Permit a CITY OF TIGARD ELECTRICAL PERMIT
'' • I ,. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00648
T [ Cr1R0, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/08/2009
Parcel: 2S101 BB00900
Jurisdiction: Tigard
Site address: 11880 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Russ Chevrolet
Project Description: Install (3) internally illuminated signs.
Owner: FEES
KNAUSS, WAYNE ET AL Quantity Description Date Amount
C/0 HUMBERSTON, RUSSELL D, REVOCABLE
TRUST, PO BOX 4300 3 ea Sign or Outline Lighting 12/08/2009 $203.52
PHONE: 1 ea 12% State Surcharge - 12/08/2009 $24.42
Electrical
Contractor:
YESCO LLC
20100 SW 112TH AVE
TUALATIN, OR 97062
PHONE: 503 - 612 -6672
FAX: 503- 612 -0914
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $227.94
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and • ether appli ,s e law. 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 ' , ork is s�'nded for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Those s are set forth are OAR
952 - 001 -0010 through j 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503. - • • or 1.800 - •".2344.
Issued By: t '� (1,A ill /' \ -�` = I ' 11 ) ' I )1 I ) Perm ittee 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' 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.
1.
Electrical Permit Application L - ^ t; e QFFICE USE.ONL7 - - ;'
` : City of Tigard 2 009 Receive I �t� � �
DEC 0 Date /By Permit No.. `` e
n 13125 SW Hall Blvd., "Tigard, OR 97223 Plan Review
I k- - Phone: 503.639.4171 Fax: 503.598.19 Date /By: Other Permit:
Inspection Line: 503.639.4175 u OF TIGARD Date Ready/By: See Page 2 for
T,IGAR p b g BUILDING IC
Internet: www.tigard G DIVISI Notified /Method: Supplemental Information
' TYPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
, CAT EGORY OF .CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling .Commercial /industrial ❑ Accessory building amps for all other installations. . buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
°
JOB SITE ' AND LOCATION 0 Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: l� OgC) 8w TGL;r;t= 100 n s. occupancy.
� W� ❑ Six o or r mo or re e residential units. ❑ R ecr
eauonal vehicle parks.
City /State /ZIP: 7 t let (c) O K / ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: aS5 CiLteoy /Sa.f r r ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. i Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
' DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
1 Limited energy, multi - family
►'∎s { 0.11 3- 1►,4ernalIy I1 residential (with above sq. ft.) 67.84 2
p K. Q y LA.) t S t 5 Ser
vices or less installation, alteration, and /or relocation
-C� t ri J.. 100.70 2
`Eit PROPERTY OWNER . TENANT 201 amps to 400 amps 133.56 2
Name: �US C IAeQr ) e -. { - (.3+e t/e e os \ 401 amps to 600 amps 20034 2
C) 601 amps to 1,000 amps 301.04 2
Address: \ \ 0 0 5 , , ) - ea C rf- t _ div y. Over 1,000 amps or volts 552.26 . 2 .
City /State /ZIP: -if .1.0., r� D P Temporary services or feeders installation, alteration, and /or
P relocation
Phone: ( » 3 ) tc, _ 0 ki (, Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 )
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration. or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT . CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: V ESG 3 • B. Fee for branch circuits
( without service or feeder fee,
Contact name: -
Y1GiCQ tr k, . In 5 first branch circuit 56.18 2
Address: 2.6i / Oa S'vJ / / , / I d Each add'I branch circuit 7.42 • 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Tuq,,a+f - g 9 (p . Each manufactured or modular 67.84 2
/ dwelling, service and /or feeder
Phone: (563 ) ( ('1 i _ LA, 7 0 Fax: : (Spy) ( 1 a - OB/ ci Reconnect only 67.84 2
E -mail: -f -'t�kt I rs e yes (0 . ("On -) Pump or irrigation circle 67.84 2
/ CONTRACTOR Sign or outline lighting 3 67.84 s 2
V gnal circuit(s) or limited-
Business name:
/ E S co (,o energy panel, alteration, or
Address: 0.0 ) 00 S A J i / ) J P 'e extension. Describe: Page 2 2
City /State /ZIP: / Ltci. /Cx'.7 t v' 0 �'-73� Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (SO3) (01 c-/ - 1 Fax: (5b3 )Lo I -, 0q (C1 Investigation per hour (1 hr min) 66.25
CCB Lic.: j + T --- Electrical Lic.:37 5/G(.-S Suprv. Lic.: (14 96 Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES.
Suprv. Electrician signature, required: „. Subtotal: laj. 5 2
Date: Plan review (25% of permit fee):
Print name:
�� (7 �/- / �� State surcharge (12% of permit fee): , � f , 412
Authorized signature: r - � TOTAL PERMIT FEE: do-7. 1'1
a / ��� ///'�h ' ON D7 permit application expires if a permit is not obtained within 180
Print name: / <� /��X kT� l� �'H 5 Date: �� (75 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ nuilding \ Permits \ELC- PermitApp. doc 10/01/09 440- 4615T(I I /05 /COM/WEF