Permit (11) CITY OF TIGARD ELECTRICAL PERMIT
IN g - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00608
Date Issued: 11/01/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S115A601900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY 0
Project: T Mobile Subdivision: 1994 -028 PARTITION PLAT Lot: 2
Project Description: Sign lighting for (1) wall sign.
Contractor: MEYER SIGN CO OF OREGON Owner: SN PROPERTIES PARTNERSHIP
15205 SW 74TH AVE 1121 SW SALMON ST
TIGARD, OR 97224 PORTLAND, OR 97205
PHONE: 503 - 620 -8200 PHONE
FAX 503 - 620 -7074
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 11/01/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 11/01/2011 $8 14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75 98
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 all other applicable law All work will
be done in accor. - - - - • approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATTE ON Oregon -w • es y• . to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -00 • thro i.h OAR 952 -01 -0090 Y• m:y obtain a copy of the rules or direct questions to OUNC by calling 50 • . 1 800 332 2344 I // /
Issued : l /� � I Permittee Signature: ��_ . ! I %+
— 7
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' /(7,7,/ Date:
LICENSE NO. cif? S -'
r Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Electrical Permit Application FOR OFFICE USE ONLY
City Of Tigard Date /B . / % dlintl / `oli"' de. CG 1C/r ,
Permit No GLe
II q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone. 503.718 2439 Fax. 503.598.1960 Date/B Other Permit.
T 1 G AR D Inspection Line 503 639.4175 Date Ready/By: Juris ® See Page 2 for
Internet www.tigard - or.gov Notified/Method: Supplemental lnformation
'' '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: x where the available fault current ❑ Marinas and boatyards
>'e , exceeds 10,000 amps at 150 volts or
'' *- < , '' ' - w " " = CATEGORY; OF ' CONSTRUCTION .2 •� �� • P 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
„ ION ❑ Emergency system larger separately denved system.
, ' , JOB SITES INFORMATION'" AND LOCAT '` ' , • " ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 16200 SW Pacific Hwy 1 or more c re atioy
❑ Six x o or r more residential units ❑ R Recreational vehicle parks.
City/State /ZIP: 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: 0 Project name: T- Mobile ❑ Service or feeder 600 amps or more
FEE SCHEDULE _
Cross street/directions to job site: Description i Qtr. I Fee_ 1 Total
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 "• WORK - • (with above sq_ ft) 75 00 2
Limited energy, multi - family 75.00 2
Connect sign to power residential (with above sq ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100 70 2
!'2,t, . 'PROPERTY., OWNER C' ': 'r „ . ,- ® TENANT. 201 amps to 400 amps 133 56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301 04 2
Address: Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( )
Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125 08 2
Owner installation: This installation is being made on property that I own which is not
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
1 „ above service or feeder fee,
i` ❑ •APP,LICA t 0 ,CONTACT PERSON- 7 42 2
'•nSs .w each branch circuit
Business �},� F B Fee for branch circuits without
usiness name:
t + L r service or feeder fee, first
Contact name:
branch circuit 56 18 2
Each add'l branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included)
Ci /Stae /ZIP: 7 Each manufactured or modular 67 84 2
ty t lip A1'' 7 7 2_K dwelling, service and/or feeder
(!/` Reconnect only 67.84 2
Phone: ( ) Fax: : ( )
Pump or irrigation circle 67 84 2
E - mail:
Sign or outline lighting 1 67 84 67 84 2
'„ . ' +•• ,';*', ", " CONTRACTOR" - - . ; , , , , - - Signalcircuit(s)orlimited-energy
Business name: Meyer Sign Co of oregon panel, alteration, or extension. Page 2 2
Each additional inspection over•allowable in any of the above
Address: 17205 SW 74 Ave Additional Inspection (1 hr min) 66 25/ hr
City/State /ZIP: Tigard Or 97224 Investigation (1 hr min) 66 25/ hr
Industrial plant (1 hr mm) 78 18/ hr
Phone: (503) 620 - 8200 Fax: (503 ) 620 7074 Inspections for which no fee is
/°Py specifically listed (Y2 hr min) 90 00/ hr
CCB Lic.: 64014 Electrical Lic.: 20 -190C1 Suprv. Li c.: &yr, , " ' ELECTRICAL, PERMIT FEES" -
Suprv. Electrician signature, require• . 7�f /t � / /;y l ic Subtotal: 67 84
C,c� y Plan review (25% of permit fee):
Print name: Dave White Date: 11 -1 -2011 State surcharge (12 %ofpermit fee): 8.14
TOTAL PERMIT FEE: 75.98
Authorized signatur-:
� This permit application expires if a permit is not obtained within 180
Print name: Dave White Date: 11 -1 -2011 • days after it has been accepted as complete.
Number of inspections allowed per permit.
1 \Building\Permits\ELC- PermitApp doc 07/01/10 440- 4615T(11 /05 /COM/wEB •