Permit A, CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00566
II DEVELOPMENT SERVICES DATE ISSUED: 9/10/03
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102CC -00500
SITE ADDRESS: 13500 SW PACIFIC HWY 17 OLD CNTRY
SUBDIVISION: BUF ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Sign lighting for (4) signs.
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: 4
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:
OCB RESTAURANT CO. MEYER SIGN CO OF OREGON
1460 BUFFET WAY 15205 SW 74TH AVE
EAGAN, MN 55121 TIGARD, OR 97223
Phone: 651- 365 -2142 Phone: 620 - 8200
Reg #: LIC 64014
SUP FEES ELE 20 CL
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/10/03 $213.60 -
[TAX] 8% State Tax 9/10/03 $17.09 Rough -
Elect'I Final
Total $230.69
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 -0100. You may obtain copies of these rules or direct questions to OU " . (503) 246-6699 or
1 -800- 332 -2344. /
Issued By: Permit Signature: • _
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
• 11r 3 - /Og
FOR OFFICE USE ONLY
Electrical Pertititctiwittion Received / Electrical
Date/By: ` l �� O � Permit No. l?3 DYE 5-4' 4p
City of Tigard Planning Approval Sign -
b
Plan R Permit No.:
13125 SW Hall Blvd. SEP 1 O 2003 y:
Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 - 639 -4171 Fafg1T506315518t36161D �� �,�,�� rail. r� Post - Review Land Use Date/By: Case No.:
Internet: www.ci.rigard.o131111;ILDING DIVISION a �"� ;III I Contact luris.: Ei See Page 2 for
`^
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial El Hazardous location
[1] � Addition/alteration/replacement LE Other:67 A Building over 10
- � ❑ Service over 320 amps - rating of El over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling in Commercial/Industrial ❑ System over 600 volts nominal one structure
Building Multi-Family ❑ Building over three stories El Feeders, 400 amps or more
Accesso
❑ Accessory g ❑ y ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATIO Submit _ sets of plans with any of the above.
Job site address: /157-v The above are not applicable to temporary construction service.
0 ./ 'adz FEE* SCHEDULE
Suite #: / 7 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: iikil ,. 7014.i,tJ igaffryr Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential-single giInc Includes or multi-family per
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
�
* a<ryr �(c{7[ �� ,gTP ,, _ jNF13„s non Limited energy, residential 75.00 - 2
�,
Subdivision: U Vt 1'Ot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
0 PROPERTY OWNER J g TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Ozeirotau kezi Reconnect only 66.85 2
Address: / 3 S ' a v ) / J i e t Ftg /// i1 • Temporary services or feeders - installation,
!!!!!! alteration, or relocation:
City /State /Zip: r t ( i2.6 O A , 9 2 3 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
El-APPLICANT I ❑ CONTACT ERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: (evfke Cdr C Ji&ele-- extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 $ 5,10 2
Job No: Signal circuit(s) or a limited energy panel,
\ ^ alteration, or extension Page 2 2
Business Name: fie§ ?s(Z ,S( a, (/ Q n K J k Description:
Address: / 5Zps .S w 7V11 ,4-U-�
City /State /Zip: �7 ��n Q 9 '� z 2 7 Each additional inspection over the allowable in any of the above:
car /`-, I Per inspection per hour (min. I hour) 62.50
Phone: • —,' Z_QZD Fax: (p 2 — 70-71 lnvesti ation fee:
CCB Lic. #: LID Li- # aD er:
— /QD C L S Electrical Permit Fees*
Supervising electricia ' Subtotal $ a-1 3 • • 654
IAA ature re I uired: I. ! I A A / 4 Plan Review (25% of Permit Fee) $
Print Name: ' ffl� T/ �F,:��� r,� V / State Surcharge (8% of Permit Fee) $ - /7. 07
TOTAL PERMIT FEE $ a 3D • lo
Authorized _ ' � / Notice: This permit application expires if a permit is not obtained within
/
Signature: ■ " �� ..�7 A!A►M, , Date: Q (F■03 180 days after it has been accepted as complete.
i 4 *Fee methodology set by Tri -County Building Industry Service Board.
X57 — &J6 &t R
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information -
LIMITED ENERGY PERMIT FEES: 0 5 s
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
. Check Type of Work Involved:
El Audio and Stereo Systems
I I Burglar Alarm •
0 Garage Door Opener
EI Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
ED Audio and Stereo Systems
•
ED Boiler Controls
' Clock Systems
•
Data Telecommunication Installation •
Fire Alarm Installation
HVAC
• Instrumentation
Intercom and Paging Systems •
Landscape Irrigation Control* •
El Medical
• Nurse Calls
0 Outdoor Landscape Lighting
El Protective Signaling
El Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations l 1 ,
1 �` '' i `
/ t ; '
•
1 l t :r ' '
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03