Permit (14) CITY OF TIGARD ELECTRICAL PERMIT
� ` COMMUNITY DEVELOPMENT Permit#: ELC2023-00319
T i GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/22/2023
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15660 SW PACIFIC HWY A-3
Project: All Stop Pipes&Tobacco Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Sign lighting.
Contractor: JERRY M YOUNGER Owner: ROIC OREGON LLC
840 NE VILLAGE SQUIRE AVE BY PROPERTY TAX RESOURCES LLC
GRESHAM, OR 97030 PO BOX 130339
CARLSBAD, CA 92013
PHONE: 503-380-4774 PHONE:
FAX: 503-253-9407
FEES
Quantity Description Date Amount
Specifics: 1 ea Sign or Outline Lighting 05/22/2023 $67.84
1 ea 12%State Surcharge- 05/22/2023 $8.14
Type of Use: COM Electrical
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 his permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the
180 days. ATTENTION: • •gon la equir::
1` ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through• . 952-0•-i09p. a` c..v of the rules or direct questions to OUNC by calling 503.23 .198 or 1.800.332.2344.
lr
Issued By: Permittee Signature: / /C :
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'N 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.
Electrical Permit Applica r„ „,'': r FOR OFFlC1: I.SE oNLv
'
City of Tigard L'— `` r'�'a° ,"' Date/Be: lr ►- / /�/�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review jam/
Phone: 503.718.2439 Fax: 503.598.1960 + )3 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: liMIII ® See Page 2 for
1 I( A R(7 Internet: www.tigard-or.gov 44;
Notified/Method. Supplemental Information
-...... 4
4 �,I#C sue,
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❑New construction Addition/alterahonjrep(acement n Please check all that apply(submit 2 sets of plans w/items checked):
/�❑
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
,` £ ' t ,,. * .m in z i j exceeds 1 Q000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling V Commercial/industrial 0 Accessory building aess to ground,or exceeds Ia,00o ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
R;
- :- A 2. s°°` r�, r.,� u ❑Emergency system. larger separately derived
Job#: I Job site address: 15O(o Q ❑Additioo of ore.motor load of system.
e.„...,,,.A..7,,, ,,,,,,fIOOHP or more. ❑••A„••E„,•l_2>,•,1_g".
City/State/ZIP: a�..� ❑Six or more residential units. occupancy.
-" Z 1 0 1 3-7i7/it ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: 2 Project name: rr ❑Hazardous locations. 0 Supply voltage for more than
7 I ' J Des �14/1"` � 600 volts nominal.
r LLLL 0 Service or feeder 600 amps or more
Cross street/directions to job site:
/t uDescription I Qtr. Each � Total I *W
Ci�(J P-Ority_ Y New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
'I 1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'!500 sq.ft.or portion 33.92 1
� -: -. ,,, ,;- Limited energy,residential
// /n� (with above sq.ft.) 75.00 2
0 Wp w `' rWI,l.e fS-H Limited energy,multi-family
V residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
- "_£ '"..Q."' _ -°-. :"' Services or feeders installation,alteration,and/or relocation
Name: `j creut 1,0 �l)-✓s.- 200 amps or less 100.70 2
p / '7 , ?_ 201 amps to 400 amps 133.56 2
Address: /6 (kf/, Ski fl��►n7VQ tC CDZ(�cz yTLj
`C 'V ��' 401 amps to 600 amps 200.34 2
City/State/ZIP: P 1 '] q`a/e R � 601 amps to 1,000 amps 301.04 2
Phone:(C0z )gl (L® Fax:( ) N 4— Over 1,000 amps or volts 552.26 2
7 ll l 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,rent,or exchange,according to ORS 447,449,670,and 701.yA 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: .}r`"l CO L i above service or feeder fee, 7.42 2
—1
each branch circuit
Contact name: „m�,,L, tip , B.Fee for branch circuits without
Address: 6`�t-�-f vre service or Feeder fee,first
branch circuit 56.18 2
City/State/ZIP: r,, ®�c et n/ Each add'l branc(circuit 7.) 2
��fJMiscellaneous service or feeder not includedPhone:(tb3) q r!,® Fax:: ) Each manufactured or modular 67.84 2
C dwelling,service and/or feeder
Email: Reconnect only 67.84 2
tt-.,, Pump or irrigation circle 67.84 2
Business name: `J.Znr Sign or outline lighting 67.84 2
Address: g�,0 ` `f/„_6 �� Signal circuit(s)or limited energy 0 See Page 2 2
„j"-4�„" o � panel,alteration,or extension.
p O 0 Each additional inspection over allowable in any of the above
City/State/ZIP:
�V,� r q 1 Additional inspection(I hr min) 66.25/hr
Phone:( fol 4t iC0 L( 71,0 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: 1 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.:1 Electrical Lic.: Su rv.Lic.: specifically listed CA hr mite
Suprv.Electrician signature,required: Subtotal:
Print name: c{(Q �,e,1 „ 42 Date: i `�Y�al2e Z ❑Plan Review Required(25%of permit fee):
c �'"`�`i�"'! (l J State surcharge(12%of permit fee):
Authorized ignature: / TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: �ate: '/ days after it has been accepted as complete.
• Number of inspections allowed per permit.
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