Permit CI TY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00598
' DEVELOPMENT SERVICES DATE ISSUED: 11/13/02
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S126C0 -01107
SITE ADDRESS: 09635 SW WASHINGTON SQUARE RD
SUBDIVISION: FC -5 ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (2) sign lightings.
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: 2
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:
PPR WASHINGTON SQUARE LLC CMR SIGN SYSTEMS
X 21545 1820 E BURNSIDE
SEATTLE, �O
SEATTLE, WA 98111 PORTLAND, OR 97214
Phone: Phone: 285 - 7918
Reg #: ELE 26- 695CLS
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/13/02 $106.80
[TAX] 8% State Tax 11/13/02 $8.54 Rough -in
Elect'I Final
Total $115.34
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty C. . d 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 d- , s of i : uance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utilit otifi.. ion Center. Those rules are set
forth in •' ' '52- 001=0Q10 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct.. -- to OUNC at (503) 246 -6699 or
1 -80' .32-2344.
Issk ed By: `/, i'd / / 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: k 1 0 ,
/ 04 -.R-> 6-7,- -� DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit App
. ,
.• Date received: / 4 2- Permit no.: && ,, -t�,s pg
v <..r ty .� ) i l � �t. *
ma y, .. I City of Tigard Project/appl. no.: • e date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: B : i Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory J� Commercial/industrial 0 Multi - family 'enant improvement
0 New construction / 0_Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: 9 (13 5 ru) L0,9- 4,,c. Bldg. no Suite no Tax map /tax lot/account no.:
Lot: Block: / ISubdivisi l:
Project name: f a )/ I Description and location of work on premises: S t ,,-
Estimated date of completion/inspection: / — , - O ,
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: /' Fee Max
Business name e/ i• Description Qty. (en.) Total no. insp
Address: /v ya Y� ew residential - single ormulti-family per
�) . ._ !c--1` t1t^ d welling unit. Includes attached garage.
✓ 4�!
City: I Stater r I ZIP: ") a.l ti • Service included:
Phone Fax:
�3 a 3 - 2 1 - x mall: 1 1000 sq. ft. or less 4
l Each additional 500 sq. ft. or portion thereof
CCB no.: C -, (�j I Elec bus lic. no:�(o —e �CL1 Lim itedener
// � / n
energy, residential 2
City /metro . C. •.:. Limited energy, non-residential 2
1_ /f — / 3.10 3— Each manufactured home or modular dwelling
Signature . sr. - rvistng - lectrician (requ, •) Date Service and/or feeder 2
Sup. elect. name (print): e � ' C) . License no: ) ' Services orfeeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): l ) 4j / A..)6__ ,7 R,�� 20l amps to 400 amps 2
Mailing address: r 401 amps to 600 amps 2
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 I
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,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 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: 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):
O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of l&2 ❑ Hazardous location Each sign or outline lighting /d4 2
family dwellings ❑ Building over 10,000 square feet four or Signal circutt(s) or a limited energy panel, vvvv
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories ❑ 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:
❑ Egress/lightingplan ❑ 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 //__
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 %) $ 7
r Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $ • i
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00/COM)
EX rk [IRE 1
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEET ,
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 `I' 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 ❑ Vacuum 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 ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits pi with purchase of service or I Clock Systems
feeder fee. I � I
Each branch circuit $6.65 2 I I 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)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above ❑
Per inspection $62.50 Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ El 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