Permit CITY OF TIGARD ELECTRICAL PERMIT
• JIC COMMUNITY DEVELOPMENT 1/3147A1111 Permit #: ELC2012 -00149
T I G A R J) 13125 SW Half Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/16/2012
Parcel: 1S136DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH ST 180
Project: Tigard Triangle Smiles Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Sign lighting for (3) signs. 4/19/12, reprinted to add suite number, 180.
•
Contractor: MEYER SIGN CO OF OREGON Owner: AMERICAN INDUSTRIES INC
15205 SW 74TH AVE 1750 NW FRONT AVE STE #106
TIGARD, OR 97224 PORTLAND, OR 97209
PHONE: 503 - 620 -8200 PHONE:
FAX: 503 - 620 -7074
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 03/16/2012 $203.52
Specifics:
1 ea 12% State Surcharge - 03/18/2012 $24.42
Electrical
Type of Use: COM
Class of Work: ALT •
Type of Const:
Occupancy Grp:
Total $227.94
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 throug 952- 001 -0090. You may gptain a cop of the rules or direct questions to OUNC by calling 51987 or 1.800.032.2344.
Issued e 1 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.
•
CITY OF TIGARD ELECTRICAL PERMIT
Per
COMMUNITY DEVELOPMENT
Permit #: ELC2012 -00149
T I G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/16/2012
Parcel: 1 S136DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH ST
Project: Tigard Triangle Smiles Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Sign lighting for (3) signs.
Contractor: MEYER SIGN CO OF OREGON Owner: AMERICAN INDUSTRIES INC
15205 SW 74TH AVE 1750 NW FRONT AVE STE #106
TIGARD, OR 97224 PORTLAND, OR 97209
PHONE: 503 - 620 -8200 PHONE:
FAX: 503 - 620 -7074
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 03/16/2012 $203.52
Specifics: 1 ea 12% State Surcharge - 03/16/2012 $24.42
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $227.94
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 Cente. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or •'I- . • uestions to OUNC by calling 503.232.y987 or 1.800 32. 44.
/ C Issued B . • _ _ Permittee Signature:
WNER 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.
64Nzom.0003I, 00032 , c b33,,
Electrical Permit Application FOR OFFICE USE ONLY
III City of Tigard �� Date/B : , �yr, Permit No.: L� , rVU ct -
Received
C ° 13125 SW Hall Blvd., Tigard, OR •- ' ; Plan Review
` . Phone: 503.7 Fax: 5 t'.¢;' " 1 ` r* . Date/ : Other Permit:
T I G A R D Inspection Line: 503.639.4175 . N Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov �(�(� ■
_ p � o DaRead Notified/Method: Supplemental Information
1^ x ,.
TYPE OF WORK t ON 0 `�`S` PLAN REVIEW
❑ New construction ❑ Addition /alterati ant Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
Demolition ❑ Other: SII\ where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling }Commercial /industrial ❑ Accessory building 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 "1- 2 ", "1 -3
Job no.: Job site address: 6 IOOHP or more. occupancy.
�� V ��(� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ,y( ct ( ( (� '- �1
L `i f/' ❑Health care facilities. ❑ Supply voltage for more than
m
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 'flit cu C (� ‹ C �,“ t r [' ❑ Service or feeder 600 amps or more.
"l ' J FEE SCHEDULE
Cross street/directions to job site: '421 „pit ' \ v ` / _ -, ascription T Qtr. I Fee. I Total I •
l '� 4 -/ ( c/l`rIII ew 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. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
.'.V t „ r Wt
' / J '( C L C G (Y� residential (with above sq. ft.) 75.00 2
✓1 Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
kl"TROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
ok a .41 L 5 nit_ L 601 amps to 1,000 amps 301.04 2
Address: 1-T _ i-' �� (.) Over 1,000 amps or volts 552.26 2
City/State /ZIP: r / 6— v 7Z- Temporary services or feeders installation, alteration, and /o
,v`� 1 c..i6 l 1 ` relocation
Phone: ( )/ Fax: ( kj 200 amps or less 59.36 I
vtr 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, re t, or change, according to ORS 447, 449, 670, and 701.
Branch circuits- new, alteration, or extension, per panel
Owner signature: r Date: A. Fee for branch circuits with
PPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: ,,, r , c 1 � A . B. Fee for branch circuits without
it,( service or feeder fee, first
Contact name: _ i 2 O S se J —4 L{ ff - A - At j branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: T( GLA2 c,
�Z 1 1 7 - Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State /ZIP: CAL , , "y
J( dwelling, service and/or feeder 67.84 2
t.�
Phone Z(5 . ' ' � ) Fax_: Cc /' �j� . 7L/ Reconnect only 67.84 2
E -mail: SO COS i ' p ,, r 5 ( t � CO , C ��t � 7 Pump or irrigation t in g e 67.84 2
n E/`^ ( L Sign or outline lighting ' 67.84 , 2
CO Signal circuit(s) or limited- energy
Business name: panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: ( Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: _ .-2 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
/ specifically lis (V2 hr min) 90.00 / hr
CCB Lic.: 6C.{ 0 1 LA Electrical Lic.: p- ( 0 Ouprv. Lic.: s-ggs b ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: j 0 it/i/ Subtotal: 9-a3 , .)..
Plan review (25% of permit fee):
Print name: CO (• _ CZ Date: 3( 2 I (rZ State surcharge (12 % of permit fee): o pi, ia
g I TOTAL PERMIT FEE: 980
Authorized signature: q This permit application expires if a permit is not o rained within 180
Print name:
days after it has been accepted as complete.
L . 1 d- Date 2 _ • Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440-4615T(I1/05 /COM/WEB