Permit CITY OF T • ELECTRICAL PERMIT
TIGARD PERMIT #: ELC2005 -00887
j13,1111111‘ DEVELOPMENT SERVICES DATE ISSUED: 11/14/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 2S103DD -00800
SITE ADDRESS: 13815 SW PACIFIC HWY 110 ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: (1) sign lighting.
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: SIGNAUPANEL:
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:
D.W. SIVERS COMPANY VANCOUVER SIGN COMPANY, INC
4730 SW MACADAM AVE 6615 SW HWY 99
#101 VANCOUVER, WA 98665
PORTLAND„ OR 97201
Phone: Phone: 360 - 693 -4773
FEES Reg #: ELE 37 -46CLS
Description Date Amount LIC 63951
SUP 525SIG
[ELPRMT] ELC Permit 11/14/200' $53.40
[TAX] 8% State Surcharge 11/14/200' $4.27 REQUIRED ITEMS AND REPORTS
Total $57.67
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: � 7) ) s � Permittee Signature: c,
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.
6&1y 5 -Dv3'
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVEDA Received permit No. • G ` _ { - *.
Date /B
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.638.4171 Fax: 503.598.196 1 �'7� Date/13 : Other Permit:
Inspection Line: 503.639.4175 NOV 1 0 2005 .- Date Ready /By: NM ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
CITY OF TIGARD
RTNIINGWMASION PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacem Please check all that apply:
❑ Demolition Other t 04N. ❑Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CO STRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ,f 7'Commercialindusttial ❑ 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.: 1 Job site address: 13$ 15 5. lib e • „j III( ❑Health - care facility ❑��
y Submit 2 sets of plans with any of the above.
City / State/ZIP: OR Gr - L -5-5 i The above are not applicable to temporary construction service.
Suite/bldgiapt. no.: c. i 0 I Project name: (- ^ COtt' -s S FEE* SCHEDULE
Dcsal I Qty. I Fee. I Total I '•
Cross street/directions to job site: ( 3 8 S ' W v G tti_ " �'ii0 W New residential single- or multi - family dwelling unit.
1
1 ^• - 1,000 sq. ft. or less j 145.15 4
Subdivision: Lot no.: Ea. add'1500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
T ,' I C ` _ - ./vC. `
dwelling, rfe service feeder 90.90 2
��1Efn1LL� Q�'VN4.J�! , 4'/� e�� Services or feeders rs installation, elteraHon, and/or relocation
. 200 amps or less 80.30 2
'PROPERTY OWNER I Ll TEN 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: a�a)"� Q Cjto.,2,(S Co ' 601 amps to 1,000 amps 240.60 2
Address: C/n I'3 b (S 5. - -(t,�`i (% b Over 1,000 amps or volts 454.65 2
� Reconnect only 66.85 2
c
City/State/ZIP: \ - e44 0 p__ 9 "1 �3- Temporary services or feeders installation, alteration, and/or
(�' ^ .14 2 ` 8 0 )t I b i I ( ) relocation
Phone: ey - 7 1-0 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, legse, t, or exchange, according to e 5S 447, 449, 670, and 701. c 401 amps to 600 amps 133.75 2
Owner signature: V - 5 ` ° ` ate: 1 %/14 0 5 Branch circuits - new, alteration, or extension, per panel
,[APPLICANT CONTACT CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: R 6 branch circuit
B. Fee for branch circuits
Contact name: 03 C j v without service or feeder fee, 46.85 2
Address: 10 a S 5� each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: eria8. IAl 9q. j q Miscellaneous (service or feeder not included)
( 25 4 -5 33 )-3 X17 (�S '3)
Phone: '7 I Fax: l 11----0 ' j ( C./ Pump or irrigation circle 53.40 2
s
/+` Sign or outline lighting /53.40) 2
E - mail: ( r va. pi (rjse, , Coir Lpn,A t (& e (.c�N�b 'LO r -ignal circuit(s) or limited -
O NTRACTOR energy panel, alteration, or
'I extension. Describe: Page 2 2
Business name: 7 1 (,„ • "it
G6 (5 ^t Y - Each additional inspection over allowable in any of the above
/ I Per inspection 62.50
c ct (J
City/State/ZIP: a 4 C(Q L b S Investigation per hour (1 hr min) 62.50
Phone: (3 C) 6 q3 4:773 Fax: ( %O) 61 3 2:742) Industrial plant per hour 73.75
11,16:1 ELECTRICAL PERMIT FEES*
CCB Lic.: (,3q 5 ( Electrical Lic.: 3-� - 4.4c3.5 Suprv. Lic.: IS6 5 Subtotal 53 • 4-0
Suprv. Electrician signature, required: 1■ - 349.0 Plan review (25% of permit fee)
Print name' Date: 11 4 O State surcharge (8% of permit fee) yt I - 1 � TOTAL PERMIT FEE
Authorized sign l I1 This permit application expires If a permit is not obtained within 180
�` WW
� ^ days after It has been accepted as complete
Print mile: Date: i I' A I O • Fee methodology set by Tri -County Building Industry Service Board
`T •• Number of inspections per permit allowed.
i:t Building \Permits1ELC- PermitApp.doc 12/03 440- 4615T(10i02 /COM/WEB
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: ELC2005-00887
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2005
Phone: (503) 639 -4171
A l �.
Inspection Requests (24 Hrs.): (503) 639 -4175 _'!!� "'ll�
INSPECTION WORKSHEET FOR DATE: 12/14/2005 TIME: 7:01AM PAGE: 50
SITE ADDRESS: 13815 SW " • CIFIC HWY 110 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GARLIC JIMS • ZZA
DESCRIPTION: (1) sign lighting.
OWNER: SIVERS COMPAN , D.W. PHONE #:
CONTRACTOR: VANCOUVER SIGN OMPANY, INC PHONE #: 360 - 6934773
Inspection Request Scheduled For: Date: 12/14/2005 Pour Time:
Code # • - - - . • Description Confirm # Contact # Message
199 Electrical fina� 023415-02 360-693-4773 N
Corrections /Comments/ Instructions:
Clk PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c N(SeL Date: Ili Hie Phone #: (503) 718- lifig