Permit (10) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2023-00538
Date Issued: 11/7/2023
T 16 A P.1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DD00300
Jurisdiction: Tigard
Site address: 15900 SW 72ND AVE
Project: Rocket Gas Station Subdivision: None Lot: None
Project Description: Sign lighting for(1)wall sign.
Contractor: ADVANCED ELECTRIC SIGNS INC Owner: PACIFIC REALTY ASSOCIATES LP
1550 DOWN RIVER DR BY APRO LLC
WOODLAND,WA 98674 4130 COVER ST
LONG BEACH, CA 90808
PHONE: 360-225-6826 PHONE:
FAX: 360-225-8299
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 09/13/2023 $67.84
Specifics: 1 ea 12%State Surcharge- 09/13/2023 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the
180 days. ATTENTION: Ore on law requires you o follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 2-001-0090. Y mv o i oov of the rules or direct questions to OUNC by callina 503.232.1987 or 1.800 332.2344.
Issued By: ;/ 7-) Permiftee Signature: 1
l ''(,[ ! 9 -' ' ' 1( _r '
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
' Electrical Permit Application RECEIVED FOR OFFICE LSE ONI,N
CityO Tigard G GG VV GED Received .7 Permit#: �^ �,r�
f g Date/By:i$e//: 14 ( 4 2�—«(,)c3
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
i II Phone: 503.718.2439 Fax: 503.598.19A(U G 1 7 2023 Date/By: A/ Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Ians..,,�-. B See Page 2 for
TIGARO Q IGARD Notified/Method: 1// "�7 /, , Supplemental Information
Internet: www.tigard-or.gov ////
' t T (,
E. TYPE OF s .', 't�Ei'lE'W - . c j ,.
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked
❑Service or feeder 400 amps or more ❑Building over three stones.
❑Demolition Other: C I(.114 where the available fault current 0 Marinas and boatyards.
t .CATEG[?R ONSUC'['JO , > z exceeds 10,000 amps at 150 volts or ❑Floating buildings.
El and 2-family dwelling �1,Commercial/industrial ElAccessory building less to ground,or exceeds 14,000 El Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
IO IT.E,INFORMATION AND LOCATION. ,I 7% 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: 1 Job site address: 1 00 fl* IOOHP or more. 0"A","E","1-2","1-3",
p ❑Six or more residential units. occupancy.
City/State/ZIP: rn 6 ,0 10 R 1'22�{ 0 Recreational vehicle parks.
❑Health-care facilities.
Suite/bldg./apt.#: I Project name: Rocker 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
Description Qty. I Each I Total
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
RI OF;WORK a Limited energy,residential
11! > iNgY, 75.00 2
(wNSTA14.- ►.-t. "Al WM-L S !Ni Limitedh above smq.multi-family
ft.)
I f �+ ��i energy,ml
75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
PROPERTY OWN r t TENAh T.-s Services or feeders installation,alteration,and/or relocation
Name: UNITED P Per Fl(•- 200 amps or less 100.70 2
Address: 'sg00 t ttpiR ficro NES MR41 RD 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 'r 4 PAD I 0 P. it/Z 21 601 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,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
d CONTACT PERSON Branch circuits-anew,alteration,or extension,per panel
APPT: A1+1I b. A.Fee for branch circuits with
e, /� TR /y above service or feeder fee,
Business name: G IG S 4/IN (NG 7.42 2
each branch circuit
Contact name: weep,? B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: i S 5'0 DarnoW /2111-elt „DR. branch circuit
City/State/ZIP: woo,t.A 1.b vvrtt. e1'641 y Each add'1 branch circuit 7.42 2
f Miscellaneous(service or feeder not included)
Phone:(3(p0) 7.2i - (p$24 I Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: W01/1 p Advanced flecfir-i ,-S,f; ••,/) CAW Reconnect only 67.84 2
E.��• ,: *�. ''CflNTi �'OR„,� ik� 1',„i � '' Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting ( 67.84 ( 2
Signal circuit(s)or limited-energy Address: 547‘,16r0'CSe L-1 T ❑ See Page 2 2
panel,alteration,or extension.Ci /State/ZIP: Each additional inspection over allowable in any of the above
City/State/ZIP: inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 105N 0SS $I Electrical Lic.:77-1(yi CL .Lie.: —7(0351L1 s ifically listed('Vshrmin
Suprv.Electrician signature,required: t't'l ( ° Subtotal:
Print name: DAnte, skims Date: -7 i
,212.3 ❑Plan Review Required(25%of permit fee):
� � [ State surcharge(12%of permit fee):
Authorized signature: (U" TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: fr/pa.R LA
Date: 7 J12)23 days after it has been accepted as complete.
* Number of inspections allowed per permit
I:\Building\Penults\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB