Permit A - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00470
i A, DEVELOPMENT SERVICES DATE ISSUED: 7/1/2005
� I � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 250 ZONING: C -G
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT : 002 JURISDICTION: TIG
Project Description: Installation of (6) sign lightings.
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: 6
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:
MILTON BROWN HIGHLIGHT SIGN CORP
8320 NE HWY 99 PO BOX 23667
TIGARD, OR 97281 -3667
Phone: 360- 566 -8192 Phone: 503 - 620 -8205
FEES Reg #: LIC 104599
SUP 517S1G
Description Date Amount
ELE 37-660 - 660CLS
[ELPRMT] ELC Permit 7/1/2005 $320.40
[TAX] 8% State Surcharge 7/1/2005 $25.63 REQUIRED ITEMS AND REPORTS
Total $346.03
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspe. • - • for more - • 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rul: a re set forth in OAR • -00 -00 0 through OAR 952 - 001 -0100. You may obtain copies of these rules or -'rect qu : :. ins to NC at
4$ -
563 -26699 o 1- 800 -332 -2 • . Ord /
I -sued By: Permittee Signature: �, / /:,� ,,,, /j/
tWir
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.
r
Z S— 00
- j trical Permit Application FOR OFFICE 1 S O\'t.l
City of Tigard Daz aed 7 - _ d Perm;t No.: (�'� ��r y 7 ■
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permi
Phone: 503.639.4171 Fax: 503.598.1960 / / "' t i 1. Date/B .
Inspection Line: 503.639.4175 _ _ 'f J, Date ReadyBy.. 115/111 ® See Page 2 for
Internet: www. ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Pr New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I 0 Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY 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 ❑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: (jam -r) 5 Pp/* p',� ❑He 2 -care ofp ay ❑eve.
�TQ Submit 2 sets of plans with any of the above.
City/State/ZIP: - ai} 0 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: 1 Project name: 7 d-'f 5 F14
Description Qty. I Fee. Total I ••
Cross street/directions to job site: ,. L ` Al--c—,D.+- "�e "� " 9,7 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
Tax map /parcel no.: - Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
h - 3 9r7A'j c ., �F' N 51�iv5 0� Sa,t - r) 7 4
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
--A'ST --k A) 02_711 S/ Pe F 131 Dr► 200 amps or less 80.30 2
EPPROPERTY OWNER I fit TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: /44/ 4 .-1 7 =', 4 —' d, /3/ (% 16J 601 amps to 1,000 amps 240.60 2
Address: e 3 c, C) 0 141 j 6 7 9' Over 1,000 amps or volts 454.65 2
n Reconnect only 66.85 2
City/State/ZIP: 1/'A1epti(/4 . Temporary services or feeders installation, alteration, and/or
Phone: ( 3e. ci l - 5 1152_ "a Fax: (Sc 0- Dfv ca / relocation
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
IT]- APPLICANT I ArscONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: �/ 6,,#,/_/ L/� f- c /4,,,...9 X90 . branch circuit
, � y - B. Fee for branch circuits
- 1 - 1 -- 1,1/7.- Contact name: liyQ(,(J�/ wit hout serv ice or feeder fee, I r,
p 2 �7�, ,,JALIz_/ , each branch circuit �'
Address: a 46.85 2
� j U) J j1' K Tf� iLt„>p- Each add'I branch circuit -. 6.65 2
City/State/ZIP: 7f &4/24_7 plz , 7 7,g 9- - 5 Miscellaneous (service or feeder not included)
Phone: (,3) O �v�s Fax: : (CD>) 41- -37p6---- Pump or irrigation circle r 53.40 � 2
&'
Sign or outline lighting (p 53.40 Ulu 2
E - mail: 71i1,JJZ () .#/( ' 9-7' 6,./.., . &N.4'L -. Signal circuit(s) or limited-
• CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Medi ) &N r 5 d .
Address: g9 C 44/z/ r�fie, Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: 7 -15.749Z/° 67ZZ , ci 7 as ) Investigation per hour (I hr min) 62.50
Phone: (gyp') (vim _ Sr i Fax: (� bi y 2 7,9 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
I CCB Lic.: )!.59' Electrical Lic.: Mg 51 Suprv. Lic.: - 57 d & Subtotal .qD
Suprv. Electrician signature, required: ✓1/4.40; 1 Plan review (25 %ofpermit fee)
Print name:) j g.L . G24 i ray r --1 . 6, /pden State surcharge (8% of permit fee) 9,5 . vrI ! TOTAL PERMIT FEE a O
Authorized signature: 1'�
. ,3,.../.( re
/ � �i/ t :�� j ...-1 Thi permit application expires if a permit i s no o m in 1 g0
days after it has been accepted as complete
Print name: S /-4._ ,¢ ' 1_44.65 / 1-/ - 0,42/1 Date: Co o tio ( • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PmnitApp.doc 12/03 4404615T(l0/02/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 918-260-260)
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
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building\Pmnits\ELC- PamitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00470 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/1/2005
Phone: (503) 639 -4171 p49hi�1�
Inspection Requests (24 Hrs.): (503) 639 -4175 _ ..
INSPECTION WORKSHEET FOR DATE: 10/10/2005 TIME: 7:04AM PAGE: 119
SITE ADDRESS: 11945 SW PACIFIC HWY 250 CLASS OF WORK:
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT #: 002 TYPE OF USE:
PROJECT NAME: JO - ANN FABRICS
DESCRIPTION: Installation of (6) sign lightings.
OWNER: BROWN, MILTON PHONE #: 360- 566 -8192
CONTRACTOR: HIGHLIGHT SIGN CORP PHONE #: 503 -620 -8205
Inspection Request Scheduled For: Date: 10/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 017791 -01 503 - 620.8205 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: J ....teal N D214 ( Date: IOddd t N " Phone #: (503) 718 -