Permit - A CITY OF TIGARD /0-- O g ELECTRICAL PERMIT
PERMIT #: ELC2006 -00595
DEVELOPMENT SERVICES DATE ISSUED: 10/19/2006
'---' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S101 AB - 02704
SITE ADDRESS: 07410 SW BEVELAND RD ZONING: MUE
SUBDIVISION: HERMOSO PARK LOT : 028 JURISDICTION: TIG
Project Description: (1) circuit for 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:
NEWHAM, DAVID ALLEN + BARBARA AN LUMINITE SIGNS OF OREGON
7410 SW BEVELAND RD 9126 SW RIDDER RD
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: Contact #: PRI 503 - 570 -6137
FAX 503 - 570 -6138
FEES
Description Date Amount Reg #: LIC 156703
[ELPRMT] ELC Permit 10/19/200( $53.40 SUP 159S1G
[TAX] 8% State Surcharge I0/19/200( $4.27
Total $57.67 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 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 - 332 -2344.
Issued By: � Permittee Signature:
s v�
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.
Electr Per Application F012 OFFICE USE ONLY
City of Tigard
A jI Received _ Date/B � 1 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 1`/ Phone: 503.639.4171 Fax: 503.598.1960 , A DateB Other Permit:
I
Inspection Line: 503.639.4175 Date Ready/By: RI See Page 2 for
Internet: www.ci.tigard.or.us J Notified/Method: I= Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteriltion/repla ement Please check all that apply:
❑ Demolition ` Other: s N pk io ❑Service over 225 amps, comm'l ❑Hazardous location
OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CA EG OF C0I STRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
Other: ❑Building over three stories OFeeders, 400 amps or more
❑ Multi- family 0 Master builder
JOB SITE INFORMATION AND LOCATION ❑up
Occant load over 99 persons ['Manufactured structures or
['Egress/lighting plan RV park
Job no.: Job site address: 74f/D 5b0 41 v Fz b j? ❑Health -care facility :Other
�= Submit 2 sets of plans with any of the above.
City /State /ZIP: ) ) 6 D I ) a 97a 2 The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: FEE* SCHEDULE
�uvv�-5 S 1^c"ok. Description P I Qty. I Fee. I Total I ••
Cross street/directions to job site: Q New residential single- or multi - family dwelling unit.
1 EVE LAN 5 -7Z P t Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
4 -614- _ `- dwelling, service and/or feeder 90.90 2
f� S C^h �lo t I f e s �' Services or feeders installation, alteration, and/or relocation
,E X ( 1 C I C C LA t ' 200 amps or less 80.30 2
g PROPERTY OWNER' I ❑ TENANT 201 amps to 400 amps 106.85 2
I 401 amps to 600 amps 160.60 2
Name: �G Yv,2 1.) 1 .... , . U O 601 amps to 1,000 amps 240.60 2
Address: - 7L/( b 'Su 636LE(_ Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: �L,zt, / 0,2 C}'-7 a a3 Temporary services or feeders installation, alteration, and /or
Phone: (`51;?j) S — 0 3 Fax: ( ) relocation
200 amps or less 66.85 I
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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A APPLICANT I A" CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: OF SS/ c I t, tL S ^) 62riftl c S branch circuit 6.65 2
Contact name: 2{L `�(2u lam- B. without for service circuits
without service or feeder fee, 46.85 2
Address: 42169'} �� C yoN C >2L €K ( S first branch circuit
I W Jl �. Each add 'I branch circuit 6.65 2
City/State/ZIP: W \ t 4_61,1 N ( / ( L D12 Miscellaneous (service or feeder not included)
i
r t .� ( Fax:: 9 7p� � Phone: (5b79 S $2 — ( v d & (5b'9 5 2 _ (' S.� Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited- '�•�
CONTRACTOR energy panel, alteration, or
Business name: D C extension. Describe: Page 2 2
(�ti h/(1 .n ,^1/4 t
Address: 4,24,, "5/.0 R t � Each additional inspection over allowable in any of the above
/` Per inspection 62.50
City/State /ZIP: I L SO N a I LL £ ' ?Or7 D Investigation per hour (I hr min) 62.50
Phone: ( Zl , ) 5'7p — ( (Z•7 Fax: ( ) - s Industrial plant per hour 73.75
CCB Lic.: r 70 - . j Electrical Lic.: 3i1 Suprv. Lic.: ELECTRICAL PERM Sub /r7�' S�� Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: G�ef� J „ � ,� Date: • State surcharge (8% of permit fee) 1/.27
TOTAL PER FEE
Authorized signature: � ryy) Jr' 9. 6o?
This permit application aspires if a rmit is not obtained within 180
Print name: � r
days after it has been accepted as complete
' 7 j 2 4 I /) Date: JAC • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
is Building \Permits\ELC- PermitApp.doc 12/03 440.4615T(10/02/COM/WEB