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Permit CITY OF TIGARD ELECTRICAL PERMIT • COMMUNITY DEVELOPMENT Permit #: ELC2011 -00039 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/18/2011 Parcel: 1S1260000300 Jurisdiction: TIGARD Site address: 9524 SW WASHINGTON SQUARE RD 1i08 Project: H & M Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project Description: Sign lighting for (1) interior wall sign and (1) exterior wall sign. Contractor: TUBE ART SIGNS & SPORTS DISPLAYS Owner: PPR WASHINGTON SQUARE LLC 4243 -A SE INTERNATIONAL WAY 2235 FARADAY AVE STE #O MILWAUKIE, OR 97222 CARLSBAD, CA 92008 PHONE: 503 - 653 -1133 PHONE: FAX: 503 - 659 -9191 FEES Quantity Description Date Amount 2 ea Sign or Outline Lighting 01/18/2011 $135.68 Specifics: 1 ea 12% State Surcharge - 01/18/2011 $16.28 Electrical 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 otification Center. . , 'se rules are set forth in OAR 952 - 001 -0010 through 0 95 0 - 09 . You may obtain a copy of the rules or direct questions to OUNC by cal t 503.232.1987 • 2.2344. Issued By: _ Permittee Signature: /. / . 1 /� OWNER INSTALLATION ONLY 11 MOP 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. _� 5 N Zo - Vo>:rt© Electrical Permit Application . .- - -- - :t t l j � � 1 .. ,. r�FOR FUSE onv a§ i q City of Tigard II ✓ 011 D d ® PermitNo.: .. I ., l 0, e' '� 13125 SW Hall Blvd., Tigard, OR 97223 J: • : I -- Plan Review e Phone: 503.718.2439 Fax: 503.598.1960 • Date /By: Other Permit' S' • „, I I — LW lb ,TTGAIi .. Inspection Line: 503.639.4175 Ch': 3ARt- ' Date Ready/By: RI See Puge 2 for ,.. ' Internet: www.tigard - or.gov -.il\tCr ;;ltliat r Supplemental Information '" _ .TY.PE °OT WORK- . ` _ ' 'i e," 4 .•,, ,.PLAN 13EVIEW . ,_ , ' Please check all that apply (submit 2 sets of plans w /items checked below) ® New construction ❑ Addlt1011/alterat1011/repl e 1 �'st 0 Service or feeder 400 amps or more ❑ Building over three stones. ❑ De111011t1011 ❑ Other: SIGN 1 . where the available fault current ❑ Marinas and boatyards o . CAT.EG CONSTRUC . T ' i Zit. ' - exceeds 10,000 amps at 150 volts or ❑ Floating buildings (� m � 4 less to ground, or exceeds 14,000 ❑Commercial -use agricultural El l- and 2- family dwelling ® CO1n]]lercial /industrial ❑ ssory bit l amps for all other installations buildings. 0� ❑ Multi- family ❑ Master builder ❑ 1 O� 9 �"' K O� ❑ Fire pump. ❑ Installation of 75 KVA or �` �����. , . ❑ Emergency system. larger separately derived system. ,a' '` ' ` ° -JOB SITE INFORMATION AND ' C G V c , . . _ a ., 0 Addition of new motor load of ❑ "A ", "E" "1 2" "1 -3" �j I00HP o r more. occupancy. Job no.: 528347 Job site address: 9524 SW Washington Square Rd. ❑ Recreational vehicle parks. ❑ Six or more residential units. City /Stale /ZIP: Tigard, OR 97223 ❑ Health -care facilities ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal • Suite/bldg. /apt. no.: Project name: H & M ❑ Service or feeder 600 amps or more " - FEE ;SCH.EDULE� -. _ ' 1' ' :- Cross street/directions to job site: Tenant in the Washington Square Mall D escription l Qty, Fee, 1 Total I R New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'l 500 sq. B. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential " '` DES N CRIPTIO OF WORK _ , : ` " , (with above sq. ft.) 75.00 2 Limited energy, multi- family Connect (1) exterior wall sign & (1) interior wall sign reading "H & M" residential (with above sq. B.) 75.00 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 ' ❑ PROPER'l'1 OWNER. °❑, TENANT -, . ' ° 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City /State/ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Brunch circuits — new, alteration, or extension, per panel Owner signature: Date: A, Fee for branch circuits with - above service or feeder fee, m El APPLICANT' • - ❑ CONTACT'PER ° y :' - :- 7.42 2 - - - each branch circuit Business name: Tube Art Group B. Fee for branch circuits without service or feeder fee, first Contact name: Dan Osterman branch circuit 56.18 2 Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular 67 84 2 City /State/ZIP: dwelling, service and /or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: dosterman(&tubeart.com _ Sign or outline lighting 2S 67.84 2 - - - CONTRACTOR , - - „ : 13 5- Signal circuit(s) or limited - energy Business name: Tube Art Group panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: 4243 - SE International Way Additional inspection (1 hr min) 66.25/hr City /State /ZIP: Milwaukie, OR 97222 Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: (503) 653 - 1133 Fax: (503) 659 - 9191 Inspections for which no fee is 90.00/ hr specifically listed (' /z hr min) CCB Lic.: 70956 Electrical Lic.: 37554cls Suprv. Lic.: 366sig : 'ELECTRICAL PERMIT „ FEES - : ' • ' - . 4 1' Subtotal: j3 Suprv. Electrician signature, required: � ��� Plan review (25% of erncit fee): _ P Print name: Ken Sch . a c : 1 /11 /11 State surcharge (12% of permit fee): f , TOTAL PERMIT FEE: f 5 � , et Authorized signature: - i [ — L�:, lk //� Thi perm app expires if a permit is not o bt a i ne d w 180 — �� days after it has been accepted as complete. Print Rame: Dan Oste n'iif 1 Date: 1/11/11 Number of inspecnons allowed per permit Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIALW.ORK;ONLY:. Fee for all residential systems combined $75.00 Check Type of Work Involved: Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems Ti Boiler Controls Ti Clock Systems Ti Data Telecommunication Installation Ti Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irription Control* Ti Medical Ti Nurse Calls Ti Outdoor Landscape Lighting* Ti Protective Signaling I I Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations