Permit (10) CITY OF TIGARD ELECTRICAL PERMIT
1111- - COMMUNITY DEVELOPMENT Permit#: ELC2013 00534
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/10/2013
Parcel: 1 S 135DD00800
Jurisdiction: Tigard
Site address: 11847 SW PACIFIC HWY
Project: Salvation Army Subdivision:kRBER TRACTS NO.16 TO NO.40 INCL Lot: PTS 19
Project Description: (4)sign lightings
Contractor: D& B SPECIALTIES LLC Owner: SANOKEE
4475 SE POWELL VALLEY RD 375 NW GILMAN BLVD, STE C-203
GRESHAM, OR 97080 ISSAQUAH,WA 98027
PHONE: 503-320-3888 PHONE:
FAX: 503-912-1363
FEES
Quantity Description Date Amount
4 ea Sign or Outline Lighting 09/10/2013 $271.36
Specifics:
1 ea 12%State Surcharge- 09/10/2013 $32.56
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $303.92
Required Items and Reports(Conditions)
This permit is issued sub ect 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 ac • •ance with ...roved plans. This permit will expire if work is not started withi a ssuance, or if work is suspended for more the 180
days. ATTE' ION: Oregon law -quires you to follow the rules adopted by the Oregon Utility No' == e ter. Those rules are set forth in OAR
952-001-00 0 thro gh OAR 952-00 •''0. ou • =y obtain a copy of the rules or direct questions to OUNC by ca' • 503.232. =87 or 1.800.33 . 344.
Issued c y: 1 J/ _.! I Permittee Sig = • 4!!„ !41 C (cam
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' Dat
„ , o: fl
X61/r ! /d�3
LICENSE NO. 7pVp s/a
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 n
i City of Tigard Date/B 9/o/6 M'il �0 3-66 �i
7,1 I •
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B Other Permit:
mr s RI Page 2 for
r, Inspection Line: 503.639.4175 Date ied/Metho
- ,Y•
C'A I:U Internet: wwwrigard-or.gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply t submit 2 sets of plans whtetns checked below): `
❑New const ructionddition/alteratioNrcplaccment ❑Service or feeder 400 amps or more ❑Building over three stones. v
❑ Demolition Other: • where the available fault current 0 Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings,
C>
less to ground,or exceeds 14.000 ❑Commercial-use agricultural
❑ I-and 2-family dwelling '5'Commercial/industrial ❑Accessory building amps for all other installations. buildings, *,
❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or (
❑Multi-family ❑Emergency system. larger separately derived system
JOB SITE INFORMATION AND LOCATION t
❑Addition of new motor load of ❑"A" "F" "I �" "I i-'
�• / / IOOHP or more occupancy.
Job no.: Job site address: 113-y7 3 Pa C ;r C I7'Gfl ❑: ❑Recreational vehicle parks
t J 11v dr more residential umu,
^ ❑Health-care facilities ❑Supply voltage for more than "-
City/State/ZIP: - i'G ared c[_ `I 7,a aZ 3 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: J ! Project name: 6 p/J,j,'Ii�4, 4,2,„,,,,, ❑Service or feeder 600 amps or more ��
FEE SCHEDULE
Cross street/directions to job site: ttI A.2 Pi-Fn PI� Description 0
New residential single-or multi-family dwelling unit. `'41
4 lit 'P�It 04 • Includes attached garage.
Subdivision:
` I.ot no.: 1.000 sq.ft.or less _ 168 54 4
Ea.add'I 500 sq fi.or portion 33.92 I Q
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq-ft.)
Limited energy.multi-family 75.00 2 IC
Y/� I gd to`/ 1 1 A 1 Q /z 6-/7 ;f/6 residential(with above sq.11.) '�
J L ry V �r Renewable Energy ❑ See Page 2
C,/ V4-e.1 9/I� /6 O a Services or feeders installation,alteration,and/or relocation
` 200 amps or less 100,70 2
- ❑ PROPERTY OWNER ❑ TENANT 2 — —
2(11 amps to 400 amps 133 56 2
Name: 401 amps to 600 amps 200,34 2
Address: 601 amps to 1.000 amps 301.114 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( ). 200 amps or less 59.36 I
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange.according to ORS 447,449.670.and 701.
401 amps to 599 amps 168 Sa 2
Owner signature: Date: Branch circuits-new,alteration,or extension.per panel
❑ APPLICANT I ❑ CONTACT PERSON A Fee for branch circuits with
above service or feeder fee,
7.42 K 2
n A. each branch circuit
Business name: ��e�/ `,t�l A.,0....-- B.Fee for branch circuits without
Contact name: service or feeder fee.first 56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Phone:( ) Fax: ( ) Reconnect only 67.84 2
E-mail: Pump or irrig tion circle 67.84 2
. CONTRACTOR Sign or outline lighting 1.t . 67.84 a47/.3 2
Business name: D4r5 '5f )"f 7,e / (" Signal circwt(s)or limited-energy See
��i /� ,/J panel,alteration,or extension. Page 2 2
Address: Lit/7�" S PO t� e 6 " 1/ /Ale c/ /C d Each additional inspection over allowable in any of the above
n 7�O ✓ Additional inspection(I hr min) 66 25/hr
City/State/ZIP: r'• c° s G y / l Investigation(I hr min) 66 251 hr
/ '� Industrial plant(I hr mm) 78.18/hr •
Phone:(57),.?) 3�0 -_3 8 Fax: 3 ) c( I v? is t0 Inspections for which no fee is 80,00:hr
CCB Lic.: 9yQ "O l/ Electrical Lic.:CL 5 ,2� Suprv.Lie.:7� S specilicallvlisted(Vahrmin)
ELECTRICAL PERMIT FEES /V Suprv. Electrician signature.required: /i� Yj Subtotal: A7/•34
Print name: U t< )q S �C Date:$Iaa i)3 Plan review(25%of permit fee):
Yre �!X/I�i��1] ` State surcharge(12%of permit fee): 3).•CO
Authorized signature: / TOTAL PERMIT FEE: 203.9',
r This permit application expires if a permit is not obtained within 180
Print name: Sri o �� eel Date: g/a a )),3 days after it has been accepted as complete.
�/i I! • Number of inspections allowed per permit.
I.iBuilding\Permiu\ELt:PermitApp ELR ERE.doc Rev 05/21/1013 440-6151(11,05ICOM.M'ED