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Permit CITY OF TIGARD ELECTRICAL PERMIT q COMMUNITY DEVELOPMENT Permit #: ELC2010 -00094 T 1 G AR D. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/26/2010 Parcel: 1S134BC00300 Jurisdiction: Tigard Site address: 12210 SW SCHOLLS FERRY RD Subdivision: Lot: 0 Project: Coffee Rush Project Description: Install sign /outline lighting for (2) signs. Owner: FEES FW OR- GREENWAY TOWN CENTER LLC Quantity Description Date Amount PO BOX 790830 SAN ANTONIO, TX 78279 1 ea Sign or Outline Lighting 02/26/2010 $67.84 PHONE: 1 ea 12% State Surcharge - 02/26/2010 $8.14 Electrical 1 ea Sign or Outline Lighting 02/26/2010 $67.84 Contractor: 0 ea 12% State Surcharge - 02/26/2010 $8.14 Electrical SECURITY SIGNS INC 2424 SE HOLGATE BLVD PORTLAND, OR 97202 PHONE: 503- 546 -7114 FAX: 503 - 230 -1861 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $151.96 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 OAR 9952- 000 - 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: � CJt.LJ y� c � /� 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' L Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. N2oty - co C) a l 1 .D a- Electrical Permit Application - FOR " 01 OFFICE USE ONLY Y City of Tigard E� �6 Vt ' ` . 1 ` 1,1 r , 131'_5 SR' Hall Blvd.. Tigard. OR 9723 Plan Review ether Perms. 9 Phone: 503.639.4171 Fax: 503.598.1960 ! ate/Bv: I:16 A It 13 Inspection Line: 503.639.4175 FEB 2 6 2 010 Date Ready /By: 10 See Page 2 for .. _ . _. Internet: www.tigard or.gov Notified /Method: Supplemental Information TYPE OF WOI(SITY OF TIGARD PLAN REVIEW . - 0 New construction © Addition /al TflikNtINt4N) ¢QGiINEERING Please check all that apply (submit 2 sets of plans v. /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. - CATEGORY- OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating huildings. less to ground. or exceeds 14.010) ❑ Commercial-use agricultural El I- and 2- family dwelling le Commercial /industrial ❑ Accessory huildine amps rm an other installations. buildings. ❑ Multi- fancily ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or _ ' • JOB SITE INFORMATION AND LOCATION . - ❑ Addition of ne w system. larger separate( derived system. ❑ Addition of new motor load of ❑ "A" "I." "I '" "I t" 1(8)0! or more. occupancy. Joh no.: Joh site address: 12210 SW Scholl's Ferry Rd ❑ Six or more residential units. ❑ Recreational vehicle parks. City / State/ZIP: Tigard, OR 97223 ❑ Health -care Facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: Coffee Rush ❑ Service or feeder 600 amps or more. • - FEE SCHEDULE Cross street/directions to job sire: (:reenway Town Center Description 1 Q I Fee. j Total I ' New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1.(8)0 sq. ft. or less 168.54 4 Ea. add') 500 sq. fl. or ponies) 33.92 1 Tax snap /parcel no.: Limited energy. residential 2 DESCRIPTION OF WORK (with above sq. ft.) 67.84 Limited energy. multi - family 67.84 2 residential (with above sq. ft.) Services or feeders installation, alteration. and/or relocation _ *Mount Only* 200 amps or less 100.70 2 ❑ PROPERTY OWNER I . ® TENANT - 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: Ron Yost 601 amps to 1.000 amps 301.04 2 Address: 2315 Falcon Dr. Oyer 1.0(0 amps or volts 552.26 2 City/State/ZIP: ' /State /ZIP: West Linn, OR 97068 Temporary services or feeders installation, alteration, and/or 5 relocation Phone: (503)970 -4964 Fax: ( ) 200 amps or less 59.36 I 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 2 401 amps to 599 amps 168.54 intended for sale. lease. rent, or exchange. according to ORS 447. 449, 670, and 701. Branch circuits — new, alteration. or extension. per panel Owner signature: Date: A. Fee for branch circuits with I' APPLICANT. - . I • - gt- CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit Business name: Security Signs B. Fee for branch circuits )cirhour service or feeder fee. first 56.18 ' Contact name: Melissa Hayden branch circuit - Each add'! branch circuit 7.42 2 Address: 2424 SE Holgate Blvd Miscellaneous (service or feeder not included) Each City/State/ZIP: Portland, OR 97202 dwel mawfrvic a d/ r f e ed er 67.84 ' dwelling. service and/or fender Phone: (503) 546.7114 Fax: : (503) 230.1861 Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Melissa@SecuritySigns.com Sign or outline lighting 67.84 2 CONTRACTOR - Signal circuit(s) or limited- energy Blltilttes name: Security Signs panel. alteration. or extension. _ Pape 2 2 Each additional inspection over allowable in any of the above Address: 2424 SE Holgate Blvd Additional inspection ( hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City / State/ZIP: Portland, OR 97202 Industrial plant (1 hr min) 78.18/ hr Phone: (503) 546.7114 Fax: (503) 230.1861 Inspections for which no fee is 90 hr specifically listed ('V hr min) CCH Lic.: 122809 Electrical Lic.: 26560CLS Suprv. Lic.: 383SIG ELECTRICAL PERMIT FEES • Su btotal: Suprv. Electrician signature. required: Plan review (25% of permit fee): Print name: Marc Linguist Dale• State surcharge ( 12% of permit fee): T OTAL PERMIT FEE: - �'` k5 -g(..17 Authorized signature: �, • "'O• f/ a This permit application expires if u permit is not obtained within 180 days after it has been accepted as complete. Print name: Melissa Hayden Date: L / / • Number of inspections allowed per permit. a 0 lln \l U' uilding'ennits \IO- I'crniitApp.d'c 1(1/01/5') 445- 4515T(111 / / nt /C7 )\Uwlill v 9-31 .ct%