Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00295
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2012
Parcel: 2S102BD00701
Jurisdiction: Tigard
Site address: 12785 SW PACIFIC HWY
Project: Burgerville Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 8
Project Description: Installation of 3 building signs
Contractor: ADVANCED ELECTRIC SIGNS INC Owner: BENNETH, CATHERINE MCNICOL
1550 DOWN RIVER DR 3830 ROBIN CREEK LN
WOODLAND, WA 98674 WEST LINN, OR 97068
PHONE: 360 - 225 -6826 PHONE:
FAX: 360 - 225 -8299
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 05/21/2012 $203.52
Specifics:
1 ea 12% State Surcharge - 05/21/2012 $24.42
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $227.94
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. � J / r
Issued By: Permittee Signature: ot.L v PPU l b4- - 1 L o J
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' Date:
LICENSE NO.
Call 503.639.4176 by 7:00 a.m. for the next available Inspection date.
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.
Electrical Permit Application - FOR OFFICE USE ONLY
City of Tigard Received Date/By: 5 - aI I S C Permit N t a / . . " , , , , . , b l . • _ o p j ,
u 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1r 11 f Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
TI G A It D Inspection Line: 503.639.4175 Date ReadyBy: tom: '' 0 See Page 2 for
Internet: www.tigard or.gov Notified/Method: W Supplemental Informa
• .� TYPE OF WORK ., n +.. {;'• ,.c•v; PLAN REVIEW '41- ii;•, J, V. t
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit a sets of plans w /items checked below)
� ' k .
`r - \ ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ' Other: W t`•/r where the available fault current ❑ Marinas and boatyards. • CATEGORY OF CONSTRUCTION •.' '.; • .. • exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling .0 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION • „ • • • • ❑ Addition system. larger separately derived system. 0
' ❑ Addition of new motor load of ❑ "A" "E ", "1 -2" "1 J"
Job no.: Job site address: f 7 cs S 'S) P t 1 G N Wt I or more. o ccupancy . o '
J ❑ Six ix or or more residential units. ❑ Recreat vehicle parks.
City /State /ZIP: I I (S A ( op_ ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: pup.ci nast 1 ) ) 11 ❑ Service or feeder 600 amps or more. Vd
,,.., : ....,,..' FEE SCHEDULE
Cross street/directions to job site: Description I Qrr. I Foe. I Total I • r.
i New residential single- or multi- family dweWng unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
. Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: • Limited energy, residential
75.00 2
. - - , : ;DESCRIPTION OF WORK .'7'. ; • ; »F. i -r,.i : (with above sq. ft.)
Limited energy, multi - family 75.00 2
IN B1 0 A r' )Or' t ll 00.1t, St GNS residential (with above sq. ft.) _
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PROPERTY OWNER t•- •-• - . • ❑ TENANT ' 201 amps to 400 amps 106.85 2
Name: Rv` �v ‘ , 1 ,e ! J 0,0(e, io l h Ln 401 amps to 600 amps 160.60 2
p 601 amps to 1,000 amps 240.60 2
Address: )' ! W 1 5 - Over 1,000 amps or volts 454.65 2
City /State /ZIP: V (Gt-"If{, f LAN 7g66 V 1 Temporary services or feeders installation, alteration, and/or
/ btZ relocation
Phone: (30 ) 95.3 -23 N 7 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 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
g" APPLICANT. :'; :: : ::. :.- I . ?' : ❑ CONTACT. PERSON,';' ' 'r. above service or feeder fee, 6.65 2
each branch circuit
Business name: ApV APB CZ,n E )l:Gtnl c S•i 61.4 S B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: pso SAA15 first branch circuit
Address: 1550 0Q(,,iNlCtVtil DV - • Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included) _
City/State /ZIP: yv A 92 G-7y Each manufactured or modular 90.90 2
D •- Fax: : q dwelling, service and/or feeder
Phone:
) �aJ G? G _ G�) ,a a5' g oa, Reconnect only 66.85 2
1
E -mail: LI AOV Ancer, L I C,CT►21 C SIGN . CON Pump or irrigation circle 53.40 2
1 CONTRACTOR 2 . • • Sign or outline lighting 3 61,K 2
Signal circuit(s) or limited -
Business name: 5��a= AS Af "P- energy panel, alteration, or
Address: J extension. Describe: Page 2 2
- / City/State/ZIP: additional inspection over allowable In any of the above
Per
Phone: (V)) 141 --poq Fax: ( �7 ` L Investigation ga
_ 1\ ��`l `� per hour (I hr min) 62.50
62.50
CCB Lic.: 105 L1 OFlectrical Lic.: 3 I f yk'r_5 Suprv. Lic.: 7(;35 I G Industrial plant per hour _ _ 73.75
h ELECTRICAL PERMIT FEES • .•
Suprv. Electrician sign dJ+�'e
re, required: ' CTR
y� Subtotal: tr ip es 5 2-
Plan review (25% of permit fee):
Print name: �� Spills. Date: 5— 6 a State surcharge (12% of permit fee): 4 91.4 4 1-
Authorized signature: TOTAL PERMIT FEE: a7 4 44
Print name: Date: ['.. Thu permit application expires If a permit B not obtained within I80
. r/an-S' I days after It has been accepted u complete.
• Number of inspections allowed per permit.
I uuilding \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(I I /05 /COM/WEB