Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
Permit #: ELC201 1 -001 54
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/31/2011
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15532 SW PACIFIC HWY C -2
Project: Supercuts Subdivision: Lot: 0
Project Description: Replacing exterior wall sign over entrance.
Contractor: TUBE ART SIGNS & SPORTS DISPLAYS Owner: GMS FIVE LLC
4243 -A SE INTERNATIONAL WAY 5973 AVENIDA ENCINAS STE 300
MILWAUKIE, OR 97222 CARLSBAD, CA 92008
PHONE: 503 - 653 -1133 PHONE:
FAX: 503 - 659 -9191
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 03/31/2011 $67.84
Specifics: 1 ea 12% State Surcharge - 03/31/2011 $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: 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 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: -- .� �'L� Permittee Signature: c -;j
• 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' 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.
SCoi1.3 9 I l 00 LE3
-. �
Electrical Permit Application Application No. Permit No. EL Lii_ 0 { ) 151-/
City of Troutdale y� ��1 Date Rece �i Date Issued
\ , - . ,./ 104 SE Kibling Avenue Troutdale Or 97060 Received By Issued By
cam- - -�
Permit Specialist 503 674 -7229 Receipt No. Receipt No.
Inspection requests may be made by: Phone: 503 674 -7204 Fax: 503 667 -0524 E -mail: inspection @ci.troutdale.or.us
TYPE OF WORK PLAN REVIEW
II New construction 1>+�Addition /alterat n/replacement) Please check all that apply: LI Service /feeder over 601 amps
I j Other: ❑ Service /feeder 400 amps or more I I Building over three stories
CATEGORY OF CONSTRUCTION ❑ Fire pump I 1 Marinas and boatyards
11- and 2- family dwelling I 1 Commercial /industrial Accessory building ❑ Emergency system 1 Floating buildings
f I Multi- family I Master builder = Other: ❑ Addition of new motor load of 100 HP ❑ Commercial -use agricultural
JOB SITE INFORMATION AND LOCATION or more buildings
Job no. // ( a 3 z ; Job site address: `rCj I 2_.. - f * 0 - L 7 4 7, / I 1 Six or more residential units ❑ Installation of 75 KVA or larger
City /State /Zip: -1 / n) L j g7z7i ❑ Health -care facilities separately derived system
Suite/bldg. /apt. no.: Project name: / / ❑ Hazardous locations CI "A," "E," "I -2," "I -3"
t &_,,, occupancy
Cross street/directions to job site: �. rili «f� g I i f i r ❑ Recreational vehicle parks
Subdivision: ` f v_ _ • Lot no.: • FEE SCHEDULE*
Tax map /parcel no.: Description I Qty Fee Total I *
DESCRIPTION OF WORK Residential single or multi- family dwelling unit. Includes attached garage
/� _ 4' Al 1,000 sq. ft. or less 175.00 4
, i.A. , ma , zrffiv.Awa it Ea. add'l 500 sq.ft. or portion 35.00
Limited energy, residential 50.00 2
5 / (with above sq.ft.)
Limited energy, multi - family 2
residential (with above sq.ft.)
❑ PROPERTY OWNER I ❑ TENANT Service or feeder installation, alteration or relocation
Name: 200 amps or less 95.00 2
Address: 201 to 400 amps 120.00 _ 2
City/State /Zip: 401 to 600 amps 180.00 2
Phone: I Fax: 601 to 1000 amps 240.00 2
Owner Installation: This installation is being made on property that I own, which is Over 1000 amps /volts 480.00 2
not intended for sale, lease, rent or exchange. Owner signature: Date: Temporary service or feeder installation, alteration and /or relocation
ItiCPPLICANT I ❑ CONTACT PERSON 200 amps or less 95.00 2
Business name: —(e /Pep --- 201 to 400 amps 120.00 2
Contact name: A ( ` j am x - 4 .1 4A 401 to 599 amps 180.00 2
Address: Branch circuits - new, alteration, or extension, per panel
City/State /Zip: A. Fee for branch circuits with above service 10.00 2
Phone: x: or feeder fee, each branch circuit
E -mail: dQ3 �[�L ( � D[a n i — B. Fee for branch circuits without service or 75.00 2
C ONT TO feeder fee, each branch circuit
Business name: ! n Each add'l branch circuit 10.00
Address: ay / - -) E /�� , j �jl,U 1 J Miscellaneous (service or feeder not included)
City/State /Zip: /0. P a_ ' Each manufactured or modular dwelling,
''�� 80.00 2
Phone: Q - - Fax: D3 - /,IWAr II service, and /or/ feeder
CCB license no: City o • etro licens- no.: y Reconnect only / �.,no.00 1
State license no.: WIEMBETa 4'L! _ �i IN i7 Pump or irrigation circle Mer5.00 ,, __ .
Al Supervising electrician , Supervising electrician's OM Sign or outline lighting ( X90.00 - 2
Signature, req i' ed: i A % License no.: S��p v') �j Signal circuit(s) or limited - energy panel, r /_7,rm
Authorized / alteration, or extension. 75.00 2
Signature: 4t - ' r0 Each additional inspection over allowable in any of the above
Print name: Aiiii /L in __, Date: TAW Per inspection 85.00 1
Department Approval Investigation fee 2 x's permit fee
Initial & Date: Electrical Permit Fees
This permit application expires if a permit is not obtained within Electrical Permit Fee $ (, 7 . 7
180 -days after it has been accepted as complete. Permits are non- 12% State Surcharge Fee $ . 1I
transferable and expire 180 -days from issuance or last inspection. 25% Plan Review Fee $
Deposit $ 75 - c l
* Number of inspections allowed per permit Total Due $