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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC1999 -00502 a�y4 • DEVELOPMENT SERVICES . DATE ISSUED: 8/13/99 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S135DD -05106 SITE ADDRESS: 11999 SW PACIFIC HWY SUBDIVISION: ZONING: C -G BLOCK: LOT : JURISDICTION: TIG Project Description: Electrical permit for a 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: HELENE GLADSTONE TRUSTEE YOUNG ELECTRIC SIGN CO 150 IRON MT RD 416 EAST 41ST ST LAKD OSWEGO, OR 97034 BOISE, ID 83714 • Phone: 503 - 624 -7239 Phone: . Reg #: LIC 000693 SUP 445SIG ELE 37 -51 CLS FEES Required Inspections Type By Date Amount Receipt Elect'l Service PRMT BON 8/13/99 $42.75 99- 317649 Elect'l Final 5PCT BON 8/13/99 $2.99 99- 317649 Total $45.74 ORIGINAL • t , . . 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 copies of these rules or direct questions to OUNC at (503) 246 -1987. Permit Signature: a Issued By: '- OWNER INSTALLATION ONLY The installation is b !rig 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: c91/\ (cr efT\ DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day CITY OF TIGARD Plan Check # ' Electrical Permit Application y31.25 SW HALL BLVD. ,� ,, Rec'd By W Date Rec'd Sol - TIGARD OR 97223 Date to P.E. Phone (503) 639 -4171, x304 Inspection (503) 639 -4175 Date Permit DST Ins p Print of Type Permit # 1~l( 1119 - ‘ 49 Z Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: • Name of Development Number of Inspections per permit allowed Name (or name of business) Aftn 4. 0-c-- a trc°,r irf% Service included: Items Cost Sum 4, Address 11199 S P-C ,I -P (C , Hwy' 4a. Residential - per unit City /State /Zip t c QQGI , 9 'Z 7 2-23 1000 sq. ft. or less $ 117.75 4 J Each additional 500 sq. ft. or portion thereof $ 26.25 1 Commercial Residential ❑ Limited Energy $ 60.00 Each Manufd 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 Contractor kini-nek 2 l!'1 &LL' s' CfrS 200 amps or less $ 64.25 2 Address i CFN 'NS c.S1, A vd.. C-l- 201 amps to 400 amps $ 85.50 2 401 amps to 600 amps $ 128.50 2 City 1 Lt +Irc1,1-) State 1T Zr0 4 - 7(76, 2. 601 amps to 1000 amps $ 192.50 2 Phone No. ( 0 12 ti) (Q 1 2.. Over 1000 amps or volts $ 363.75 2 Job No. Reconnect only $ 53.50 2 Elec. Cont. Lice. No. ,37 ( L5 Exp.Date J nf.- 1 - 9 . 4c. Temporary Services or Feeders OR State CCB Reg. No. (01 c) xp.Date `7 -2[L1- Installation, alteration, or relocation COT Business Tax or Metro No. y(nb Exp.Date 1 1 - 200 amps or 400 amps less $ $ 53.50 2 201 amps to 80.25 2 Signature of Supr. Elec'n 7 d. `= ! ;,a. Over 600 amps to 1000 volts, 401 amps to 600 amps $ 107.00 2 License No.- `t .S a11s xp�a I(,-Cri see "b" above. Phone No. (j1 12- ( 0'1 2_ 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 I $ 42.75 Signal circuit(s) or a limited energy 3. Plan Review section (if required):* panel, alteration or extension $ 60.00 Mi nor Labels bels (10) $ 107.00 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: c / 5a. Enter total of above fees $ 4Z -is * Submit 2 sets of plans with application where any of the above apply. 11. 5/o Surcharge (.05 X total fees) $ d Not required for temporary construction services. Subtotal $ t ,L14 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 WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # 45,14 AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ is \dsts \forms \electric.doc CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639-4175 Business Line: 639 -4171 Olr3��� BUP Date Requested, t AM PM BLD Location / (Q 5 (4) fe?a -C.C../ 4W(1 f Suite MEC Contact Person & 66 S Ph Sig - `f( PLM Contractor _ nn L Ph SWR oa BUILDING Tenant/Owner &j,� P+ AYYLP- ,/)CC.. ELC c C ? —. MSQo � Retaining Wall ELR Footing Access' Foundation n f w FPS Ftg Drain ` SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm f Susp'd Ceiling � Gj Q ✓��' 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 I) Smoke Dampers Final 1 FAIL Rough In Low Low Voltage Fire Alarm PART FAIL Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA j Q (� Approach /Sidewalk Date / 0 v — / Inspector ct� JI Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.