Permit CITY OF TIGARD ELECTRICAL PERMIT
1114
D COMMUNITY DEVELOPMENT Permit #: ELC2012 -00219
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/17/2012
Parcel: 1S 135 BA00102
Jurisdiction: Tigard
Site address: 10140 SW WASHINGTON SQUARE RD B -1
Project: Color Me Mine Subdivision: MYERS ESTATES Lot: 5
Project Description: (1) sign lighting..
Contractor: MEYER SIGN CO OF OREGON Owner: PPR SQUARE TOO LLC
15205 SW 74TH AVE BY THOMSON PROPERTY TAX SERVICES
TIGARD, OR 97224 ATTN HILARY RAYMOND
2235 FARADAY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 620 -8200 PHONE:
FAX: 503 - 620 -7074
FEES
Quantity Description Date Amount
Specifics: 1 ea Sign or Outline Lighting . 04/17/2012 $67.84 •
• 1 ea 12% State Surcharge - 04/17/2012 $8.14
Electrical
Type of Use:. , COM -
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Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
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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 ac nrrinnce 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. A TION: Ore! law requires you to follow the rules adopted by the Oregon Utility 'Notification Center. Those rules are set forth in OAR
952 -00 0010 through OAR 9' . : • -0 . = 1. You may obtain a copy of the rules or direct questions to OUNC by calling 503 .1987 or 1.800.332.2344.
Iss ed By: ■ , / i�� Permittee Signature:
k
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.
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Electrical Permit Application FOR OF• F• ICI: US J: ONLY
City of Tigard Received y /� a Permit No.: ariftYl a5: 9
II t o 13125 SW Hall Blvd.. Tigard, OR 97223 Plan Review
: C Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
I" I G A R U Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for V
Internet: www.tigard - or.gov Notified/Method: Supplemental Information L'
TYPE OF WORK PLAN REVIEW G
Please check all that apply (submit 2 sets of plans w /items checked below):
.l New construction El Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories. W
❑ Demolition ❑ Other: 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 1 1:10
❑ 1- and 2- family dwelling 1 Commercial /industrial ❑ Accessory building amps for all other installations. buildings. O
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or CI
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. C
(,/�� " 1 LO t _ ❑ Addition of new motor load of ❑ "A ". "E ", "1 -2 ". "I -3 ", c
Job no.:
Jo adxrPes: Ws4Sl4 COtt41 3 Aft T du1LO11� s 1 more. occupancy.
1 V ❑ Six or or mo more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: 11 44 O g (It 7-22.3 Su-ire to ❑ Health-care facilities. ❑ Supply 0volts is norm for more than
11 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Co 1.. .D14. ME M t, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 6a 5.1 g L 4, WASH IN/ rDi4 SQ Description I Pm I Fee. I Total I •
Q,,p 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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
11 Figs H- M otA.tt„1 r FACE L► r L v residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
e...14 OE L.6-rj62. -S 200 amps or less 100.70 2
❑ PROPERTY OWNER I g TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200. 2
Col. p2 M� t t�E 601 amps to 1,000 amps 301.04 2
Address: Was1+►t.1 rz;g sn,„„41.42_E 131U.1* -.t kla B &Lyre 10 Over 1.000 amps or volts 552.26 2
Cit /State/ZIP: C C)R 9 1-223 Temporary services or feeders installation, alteration, and/or
Y .1GAR relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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 with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: lilelelZ 516.,.1 CO . CF OR B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: 2 M µla_, 2 A Li_ branch circuit
Each add'I branch circuit 7.42 2
Address: I S 2s S In) 1 1t 4tJG— Miscellaneous (service or feeder not included)
- � Z Z Each manufactured or modular 67.84 2
City / State/ZIP:
I 1 4 Alto Oa_ 9 dwelling. service and/or feeder
Phone: (5b3 620- $ Fax:: (g03) (off O — 3 Reconnect only 67.84 2
; MG Pump or irrigation circle 67.84 2
E - mail: Rol
a, . Sign or outline lighting 1 67.84 61 -.g►i 2
CONTRACTOR 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: C A -f n c Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP:
J ' �/` Investigation (l hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed ('/ hr min) 90.00/ hr
CCB Lic.: 04014 Electrical Lie.: 20 _190 as Suprv. Lic.: 524 S1 ELECTRICAL PERMIT FEES (o
C
Subtotal: .. ST
Suprv. Electrician signature, required: / A q f
Plan review (25% of permit fee):
Print name: ( ti fj�S 0 Date: � / (( o ) (Z Sta te sur charge (12% of permit fee): 8', 4
0 n TOTAL PERMIT FEE: 1S• 9 B'
Authorized signature: _ i �^ 4 tl This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Roo M 1 ZA L L Date: 4A (0 1, 2 _ • Number of inspections allowed per permit.
t: \Building \I'crmitsUil.C- PermitApp.doc 07/01 /10 4411 4615T(1I /05 /COM/WIiB