Permit CITY OF TIGARD ELECTRICAL PERMIT
3 COMMUNITY DEVELOPMENT Permit#: ELC2020-00116
T t C A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/29/2020
;
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11577 SW PACIFIC HWY
Project: Bridgetown Optometric Associates Subdivision: None Lot: None
Project Description: Sign light for 100 pound illuminated wall sign on the east elevation.
Contractor: SECURITY SIGNS INC Owner: FRED MEYER STORES INC
2424 SE HOLGATE BLVD STORE#375
PORTLAND, OR 97202 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503-546-7114 PHONE:
FAX: 503-230-1861
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 04/28/2020 $67.84
Specifics:
1 ea 12%State Surcharge- 04/28/2020 $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 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA 52-00 090. u mayobt in a of the rules or direct questions to OUNC by calling 503.232 987 or 1.800.332 2344.
9 Y �
Issued By: Permittee 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 503.639.4176 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.
E1eetrical Permit Application FOR OFFICE USE ONLY
City of Tigard { Received I/
• 13125 SW Hall Blvd.,Tigard,OR 97223 Dan Review
: filiM
i�l zi �u�/L ,_�f `�
g Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : h 'j rt��� A ,
Inspection Line: 503.639.4175 Ready Date/By: -uris: ® See Page 2 for
"I 1('ARD, Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
ra New construction ❑Addition/alteration/replacement Please check all that apply(submit2 sets of plans wine mschecked):
❑Service or feeder 400 amps or more ❑Building over three stones.
❑Demolition ❑Other:
where the available fault current ['Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
IllI-and 2-family dwelling Commercial/industrial E Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
ampEl Multi-family [ Master builder ❑ Other: ❑Fsu
Fire pump.
other installations. buildings.
p p. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: 4, y ( Job site address: ji 77 $ ) /�JG' �/�' ❑10HAddition of new motor load of system.
Job
✓ �rear' L i rvri 100HP or more. A,• „E„ "1_2" "1_3"
City/State/ZIP: ella /� Q`] 2 ❑Six or more residential units. occupancy.
y /t`j t//'� -(, ` ZZ7 ❑Recreational vehicle parks.
❑Health-care facilities.
Suite/bldg./apt.#: Project name:Oa(17(& `0�/V r1 Q-77smeer ous locations. El Supply voltage for more than
n��C��T,�(,lI t� Service or feeder 600 amps or more. 600 volts normnal.
Cross street/directions to job site: r( ;?° t' k' FEE SCHEDULE,;iWili$.10
/], �� Description I Qty. I Each j Total s
e S o 7 2 f I G i la New residential single-or multi-family dwelling unit
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
pilx.)/UT 1LLUrniN I..1/ W�LL C t ` r itedmlth above sq. ti 75'00 2
J( `�1,V Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
,p;, El PROPERTY OWNER I itiTENANT Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: l t p 3 fel 06 i"r o� (pip `r�L' . . 200 amps or less 100.70 2
Address: V t J 577 5f '1 p he- AVE r201 amps to400amps I33.56 2
f ^ t/6n Q 401 amps to 600 amps 200.34 2
City/State/ZIP: 7'` L�� _l?'L23 601 amps to 1,000 amps 301.04 2
Phone:( ) / Fax:( ) Over.1,000 amps or volts 552.26 2
' Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,r nt,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: / i I� Date: 401 amps to 599 amps 168.54 2
0 APPLICANT
-s z v�s x �"�. ta+.;; , g;??1� ; Ifs Branch circuits—new,alteration,or extension,per panel
i7:d .e_.,
- A.Fee far branch circturs with
Business name:SECURITY SIGNS,INC above service or feeder fee, 7.42 2
each branch circuit
Contact name: CYNDI STOCKS B.Fee for branch circuits without
Address:2424 SE HOLGATE BLVD service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:PORTLAND,OR 97202 Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)546-7102 I Fax: : (503)230-1861 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:permits@securitysigns.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: SECURITY SIGNS,INC Sign or outline lighting / 67.84 2
Address:2424 SE HOLGATE BLVD Signaln circuit(s)or extension. 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:PORTLAND,OR 97202 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)546-7102 I Fax:(503)230-1861 Investigation(1 hr min) • 90.00/hr
Email:permits@securitysigns.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee isAn
90.00/hr
CCB Lic.: 122809 I Electrical Lic.: 26- .t L I Suprv.Lic.: 383-SIG specifically listed(1/2hr min)
►, ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: �KVA Subtotal:
Print name: MARC LIND UIST Date: QO,26/20 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: CYNDI STOCKS Date: /92.112.612.40 days after it has been accepted as complete.
* Number of inspections allowed per permit.
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•
. Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qly. I Each I rota!
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
2
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
El Garage Door Opener* 50.01 to kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s.ecifically listed('h hr min)
COMMERCIAL WORK ONLY: v_.. •
ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
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