Permit A CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00272
;, i DEVELOPMENT SERVICES DATE ISSUED: 5/18/2004
II 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 102CC -00600
SITE ADDRESS: 13545 SW PACIFIC HWY
SUBDIVISION: ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Pole 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:
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: 1 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:
DDHK VENTURES, LLC LUMINITE SIGN CRAFT INC.
12604 SW 60TH CT 9033 SW BURNHAM
PORTLAND, OR 97219 TIGARD, OR 97223
Phone: 503 - 977 -0578 Phone: 503 - 639 -4991
Reg #: LIC 116449
ELE 34- 530CLS
•
FEES SUP 159S1G
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/18/2004 $46.85
[TAX] 8% State Surcharge 5/18/2004 $3.75 Elect'l Final
Total $50.60
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 OUNC at (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:
NTRACTOR I AL ION ONLY
SIGNATURE OF SUPRNELEC'N: y i .04 740 % - DATE:
LICENSE NO: /51 7 yl
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit ApRittE FOR OFFICE USE ONLY
Rece ived
Cit of Tigard .:
Y g Date/By: Permit No F /(.2 r f —DOD-7?—t--
13125 SW Hall Blvd., Tigard, OR 97223 p .l Plan Reviev
Phone: 503.639.4171 Fax: 503.598 8 �oo� •I I Other Permit j?y�a� y _ � s
I DatelBy: -_ oo a -
Inspection Line: 503.639.417 ^� Date R eady Dv: leis 0 She Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGAR NotifiedAlethod: Supplemental Information ,
,�,/' E' �� q I�IsION PLAN REVIEWEGN 2`ooq- O/l b
1J9.IVew construction Demolition Please check all that apply.
!��❑ __Demolition ❑Other: ❑Service over 225 amps, comm'I ❑ Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10.000 sq. ft.. ,
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more nem residential
[:1 I and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi family 0 Master builder 0 Other:
❑Occupant load over 99 persons 0 structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
7]
0 Health facility ❑Other
/ :
Job no.: Job site address: 3 ' f ��
l'Cie e, f Submit 2 se of plans with any of the above.
City /State /ZIP: ,..). 74/1, On./ / 1 / ., a,`3 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg./apt. no.: I Project name: //
fr 7 ` f /VL+ iu... Description I QtY' l Fee. fool
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 I 4
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.: 2
Limited energy, non - residential 75.00
DESCRIPTION OF WORK Each manufactured or modular
dwelling. service and /or feeder 90.90 '_
5 -
t ? Ai Wa-ok uf 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
/� /f ,, 401 amps to 600 amps 160.60 2
Name: &toe t� 601 amps to 1,000 amps 240.60 2
Address: ,
f,, , y Over 1,000 amps or volts 454.65 2
Jrl�f 6 t1�(,� ��4Cr�i� J`7[�lj
Reconnect only 66.85 7
City /State /ZIP: X904, 0 O 17 V 2 9/? Temporary services or feeders installation, alteration, and /or
Phone: ( ) / I Fax: ( ) 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 '
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I 7I�CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: "[id a l , / / 1--f - S/ 9)/4 branch circuit
B. Fee for branch circuits
Contact name: / A -z ace without service or feeder fee, 46.85 2
Address: Gli / � , �u /YJ 72 dr 2 each branch circuit
Each addl branch circuit 6.65 2
City /State /ZIP: b /1 �Qt ^�0 Miscellaneous (service or feeder not included)
Phone: 3 )4..-2,0 4 / 2 9 I Fax:: ( ) f Pump or irrigation circle 53.40 2
r 1 9 Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
L extension. Describe: Page 2 2
Business name: A u %Yl1 /►t/ r� q.1/5
,{ /, , ,(� /� Each additional inspection over allowable in any of the above
Address:
l« ll d �/ L` " "� r" ° ` Per inspection 62.50
City /State /ZIP: k ' , f j 4 / 6 / � P i , W 7# Investigation per hour (I hr min) 62.50
Phone: (6 3) 00 ./ 7 I Fax: (y 4.7, biz Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.:I5p703 I Electrical Lic.:3 O. uprv. Lic.:S' 51 g Subtotal Lt gs
�,J�,
Suprv. Electrician signature, required: ^/ Plan review (25% of permit fee)
Print name: 1 /J �,� D,�, Date:
S tate surcharge (8% of permit fee) 3 1
� /°'D' / %!/e7 /'/� TOTAL PERMIT FEE , 5
Authorized signature:
r M This permit application expires if r permit is not obtained ssithin IKII
/ � days after it has been accepted •as complete
Print name: 1 � „ L �,� / Date: mogy by Teronty ung Industry Set ice Board
'Y , 1' �/K y •' NumFee ber of ethodol inspections set per pe C n u nn allo B se
i Building Permits`.ELC.PermiiApp doe I2:03 440.4015T( 10'02 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
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 \Permits \ELC.PcrmitApp.doc 04 /03