Permit CITY OF TIGARD ELECTRICAL PERMIT
_ ! , PERMIT #: ELC2009-00033
COMMUNITY DEVELOPMENT DATE ISSUED: 1/26/2009
TIdARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 135BD -01200
SITE ADDRESS: 09804 SW SHADY LN ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: ROVENTE PIZZA
Project Description: Sign installation.
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:
FORBES, DONALD CAROLYN ABLE SIGNS
BURDICK, DONALD LINDA 2007 SE POWELL
434 RIDGEWAY RD PORTLAND, OR 97202
LAKE OSWEGO, OR 97034
Phone: Contact #: PRI 503 - 232 -6430
FAX 503 - 235 -3530
FEES
Description Date Amount Reg #: ELE 26 -11 19CLS
[ELPRMT] ELC Permit 1/26/2009 $53.40 LIC 134473
[TAX] 12% State Surchar 1/26/2009 $6.41 SUP 676SIG
Total $59.81 REQUIRED ITEMS AND REPORTS
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 i suance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notificati7 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 OUNj at 503.246.6699 or 1.800.332.2344.
Issued By: c ( ,n� � a Qn f� Permittee 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 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.
5 C 2'ooS- OJ, /d?
Electrical Permit Applicatio FOR OFFICE t'Sl: ONLY
'' City of Tigard DECE Received Permit No.
13125 SW Hall Blvd., Tigard, OR 97223 Plate/B ' r •�
II I II .
4A N 2 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 6 2009 Date/B : Other Permit: • , Al di e ` Q/;V 1 �!
111] A It 17 inspection lane: 503.639.4175 Date Ready/By: luris: ', See Page 2 for O
Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: 10 000000 Supplemental Information
TYPE oFBING DIVISION PLAN REVIEW
Please check all that apply (submit 2 sets of plans w/itcms checked below):
CI New construction ❑ Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
' ❑ Demolition ® Other: Sign Installati where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ® Other: Sign Install ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "t -2 ", "1 -3 ",
Job no.: 081041 Job site address: 9804 SW Shady Lane lool{P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgiapt. no.: Project name: Rovente Pizza ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Corner of SW Shady Ln & Greenberg Rd. Description I Qty. L Fee. I Total (
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 si• ft• or less 145.15 4
Ea. add'] 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential -
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Sign Installation Limited energy, multi family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ® TENANT 201 amps to 400 amps 106.85 2
Name: Rovente Pizza 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 9804 SW Shady Lane Over 1,000 amps or volts 454.65 i 2
City /State/ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)720 -0067 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, Rer panel
A. Fee for branch circuits with
F2 APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Able Signs B. Fee for branch circuits
Contact name: Dave Lanphere without service or feeder fee, 46.85 2
first branch circuit
Address: 2007 SE Powell Blvd. Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Portland, OR 97202 Each manufactured or modular
_ dwelling, service and/or feeder 90.90 2
Phone: (503) 232 -6430 Fax: : (503) 235 -3530 Reconnect only 66.85 2
E -mail: dave @ablesigns.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 1 53.40 53.40 2
Business name: Able Signs Signal circuit(s) or limited -
energy panel, alteration, or
Address: 2007 SE Powell Blvd extension. Describe: Page 2 2
City /State/ZIP: Portland, OR 97202 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 232 -6430 Fax: (503) 235 -3530 Investigation per hour (1 hr Dan) 62.50
CCB Lic.: 134473 Electrical Lic.: Suprv. Lic.: 676SIG Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES _
Suprv. Electrician signature, required: Subtotal: 53.40
Print name: David Demuth Date: 1 -23 -2009 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 6.41
Authorized signature: TOTAL PERMIT FEE: 59.81
Print name: David Demuth Date: 1 -23 -2009
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
•
* Number of inspections allowed per permit.
I:[ Building \Permils0FLC4ermitApp.doc 05/23/06 440 4615T(II /05 /COMM'EB
Electrical Permit Application - City of Tigard
Page 2 Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ B urglar Alarm
❑ G arage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ A udio and Stereo Systems
❑ Boiler Controls
❑ C lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
•
for all other installations
•
I: lBuilding \Permits\BLC- PermitApp.doc 03/23/06
Pp. , . CITY OF TIGARD
COMMUNITY DEVELOPMENT
1 ( A . " 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
RE CE IVED
Electrical Signature Form JAN 2 6 2009
CITY OF TIGARD
BUILDING DIVISION
IMPORTANT PERMIT NOTICE
ABLE SIGNS
2007 SE POWELL
PORTLAND, OR 97202
Permit #: ELC2009 -00033
Date Issued:
Parcel: 1 S135BD -01200
Site Address; 09804 SW SHADY LN
Subdivision:
Lot:
Jurisdiction: TIG
Zoning: C -G
Project Name: ROVENTE PIZZA
Description: Sign installation.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form Is received
OWNER: ELECTRICAL CONTRACTOR:
FORBES, DONALD CAROLYN ABLE SIGNS
BURDICK, DONALD LINDA 2007 SE POWELL
434 RIDGEWAY RD PORTLAND, OR 97202
LAKE OSWEGO, OR 97034
Phone #: Phone #: 503- 232 -6430
Reg #: ELE 26- 111.9CLS
LIC 134473
SUP 676510
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
• .12AVI 17EM U 676 SKI
Siena a of Supervising Electrician Name (printed) SUP LIC #
CITY OF TIGARD
L COMMUNITY DEVELOPMENT
TIGARD 1 3125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Electrical Signature Form
IMPORTANT PERMIT NOTICE
ABLE SIGNS
2007 SE POWELL
PORTLAND, OR 97202
Permit #: ELC2009 -00033
Date Issued:
Parcel: 1 S135BD -01200
Site Address: 09804 SW SHADY LN
Subdivision:
Lot:
Jurisdiction: TIG
Zoning: C -G
Project Name: ROVENTE PIZZA
Description: Sign installation.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
FORBES, DONALD CAROLYN ABLE SIGNS
BURDICK, DONALD LINDA 2007 SE POWELL
434 RIDGEWAY RD PORTLAND, OR 97202
LAKE OSWEGO, OR 97034
Phone #: Phone #: 503- 232 -6430
Reg #: ELE 26-11 l9CLS
LIC 134473
SUP 676SIG
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signature of Supervising Electrician Name (printed) SUP LIC #