Permit ,� CITY QF TI ARD ELECTRICAL PERMIT
V PERMIT #: 164444r DEVELOPMENT SERVICES DATE ISSUED: 8/2/2004
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13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: • 2S112DA -00300
SITE ADDRESS: 15230 SW SEQUOIA PKWY 100
SUBDIVISION: ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project 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: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PACIFIC REALTY ASSOCIATES LP MULTI -LIGHT SIGN CO.
15350 SW SEQUIOA PKWY #300 809 N E LOMBARD
PORTLAND, OR 97224 PORTLAND, OR 97211
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Phone: 503 - 624 -6300 Phone: 281 -3083
Reg #: LIC 64107
SUP 343SIG
FEES ELE 26 -90CLS
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/2/2004 $53.40
[TAX] 8% State Surcharge 8/2/2004 $4 Rough -
Elect'I Final
Total $57.68
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire . if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800 -3 -2344 1
Issued By: — - .... - ,AO _1 Permit Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY •
SIGNATURE OF SUPR. ELEC'N• DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
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5 2-voLl - )/ ?7
. A Electrical Permit Application
Date received 9.- Permit no.r o -
_i i City of Tigar iIEC E IV E Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: q,� Receipt no.:
Phone: (503) 639 -4171 AUG 0 re' 20
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: CITY OF TIGARD
RIIILDINU LAN/ tot "
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TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi-famy ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement > Other: hg ❑ Partial
JOB SITE INFORMATION
Job address: /$ 7_ ,5„ I1 % 5gicoDgf P)j Bldg. no.: Suite no.: Jo Tax map /tax lot/account no.:
• Lot: 'Block: 'Subdivision: •
Project name: • • 'I Description and location of work on premises:
Estimated date of completion/inspection: -
. -,' . • f wt' • CONTRACTOR APPLICATION FEE SCHEDULE
Job no: r Fee Max
Business name: (t1 � i bcikJ 5t , Description Qty. (ea.) Total no. insp
i 9 New residential or multi- family per
Address:
Slsq ALE • Df@'et7 dwelling unit . Includes attached garage.
City: [ I State: et I ZIP: q7-1.,-1 ( . Service included:
Phone: .6 •'Sp 1000 sq. ft. or less 4 Fax: I E -mail: Each additional 500 sq. ft. or portion thereof
CCB no.: j I Elec. bus. lie. no: —7041,5 Limited energy, residential 2
City /metro ic. O.: Limited energy, non- residential • 2
Each manufactured home or modular dwelling
Signature f su ervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): 'U�a:.a License no: 45 s' Services o rfeeders— installation, •
alteration or relocation:
PROPERTY OWNER 200 amps or less 2 •
f I . -, t!_ „ -, viv . . 4 4 0V • 201 amps to 400 amps 2
Name (print): tite YtJ�f�fA/ 1 401 amps to 600 amps 2
Mailing address: SAoLt 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 1 ,
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 47*, •, 7 1 ' 200 amps or less •
2
201 amps to 400 amps 2
Owner's signature: Date: 401 to600 amps 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: 1 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 ❑ 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
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
O 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 I •I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$ ' .
Cardholder signature Amount 440 -4615 (6/00/COM)
yr _ - _
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total `►' 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 ❑ Garage 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 ❑
201 amps to 400 amps $106.85 2 Vacuum Systems
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 ❑
New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
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with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 n 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
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(Service or feeder not included)
Each pump or irrigation circle . • $53.40 '
• Each sign or outline lighting • , $53.40 El Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00 '
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
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Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms \elc- fees.doc 08/30/01
CITY OF TIGARD 24 -Hour
BUILDING I Inspection Line: (503) 639 -4175
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INSPECTION DIVISION Business Liner `(503) 639 -4171 MST
BUP
Received Date Requested C r — I AM PM BUP
Location /5 <egeVt' / Iq- Suite / MEC
Contact Person iE Ph ( ) _32-0 goo/ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 444 5/ ELC Z_Doy '- CtV 4' 7
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: . f �� / SIT ArriTh
Post & Beam &A
Shear Anchors
Ext Sheath/Shear UMW
Int Sheath/Shear W
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
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
Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
.❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire
ADASupply Line
J
Approach/Sidewalk Date o Inspector Ext
Y
P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL