Permit ` CITY OF T I G A R D ELECTRICAL PERMIT
P ERMIT #: ELC1999 -00234
C DEVELOPMENT SERVICES DATE ISSUED: 4/19/99
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S101 DC -03900
SITE ADDRESS: 07150 SW SANDBURG ST
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: C -P
BLOCK: LOT : 004 JURISDICTION: TIG
Proiect Description: Add sign or outline lighting for a new permenant freestanding sign.
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:
DOUG BEAN & ASSOC. RAMSAY S IGNS
101 SW MAIN STREET 9160 SE 74TH AVE
SUITE 245 PORTLAND, OR 97206
PORTLAND, OR 97204
Phone: Phone: 777 -4555
Reg #: SUP 157SIG
LIC 00063422
FEES Required Inspections
Type By Date Amount Receipt Elect'l Final
PRMT GEO 4/14/99 $40.00 99- 314504
5PCT GEO 4/14/99 $2.00 99- 314504
Total $42.00
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 OUNC at (503)
246 -1987.
Permit Signature: / 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: 41 '/y �f
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CflY 00 TIGARD Electrical Permit Application Plan Chi
13125 SW HALL BLVD. Rec'd
Date Rec'd V- /y -/y7
TIGARD OR 97223
Date to P.E. `
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit #0c-d_ iff1 -6d R3
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development ✓L (j(d R V\k. Number of Inspections per permit allowed
Name (or name of business) - R2 &tz SS ',fir 'nls J2A r%kz. Service included: Items Cost Sum
I
Address .- 1 ('in -,,tnl A1y t.1 pa P-D 4a. Residential - per unit
�
1000 sq ft or less $110 00 4
City /State /Zip'' ���
t ,A
� � Each additional 500 sq ft or
portion thereof $25 00 1
Commercial in. Residential ❑ Limited Energy $25.00
Each Manuf d Home or Modular
Dwelling Service or Feeder $68 00 2
2a. Contractor installation only:
(Attach copy of all current licenses) � 4b. Services or Feeders
Electrical Contractor pq L� S 1.A Installation, alteration, or relocation
'tom `M 200 amps or less $60.00 2 -
Address 1 O ba/� 201 amps to 400 amps $80.00
Ci � LAP.. State Z Zip a l 720 401 amps to 600 amps 2
ty' � p p $120 00 2
Phone No. - 1 - 1 - 1 4 4 ‘---5"-- 601 amps to 1000 amps - $180 00 2
Over 1000 amps or volts - $340.00 2
Job No. ZS 1 Q�, Reconnect only $50.00 2
Elec. Cont. Lice. No. 4. -1iO1p C'ts Exp.Date ( 0 - ( • e% IcI
OR State CCB Reg. No. (e)3y z-Z Exp.Date I • 17% v) 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
/ / 201 amps to 400 amps $75.00 2
Signature of Supr. Elec'n ._ f i. / 401 amps to 600 amps $100.00 2
c r Over 600 amps to 1000 volts,
License No.,.)-'? < /4 Exp.Date /- , -• b i see "b" above.
Phone No. 7-7-7 Li S� 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
feeder fee.
Print Owner's Name
Address Each branch circuit - $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit - $35 00 2
Each additional branch circuit - $5.00 2
The installation is being made on property I own which is not
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting ( $40.00 2
3. Plan Review section (if required):*
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $35.00
System over 600 volts nominal Per hour - $55.00
Classified area or structure containing special occupancy In Plant - $55.00
as described in N.E.C. Chapter 5
5. Fees: o0
* Submit 2 sets of plans with application where any of the above apply. 5a. Enter total of above fees $ •
Not required for temporary construction services. 5% Surcharge (.05 X total fees) $ ' ''
Subtotal $
NOTICE 5b. Enter 25% of line 5a for
Plan Review if required (Sec 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Subtotal $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK , pd
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY ❑ Trust Account #
TIME AFTER WORK IS COMMENCED Total balance Due $
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