Permit CI TY OF TIGARD ELECTRICAL PERMIT
• - PERMIT #: ELC2004 -00166
� DEVELOPMENT SERVICES DATE ISSUED: 4/1/04
+`
. PAL 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S 110DC -02200
SITE ADDRESS: 15532 SW PACIFIC HWY C -5
SUBDIVISION: WILLOW BROOK FARM ZONING: C -
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Installation of (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: 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+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
GMS REALTY BIGFOOT SIGNS LLC
14254 SE 176TH ST 2413 LITTLE KALAMA RIVER RD.
RENTON, WA 98058 WOODLAND, WA 98674
Phone: 503 - 225 -0429 Phone: 360- 255 -9011
Reg #: ELE 37- 990CLS
LIC 155744
FEES SUP 569S1G
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/1/04 $53.40
[TAX] 8% State Surcharge 4/1/04 $4.27 Rough -in
Elect'I Final
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 mo - - :: • : ... ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
fo • in OAR 952 -001 -• I 0 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 :00- 332 -2344.
•
I- ued By: . I 610,101/ Permit Signature: I , t
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
2cX) — 000 5 ,
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date/By: / Q e I Pemtit No.:EC( % zD ((''
f
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 kat `".i4; I \ Date/By: Other Permit:
Inspection Line: 503.639.4175 a!J •'' Date Ready/By: Jurh: BI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW •
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition Other: S ICI h ['Service over 225 amps, comm'I ❑Hazardous location
A ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
•
CATEGORY OF CONSTRUCTION of l- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling af 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: S S3 Z $ �� 1 1 G t ��{ C �' ❑Health care facility ❑Other:
S Submit 2 sets of plans with any of the above.
City/State/ZIP: - i cu z , ` O12Z3 ( The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Lt c ( Project name: FEE* SCHEDULE
(�
1 Description I Qty. I Fee. I Total I '*
Cross street/directions to job site: 5 J R00. 1 4'-, ?aekt o_s-., New residential single- or multi - family dwelling unit.
G Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 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
dwelling, service and /or feeder 90.90 2
14,O.LJ -) (.)..)0-k 5 `q h Services or feeders installation, alteration, and/or relocation
•
200 amps or less 80.30 2
(At PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: G,• to S RP�.I 601 amps to 1,000 amps 240.60 2
Address: 142_54 5 e 0 lQ ¥i \ sA. Over 1,000 amps or volts 454.65 2
-,
n_ Reconnect only 66.85 2
City/State/ZIP: ee"{ ) LOS . 4coC S 8 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (4t ) 2 O■kZ9 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, 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
vi APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
r service or feeder fee, each 6.65 2
Business name: l �0� S
■ (L branch circuit
J B. Fee for branch circuits
Contact name: "('pd,& 'Eatt•k ., without service or feeder fee,
1 ` each branch circuit 46.85 2
Address: 241 Ltd k'a (a.ws, � s � Pc' Each add'I branch circuit 6.65 2
City/State/ZIP: (Ak'JO17L itANtD I Li , Q9 Miscellaneous (service or feeder not included)
(3 ) Z2 S , '10 i ( ) 22S-- (o (E. Pump or irrigation circle 53.40 / 2
Phone: (�O Fax: 4'
Sign or outline lighting ( 53.40 �j • j• O 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR • energy panel, alteration, or
• extension. Describe: Page 2 2
Business name ( _ 5 t utas Li... 4
Address: •a,tka u k�. la�z iz� n p I Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: 1 Rb ( �QI 4:)4e)(0 7 y Investigation per hour (1 hr min) 62.50
Phone: (3/ 2 -9O (I Fax: g( ,o) Z L S - (o ( ZS— Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: /cc 7 y Electrical Lic. :a 31- O Suprv. Lic.: _c o SL 6--• Subtotal 53 . Vt� d LS
Suprv. Electrician signature, required: � n Plan review (25% of permit fee)
0 r' / �� State surcharge (8% of permit fee) ii, a7
Print name: I -0-D 0 il a, 4'c -k, j Date: Z -- I , - 0 l
TOTAL PERMIT FEE 5 9 , to 7
Authorized signature: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete
Print name: Date: 2 -' --0 y • • Fee methodology set by Tri -County Building Industry Service Board
— Top (')a cc �y
1 • • Number of inspections per permit allowed.
i:\ Building \Pennits\ELC-PeemitApp.doc 12/03 440.4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
•
-
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
1 RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
El 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
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i: \Buildineamits\ELC-Pc n itApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection. LING (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested - - AM PM BUP
Location / .S" 5 3 Suite - J MEC
Contact Person Ph (36 O ) oo' SOO PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner F LA ELC 2 'I- 66 / (,
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes;.__ SIT
Post & Beam �!� c I
Shear Anchors
Ext Sheath/Shear ' • - _ I
WIP
Int Sheath/Shear -
Framing ,L_i _ 1 i ` _iJ ari —141
Insulation — -
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
(
Susp'd Ceiling r �1
Roof I & ( P '` - 19 14 ' I` F!4
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post& Beam •
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
_____ PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE: El Unable to inspect – no access
Fire ADASupply Line v 0 ../ / , J eh
Approach/Sidewalk Date C ( Inspector ��
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL