Permit CITY OF TIGARD ELECTRICAL PERMIT
' °! COMMUNITY DEVELOPMENT Permit #: ELC2011 -00540
T EGARJJ 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 09/30/2011
Parcel: 1 S 126CA00100
Jurisdiction: Tigard
Site address: 9225 SW HALL BLVD H
Project: Tan Republic Subdivision: Lot:
Project Description: Sign lighting.
Contractor: CARLSON SIGN CO Owner: GREENBURG CORNERS LLC
1605 NE FORBES RD BY MENASHE, R BARRY
BEND, OR 97701 621 SW ALDER, SUITE 605
PORTLAND, OR 97205
PHONE 541 - 382 -2182 PHONE:
FAX 541 - 382 -2196
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 09/30/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 09/30/2011 $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 OA' • - 001 -0090. You *ay obtain a copy of the rules ' •irec -questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: l � _� ✓' 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' 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.
(PV,, / —/ tAi
Electrical Permit A�plicatio> FOR OFFICE USE ONLY
City of Tigard Received
y g an Date /B : e' j1 ` Pernut No : / _
'' 13125 SW Hall Blvd , Tigard, OR 97223 S E P 2011 Plan Review w
'- 9 Phone. 503.718.2439 Fax: 503.598.1960 Other Permit
Date /By
I [GARD:
Inspection Line: 503.639.4175 or: Date Ready /B Surfs El See Page 2 for
Internet: www. tigard -orgov CITY • � TIGARD f�, Nonfied/Method P Supplemental Information
PLA Yi'd ` -7 t`dCINEE SIN .
TY F WORD PLAN REVIEW
❑ New construction Addition/alteration /replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ommercial /industrial ❑ Accessory building
rY � amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "I -
Job no.: Job site address: e 5 // 6,,,,,, too HP or more. occupancy.
❑
0 Six or more residential units Recreational vehicle parks
City /State /ZIP: / 0 Health-care facilities.
0 Supply voltage for more than
�� C" ❑ Hazardous locations 600 volts nominal.
Suite/bld /a t. no.: Pro ject name: r—
g P Project fGGI/ 4,_pL✓bljC; ❑ Service or feeder 600 amps or more. p
FEE SCHEDULE
Cross street/directions to job site: Description Q�i Fee. 1 Total I '
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75 00 2
Limited energy, multi -family 75.00 2
residential (with above sq. ft )
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ? ❑ TENANT 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 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
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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits u•it/i
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: Carlson Sign Company B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Chris Cox branch circuit
Each add'l branch circuit 7.42 2
Address: 1605 NE Forbes Rd Miscellaneous (service or feeder not included) ,
Each manufactured or modular
City/State /ZiP: Bend Or 97701 dwelling, service and/or feeder 67.84 2
Phone: ( 541) 382.2 Fax: : ( 541) 382.2196 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: chris@carlsonsign.com Sign or outline lighting 1 67 84 g67 84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Carlson Sign Company panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address: • 1 605 NE Forbes Rd Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: Bend Or 97701 Investigation (I hr min) 66.25/ hr
industrial plant (l hr min) 78.18/ hr
Phone: ( 54 D 382.2 Fax: ( 54 1) 382.2196 Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.: 64549 Electrical Lic.: 9 -255 CLS Suprv. Lie.: 762SSIG ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Brig Eddington lOI l /1'1 Subtotal: $67 84
Plan review (25% of permit fee):
Print name: Brig Eddington Date: 9.23. I I State surcharge (12% of permit fee): 8.14
TOTAL PERMIT FEE: $75.98
Authorized signature: Chris Cox
This permit application expires If a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Chris Cox Date: 9.23.1 • Number of inspections allowed per permit.
I \ Building \Permits \ELC- PermitApp doc 07 /01/10 440- 4615T(11 /05 /COMAVEB