200 Fax: (Sin ) 4,2o - 7071.4 Investigation per hour (l hr min) 62.50
CCB Lic.: 6Y0 r 4 Electrical Lic.: Zo -MO et S Suprv. L • / G Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: � , 10
Print name: n1, (2 .9.4.4 1c Date: 8. D2 ,- 0'7 Plan review (25 % of permit fee):
I' � State surcharge (8% of permit fee): 4.2
Authorized signature: n !- TOTAL PERMIT FEE: 5
This permit application expires if a permit is not obtained within 180
Print name: 5 S 6 y Date: 0 y- 02 —07 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: 1BuildinglPermiutELC- PermitApp.doc 05/23/06 440-46I5T( I I /05/COM/WEB