Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00498
,, DEVELOPMENT SERVICES DATE ISSUED: 10/9/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134BC -00800
SITE ADDRESS: 12398 SW SCHOLLS FERRY RD
SUBDIVISION: PP1993 -058 ZONING: C -P
BLOCK: LOT : 002 JURISDICTION: TIG
Prolect Description: 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+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
THOMPSON /DAVIDSON LEA SE TUBEART SIGNS
PROPERTY VENTURE, THE 4243 -A SE INTERNATIONAL WAY
PO BOX 398 MILWAUKIE, OR 97222
PORTLAND, OR 97207
Phone: Phone: 503 -653 -1133
Reg #: LIC 00070956
SUP 366SIG
ELE 37- 554CLS
FEES Required Inspections
Type By Date Amount Receipt Elect'l Final
PRMT . CTR 10/9/01 $53.40 2720010000(
5PCT CTR 10/9/01 $4.27 2720010000( EXPIRED
Total $57.67 A �
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 -0080. You may obtain copies of these rules or direct questions to
Permit Signature:
OA/ APL/ 69-770 Issued By: `
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
•
4P A-‘ Electrical Permit Application
,11,11?' Date received: /a /q /p/ Permitno.rac gm] -op y9,
City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By;j)J.J Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: ZOO( - OO(,
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family O Tenant improvement
0 New construction ❑ Addition/alteration /replacement ❑ Other: O Partial
JOB SITE INFORMATION
Job address: i� T/ j, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: I Description and location o work on premises: / -// 6 i eak
Estimated date of completion/inspection: Si _a:Mr 1 ' • •
CONTRACTOR APPLICATION FEE SCI IMULE
Job no: ` ,QS— Fee Max
Business name: -- i/ Description Qty. (ea) Total no. (nsp
Address: 4 New residential - single ormuld- family per
i �_ _ � %L a- a !L 4 a dwelling unit Includes attached garage.
City: / 4,44 Stat:s� ZIP: d ` Service included:
Phone: C c's /j33 I Fax4 7/1 E -mail: 1000 sq. ft. or less 4
CCB no.- Q ro I Elec. bus. lie. no: J ! "C.C.S Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
Cit etro 'c. no.: ,_!I. Limited energy, non- residential • 2
����� /� ' MM 7 Each manufactured home or modular dwelling
Signature of supervis ng electric'ai uired) Sat: Service and/or feeder 2
Sup. elect name (print): /�E s; 7'Z License no: 3�v�e Services orfeeders Installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only
Owner installation: The installation is being made on property I own Tempora services or feeders .
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am.s 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each sign or outline lighting / 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension' 2
O Building over three stories O Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
O Egress/lightingplan 0 Other. Per inspection I 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other a t�
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ . 1 3 • /�
Cl Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ y _ . 7
Expires accepted as complete. TOTAL $ _s___1.____-
7 r G 7
Name of cardholder as shown on credit card
$
Cardholder signature Amount EXPIRED 440.4615 (6/O0fCOM)
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Electrical Permit Fees: Limited Energy Fees: :. ". ...„
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•
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: . Items • Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Door Opener'
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 Systems'
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps _ $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 -260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems
Branch Circuits l i Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included) �b�
Each pump or irrigation circle $53.40 '�� G ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40\
Signal circuit(s) or a limited energ Landscape Irrigation Control'
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over
the allowable in any of the above ❑ Nurse Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Enter total of above fees $ 19-- n � Other
U
8% State Surcharge $ / / 2-7 Number of Systems
25% Plan Review Fee
* No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application. •
Fees:
Total Balance Due $ - 7. Co 7
E nter total of above fees $
❑ Trust Account # 8% State Surcharge $
•
Total Balance Due $
i :'dsts\forms\elc- fees.doc 10/09/00