Permit illi CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Per
COMMUNITY ELC2020-00463
Date Issued: 10/21/2020
I r C;A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S134DA00100
Jurisdiction: Tigard
Site address: 10399 SW NORTH DAKOTA ST
Project: Dakota Station Apartments Subdivision: None Lot: None
Project Description: Sign lighting for(1)monument sign.
Contractor: CLARK SIGNS Owner: DAKOTA STATION APARTMENTS LLC
PO BOX 1113 1025 NW COUCH ST#1415
ST HELENS, OR 97051 PORTLAND, OR 97209
PHONE:
PHONE: 503-781-6081
FAX: 503-543-5141
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 10/21/2020 $67.84
Specifics:
1 ea 12%State Surcharge- 10/21/2020 $8.14
Electrical
Type of Use: MF
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 through1gh 1 `J OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: C%�` l �V
Permittee Signature: 0Y\ a `k(,.�
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 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.
RECEIVE '7' r-e
Electrical Permit Application fOR(,111( 1 1 ,1 (I\„
2020 a i°Y' 9 z3 2aZo bZa �4�3
111 City of Tigard SEP 0 �uBy: :h. rmil4:
4 13125 SW Hall Blvd.,Tigard,OR 97223 Piers Review
g Phone: 503,718.2439 Fax: 503.598.Ic TY OF TIGARD D /BY: Related Permit a:
k f Inspection Line: 03.639.4175 Ready Date/By: arcs
Ga Ready Div10/0 Io sec Pau 2 for
Internet: www.tigard-ongov ,INotified/Method: & asements!information
I. TYPE OF WORK PLAN REVIEW.
o New construction ❑A ton/alteration/rretapllaacement Please check all that apply(submit i sets of plans w/items checked):
❑Demolition Cher: INil)ryt .SOV47T L'D ❑where
fe or feeder 400tampsee or more ❑Building overtatyaeta es.
where the available fault cement 0 Marinas and boatyards
I .. .CAIITEGORV OF.CoPISTRIMtIOPil : .. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building km to ground,or exceeds 14,000 ❑Cotnlnemiat-use agricultural
amps for all other installations, buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fie pump. ❑Installation of 150 KVA or
_ i+lOB SITE"INFORMATION AND LOCATION 0 Emergency system larger separately derived
b site address:' R yea 5- U S eer 'P,,, 0 Addition of new motor load of system.
Job 4: Jo
!Q�7 I4J IOOHP or more. ❑•A•••E••"I-2••"I-3••
City/State/ZIP: 176 /� ❑&ixurmore residential units. occupancy.
❑/ sit f:/� 47�7 3 ❑Health-cure facilities.. Recreational vehicle parka.
Suite/bldg./apt.#: Project name:D ❑Ramrdaus lotions. ❑Supply voltage for more than
K57Ax7va1 kP ❑ locations.Service or feeder 600 amps or more. 6Wvoltsnominal
Cross street/directions to job Site: ,614.) 6/2,FEAYaaMA la/MARC).Li 3r-j , FEE SCHEDULE ;:. n.,s
/�pj�TN Beacdtaka I Oty. I Each ( ToolI *
lOa49 S fJ DA�Cf��J1 .�I r r New residential single-or meld-family dwelling unit.
Subdivision: �pF G. T3 r�'ipaz—/W tat, I Lot#' iclude ink desTM attached garage.or less 165.34 4
Tax map/parcel#. Ea.add'I 500 sq.R.or portion 33.92 1+
' IDESCRIPTION'.OE WORK Limited energy,residential
,ems fESry rv. �s� (with above sq.11.1
75.00 2
I Al 5 I Mom-. ( )Sip kW--i- r LE PiYrr' u l .Tg12}j Limited energy,multi-flintily 75.00 2
7 }g- LQn Sig so,cst ba) Shy 1 fl/F' residential(with above sq.R.)
,,� - T,"� t� 5 �1�7 Renewable Energy ❑See Page 2
ROP R Y OWNER o.TENANT Services or feeders Installation,alteration,and/or relocation
Name: D 4 KtrrAl t57W4-r/oft( /4.P/(IR:m4 L-Lt=. 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: 940 Sid sth.Ayr es-L TI TE-Z Sp0
401 amps to 600 amps 2W.30 2
City/State/ZIP:�kjG,�, , a�Q72O!( 601 amps to 1,000 amps - 301.04 2
Phone:0,3 ),5 g_ p j4 g SI Fax:( ! ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders Installatka,alteration,and/or
Email: t relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 snips to 599 amps 165.54 2
AfPLICAN' Q'CONTACT PERSON Branch circuits-new,alteration,or extension, r panel
A.Fee for branch circuits with
Business name:( i4d€V. 'I6 al.S above service or feeder fee, 7.42 2
each branch circuit
Contact name: j)4 - .a(2i, n a . , B.Fee for branch circuits without
4119/v✓ '`/4 service or fee,first 56.18 2
Address: branch circuit
h
City/State/ZIP: r1.114.s.. Die 9 70s/
Fachellanbmnch circuit 7.42 2
1 ,c �/ Miscellaneous(service or feeder not included)
Phone:(03)781-(,Gg J Fax::Y7[.L7) Sz/3..�r/ T/ Each manufactured or modular 67.84 2
dwelling,service and/or(ceder
Email:drak[a2,Oki,I1't x i a as el;M Reconnect only 67.84 2
CtjNTRACTOR Pump or irrigation circle 67.84 2
Business name: to ,..Ass Sign or outline lighting I 67.84 a7. 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: clo gog/us panel,alteration,or extension.
Each additional inspection over allowable In any of the above
City/State/ZIP: S'T N FSrUS,Oiis-el o 5/ Additional inspection(I hr min) 66.25/hr
Phone:6,09)9-gI.(pOBI I Fax:6-b3)S 3-Sl41I Investigation(I hr min) 90.00/hr
Emily!), Industrial plant(I hr min) 78.18/hr
I 4 ts 4eQict,-,kfiriil(pa, .% Inspections for which iso feet 90.00lhr
CCB Lic.:6,4/933 I Electrical Lic.:s/2 as I Suprv.LIa Z3g l4, specifically listed('A hr min)
E[.ECTRICAI. PERMIT
Suprv.Electrician signature,tPquireA:� Subtotal:
I
Print name:D 4 LE- Li aLahQIe__ Dater/3 J2o ❑Plan Review Required(25%of permit fee):
�fff/ .O State surcharge(12%of permit fee):
Authorized signature: I TOTAL PERMIT FEE:
���� This permit application expires If a permit h not obtained Mihia 1R0
Print name:f\4L4-/ Detei7T/3/ z(��' days alter It has bees accepted u compete.
Il 4,. �/f • Number of inspections allowed per permit.
Ii8u1Waig\PmneAELC PemlApp_ElR_EIIE.doc Rev 04/17/201$ 44046 57(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RSIDENTLAL WORk ONLY: - FEE SCHEDULE p',<
Fee for all residential systems combined: $75.00 Rte 1 Qty.1 Each 1 Toni 1 •
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 00.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* Is.o1 to 25 kva 200.34 2
Wind generation systems in excess or25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
0 Garage Door Opener* So ul to IOU kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning
Solar generation systems in excess MIS kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
rr--���� Each additional Inspecdon over allowable In an&of the above:
K
t rather: i� LEO C 16 HT$' Each additional inspection is
66.
u `� charged al an hourly(1 hr min) 25/hr 1
Inspections for which no fce is 90.001 hr
specifically listed(%hr min)
COMMERCIAL wow(ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):,
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
0 Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommuhication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
•
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other: FiQEE 7kt pis)6 s 6iSL
Total number of comlptercial systems: _
*No licenses are required, Licenses are required for all
other installations
1:\RuiIJ'ma\permit.\LLC PmmJApp_ELR 6RG.dw Rcv 06)11/201S