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��� �� ������� _ ELECTRICAL PERMIT
C PERMIT#: ELC2001-00633
DEVELOPMENT SERVICES DATE ISSUED: 1213/01
13125 SW Ha!I Blvd.,Tioard. OR 97223 (503) 639-4171 PARCEL: 1S136DB-00201
Si I E ADDRESS: 1157;) �iW PACIFIC HWY
SUBDIVISION: FRED MEYER ZONING: C-G
BLOCK: LOT : JURISDICTION: TIG
Proiect Description: Sigh or otitline lighting.
_RESIDENTIAL UNIT TEMP SR_V_C_/FEEDERS _ MISCELLANEOUS
1000 SF OR LESS: 0 200 amp- PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 400 amp: SIGN/OUT LINE LTG: i
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/SVC/ FDR: 601+amus - 1000 volts: MINOR LABEL (10):
SE_RVICEiFEED_ER _ BRANCH CIRCUITS ADD L INSPECTIONS
_
U 200 amp: WISE.RVICE CR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'1 BRNCH CIRC: IN PLANT:
601 .000 amp: _PLAN REV!EW SECTION___
1000+ amp/volt: >=4 RES UNITS: '> 600 VOLT NOMINAL:
_ Reconnect ons_ __ _,_ SVCIFDR >= 225 AMPS: CLASS AFFA/SPEC OCC:
Owner: C;ntractor:
CLARK SIGNS
PO BOX 1113
ST HELENS, OR 97051
Phone: Phone: 781-6081
Reg#: SUP 636SIG
ELE 518cls
LIC 00064933
FEES _ Required Inspections—
Type
nspectionsType By [late Amount Receipt � E� lecl'I Final
PRMT CTR 12/13/01 $53.40 27200100001
5PCT CTR 12/13101 $4.27 2720010000(
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. Ths permit will expired work Is not started within 180 days of'ssuance,or if
work is suspended for more than 180 days. ATTENTION: Oregon law requires you to folkrw rules adopted by the Oregon Utility Notification
Center. 'Those rules are set forth '^,)AR 952-001-0010 through OAR 952-001-0080. You may ubtain copies of these rules or direct questions to
Permit Signature: Issued By:
_ OWNER INSTALLATION ONLY _
The installation is being made ol, property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
c.ONTRACTOR INSTALLATION ONLY
LL'SIGNATURE OF SUPR. ELEC'N: �. _�, ,r 1A _U ild i. t DA1'E: __—
LICENSF NO:
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
71�'Tqject/appl.
ceived:J� Permit no.:
City of Tigard
Expiredate: —
11n of l'ipurd Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt nu.:_
Phone: (503) 639-4171
Pax: (503) 595-1960 Case file no.: Paymenttypc:
Land use approval:
U 1 &2 family dwelling;oraccessory commercial/industrial U Multi-family U Tenant improvement
U New construction U Addition/alteralion/replacement U Other: U Partial
lob addnas; //S?q �u G.' r c ffw Bldg.
no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivision: _
Project name: T r a r c>! M u s r c_ mscription and location of work on premises: UV-N S,g., - /Zu eC wK)e 44 aa.•Fa l—
Estimated date of completion/ins ectioll - 6 tvc:Ct<s CAP-., e
fee nta�
Job no: ca Total no.ins
Description �Y• ( 1 p
Business name: 6 /e,r K S,' ►, New residefuial-single or nadti-famliv per
Address: fi,o , Ilex 111 dwelling unit.Inclullmatlachrdganrgr.
Cit jState: < ZIP: oS f Service Included: 4
y CJC NS I OW sy ft.ur less _
Phone:50 -Ir 17- i2 ad
Pax: E-mail: — —
_ Mach ditional St10 s .ft.or orttan Ihcrcof
CCB no.: G 4 733 14 ( ! Elec,bus.lic.no: L S i., Limited energy.residenti I 2
City/metro lic.no.: Z2$(. Limited energy non-residential 2
Bach manufactured home or modular dwelling
- - - Service and/or feeder 2
Si�rcof cru
ryisitt elician anyuncdl - -- Date i . �. — — —
Services or feedcn-Installation,
Sup.elect.name(primP C„ �. M l� fl, W+S I.icenscnu �tb SIG+ alteration or relocation:
II ILU 2W amps or less
201 amps to 4W amps 2
Name(print): FrVe r S f a. cs ^c . -- 401 amps to 600 amps — _— 2
Mailing address: 0, !4e 2 1 I 601 maps to IOW amps 2
City: u r as Stale:0 r ZIP: 9 71 ti t Over IOW amps or volts _ 2
Phone: 5 o1 7.3 ll lax: f:-moil: Retxn,nccuntly _,. I
Temporary services or feeders-
Owner installation:The installation is being made on property I own installation,literal ion,orrelocation;
which is not intended for sang,lease,rent,or exchange according to 21x)amps or lens — '-
()RS 447,455,479,670,701. 710 1 loops to 4W amps — 2
Owner's si mature: I lair 40I to 600 amps 2
Branch circuits-new,alteration,
or extensinn per panel:
Name: A I-ce for branch circuits with purchase of
AtWrew.: — service or feeder fee,each branch circuit _
ZIP: B. Fee fat branch circuits without purchase
(11,service or feeder ke,first branch circuit:
Pltotte I i, I', mail: Fach additional brand circuit:
mile.(service 'feeder not Included):
Each pump or irrigation circle_ 2
7getv,,c, er 215 maps unnnu•tn;tl J I Icalth-care facilityteach signtt outline hghliog 2
erl2Omnps-rating oflNt2 UNazardouslocalion Si nalcinuh(s)oralimitedrner inclellings UBuildingoverlfl1Mx)syutuefeellouror g gyper 6W volts nominal more residential units in one structure alteration,of extension' _ 2
U Building over three stories U Feeders,4W amps or more •oescri,tion
U tkcupant load over 99 persons U Manufactured structures or RV p,rk Each additional impection over the a11ov►able in any of the above: -
U P.gtess/lightingplan U Other-
Submit
titer Stubmit___sets of plans with any of the above. investigation fee --_
The above are not applicable to temporary construction aervlce. Met
f ---— Pcrr•,tit fee.....................$ ——
Not all juriedicuanx accept credit cant+,please call luriutktiun fex traxe infrxrtunicm Notice:This permit application Ilan+cute..(at - _ �)
U visa U MasterCard expires If a permit is not obtained
1_ within ISO days after it has been State surcharge(11%)....$
credii cad numbet -oil hec
accepted,tscomplete. TOTAL .......................$
Name of car&wl r n&how, on cre int cater s
cardholder riputure Amount 440-461516A10MM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
— - TYPF OF WORK INVOLVED -RESIDENTIAL ONLY
Cc.mplete Fee Schedule Below: Restricted Energy Fee..................... ...............................
_ Number or Inspections per ermit allowed (FOR ALI.SYSTEMS)
Seivice included: Items Cost Total Check Type of Work Involved:
Residential-per unit
1000 sq.It or less $14515— _ q Audio and Stereo Systerns'
Each additional 500 sq ft.or
portion thereof $33,40 _ t ❑ Burglar Alarm
Limited Energy $75.00
Each Manurd Home or Modular El Garage Door Opener'
Dwelling Service of Feeder $90.90
Services or Feeders Heating,Ventilation and Air Conditionln7 Syste-n'
Installation,alteration,or relocation
200 amps or less $80.30 2 Vacuum Systems'
7.01 amps to 400 amps — $106.85—_ 2
Ej
401 amps to 600 amps $160.60 _ 2 O v
Other
601 amps to 1000 amps ---- $240.60 2
Over 1000 amps or volts $454.65 _ 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Fee for each system......................... .......................... ..... $75.00
Installation,alteration,or relocation
200 amps or less $66.85 (SEE OAR 918-260-260)
201 amps to 400 amps; $100.30 _ Check Type of Work Involved:
401 amps to 600 amps $133.75 _
Over 600 amps to 1000 volts, Audio and stereo Systems
see"b"above.
Branch Circuits ❑ Boller Controls
New,alteration or extension per panel
a)The fee for branch circuits O
with purchase of service or Clock Sy'-:r::ns
feeder fee.
Each branch circuit __ $6.65 _ Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service I Fire Alarm Installaticn
or feeder fee.
First branch circuit $46.85 _ HVAC
Each additional branch circuit $6 r5 _
Miscellaneous I Instrumentation
(Service or feeder not included)
Each pump or Irrigation circle $53.40 Interann and Pacirg Systems
Each sign or outline lighting $53.40
Signal circult(s)or a limited energy Landscape Irrigalio Control'
panel,alteration or extension — $75.00
Minor labels(10) $125.00 ❑
Medical
Each additional Inspection over
the allowable In any of the above Nurse Calls
Per inspection $62 50
Per hour $62.50 _ ❑
In Plant __ $73.75 Outdoor Landscape Lighting'
Fees: r ❑ Protective Signaling
Enter total of above fees $ �' ` ❑ Other_ — ----
8%Slate Surcharge $ _____Number of Systems
250/.Plan Review Foe No licenses are required Lica,ses are required for all other installations
.`:.re"Plan Review"section on $ -
front of applicatinn _____--- _
Fees:
Total Balance Due $ Fnter total of above toes = —
❑ Trust Account# __- __ 8%State Surcharge $
Total Balance Due —
Ai1 New Commercial Buildings require 2 sets of plans.
i\rists\fnrmq,,elc-fees.doc 08/30/01
Y OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP -
Received Date Requested _z -_AM_- PM BUP
Location _� 5 �� _u-� Suite _ MEC
Contact Person __—__ Ph(—) PLM _
Contractor_ — Ph(—) , SWR
BUILDING _ Tenant/Owner ��-LC� �1 L4,4-L��. ��' ELC 66633
Footing F-114 �/1 , StLd Z ELC _
Foundation Access: -=
Ftg Drain ELR -
Crawl Drain
;.flab Inspection Notes: SIT —_
Post&Beam
Shear Anchors
F:xt Sheath/Sh3ar
Int Sheath/Shear - -
Framing - ---- ----- - - ----
Insulation
Drywall Nailing -_-----__---____-_-
Firewall
Fire Sprinkler -- -- -- -- -
Fire Alarm
Susp'd Ceiling _--
Roof
Other: -----____- - - --_-_---
Final -^ --
PASS PART FAIL
PLUMBING
Post
--
Post&Beam-
Under Slab
Hough-In
Water Service
Sanitary Sewer
Rain Drains ---- - ----- -- - -
Catch Basin/Manhole
Storm Drain ---
Shower Pan
Other'
Final
PASS PART FAIL - -`---- -`
MECHANICAL ^_, _-.----- -- ----- ---- - --- - ---
Post&Beam
Rough-In -- ---- --------- --�.- -- - - -..�_
Gas Line AZ
Smoke Dampers --_ _ . - _. -- --------- --- --
Final
PASS_PART FAIL -- ----. _. -- - -- ---_ - - - ------ _
ELECTRICAL
Service '--------------. -�------------- --_.__
Rough-In J _-
UG/Slab
Low Voltage - ----------- ----- -- ---- - -___-- ----
Fire _!arm
mal El Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hell Blvd.
S PART FAIL
S _ [� Please call for reinspection RE..__--__ __ -_ r
Fire Supply Line i � Unable to Inspect-no access
ADA �f
Approach/Sidewalk D>ats �_ Inap�tOr � 't'��2=+- am -
Uther. -- --------- ��
Final DO NOT REMOVE this Inspection record from too/job sit•.
PASS PART FAIL