Permit C ITY OF TIGARD • ELECTRICAL PERMIT
PERMIT #: ELC2005 -00913
Z 1`--' DEVELOPMENT SERVICES DATE ISSUED: 11/22/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09364 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
Project Description: Lighting for one 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:
WASHINGTON SQUARE LLC MEYER SIGN CO OF OREGON
BY THE MAC ERIC H COMPANY 15205 SW 74TH AVE
9585 SW WASHINGTON SQUARE RD TIGARD, OR 97223
TIGARD, OR 97223
Phone: Phone: 620 -8200
FEES Reg #: LIC 64014
ELE 20- 190CLS
Description Date Amount
[ELPRMT] ELC Permit 11/22/200' $53.40
[TAX] 8% State Surcharge 1 1/22/200' $4.27 REQUIRED ITEMS AND REPORTS
Total $57.67
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 issuance, or rf work is
suspe = - • for more : 180 da = -TT . TION: Oregon law requires you to follow rules adopted by the Oregon Utility ■ • I'cation Center Those
rule: are set forth in OAR 15 001 -P :'1 Or •ugh OAR 952 - 001 -0100. You may obtain copies of these rules or direct • • esti• • • NC at
58 246 -6699 •r 1- 800 -332 , 344/ / I
I sued By: ( � '� Permittee Signatur ` �� ��
OWNER INSTALLATION ONLY �I
The ins i ion 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.
Electric al Permit Application FOR OFFICE USE ONLY
Received d f Permi o. - 27
Date/By: - V9/5
atBy # * C/ Permit N
Planning Approval Sign
City of Tigard Date/By Permit No:
13125 SW Hall Blvd. • Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No :
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review . Land Use
S Date/By: Case No.:
Internet: www.ci.tigard.or.us��i Contact iu ® See Page 2 for
'"
24 -hour Inspection Request: 503- 639 - 4175 -'— W Name /Method. -�y�
/ i (j Supplemental Information.
TYPE OF WORK . - PLAN REVIEW (Please check all that apply) . '
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition /alteration/replacement M Other: 6j4 J ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
•- • •CATEGORY OF CONSTRUCTION : "" • -• 1 & 2 family dwellings four or more residential units in
(1 1 & 2- Family dwelling ® Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
111 Accessory Building ❑ Multi- Family 0 Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other
JOB SITE INFORMATION and LOCATION - Submit _ sets of plans with any of the above.
_ /J The above are not applicable to temporary construction service.
Job site address: lJ gj 3k3k yl/,6'/ �/,cg7D// .S /�I , - FEE* SCHEDULE
Suite #: g .0l Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: / / j 4q -So4 - Description Qty Fee (ea.) Total 1
f
New residential - single or multi - family per
Cross street/Direct }9ns to job site: dwelling unit. Includes attached garage.
WA , , a1 a' Service included:
�7 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
" DESCRIPTION OF WORK - service and/or feeder 90.90 2
(( Services or feeders - installation,
1// Ciao' , Ai alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160 60 2
- IN PROPERTY OWNER I ❑ TENANT -- • - 601 amps to 1000 amps 240.60 2
/ / n Over 1000 amps or volts 454.65 2
Name: " L(/,f(,�i,( 7v,IJ skA / L C'- Reconnect only 66.85 2
Address: des 6,,_, /.f/Tr 1 /ee , Op - Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: - 7764-12 , Die ?7 z ? 3 200 amps or less 66.85 I
201 amps to 400 amps 100.30 2
Phone:3 -� 3p 8�6 o Fax: 401 to 600 amps 133.75 2
APPLICANT El CONTACT PERSON Branch circuits - new, alteration, or
Name: 4/„P 4.0 (dpi / / 1 extension per panel:
JJ A Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc (Service or feeder not included):
Each pump or irrigation circle 53.40 2
CONTRACTOR Each sign or outline lighting f 53.40 S). ti[ 2
Job No: Signal circuit(s) or a limited energy panel,
ri p f _� ^ alteration, or extension Page 2 2
Business Name: / W s -y6-72_ , ,t1 a . c OR 4- Description.
Address: /5 lac 6w 7V - /
(� ' Each additional inspection over the allowable in any of the above:
City /State /Zip: 77 77 6 OR_ . r r Z ` 2 7 Per inspection per hour (mm. I hour) 62.50
Phone: ...2 3 . k, -32Dc Fax:.S -6 20 --7 / Investigation fee.
Le. : 2O -/ c L s Other
CCB Lic. #: 19 (//0/ i i # Electrical Permit Fees*
Supervising electricia i / /� /� Subtotal $ 53.40 .
signature required: J� Plan Review (25% of Permit Fee) S
Print Name: p 0 L., 0. 4 ,,„: , ,11 Lic. #: 51G$� 6 State Surcharge (8% of Permit Fee) $ L i- 7 -7
TOTAL PERMIT FEE $ S T•"lo]
Authorized , AliCil Notice: This permit application expires if a permit is not obtained within
Signature: _ J:....�i � Date. // Z - ar 180 days after it has been accepted as complete.
i * Fee methodology set by Tri- County Building Industry Service Board.
(Please print n -
is \Dsts\Permit Forms \ElcPermitApp doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: •
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
❑ Burglar Alarm
Garage Door Opener
El Heating, Ventilation and Air Conditioning System .
El Vacuum Systems
•
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
• 0 Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
Data Telecommunication Installation .
n Fire Alarm Installation
n HVAC
Instrumentation
T I Intercom and Paging Systems •
0 Landscape Irrigation Control
n Medical
Nurse Calls
0 Outdoor Landscape Lighting
0 Protective Signaling
El Other
Number of Systems
* No licenses are-required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPemmtAppPg2.doc 01/03
•
CITNOF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 00913
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/22/2006
Phone: (503) 639 -4171 g i ll
Inspection Requests (24 Hrs.): (503) 639 -417 ^_
INSPECTION WORKSHEET FOR DAT 11/30/2005 TIME: 7:09AM PAGE: 58
SITE ADDRESS: 09364 SW WASHINGTO a SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE \ LOT #: TYPE OF USE:
PROJECT NA - . = 1 = !LE
DESCRIPTI• ' • Lighting for one sign.
.. OWNER: WASHING I P TARE C, PHONE #:
CONTRACT* ' • OREGO \\ PHONE #: 620 -8200
Inspection Request Scheduled For: Da' : 11/30/2005 Pour Time:
Code # Inspection Description Con m # Contact # Message
199 Electrical fin 022 -01 503-620-8200 N
Corrections /Comments • n
11 i
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ C LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ad W Phone #: (503) 718- ����'