Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00192
T r G A R I? 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/19/2012
Parcel: 2S113AB00101
Jurisdiction: Tigard
Site address: 16101 SW 72 AVE
Project: Perlo Construction Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (1) sign lighting for monument sign.
Contractor: SECURITY SIGNS INC Owner: PACIFIC REALTY ASSOCIATES LP
2424 SE HOLGATE BLVD ATTN: N PIVEN
PORTLAND, OR 97202 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 -546 -7114 PHONE: 503 - 624 -6300
FAX: 503 - 230 -1861
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 04 /19/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 04/19/2012 $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 2- 001 -0090. You may obtain a obtain of the rules • •' ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / C ' _—� Permittee Signature: –tee 6l
�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.
660 0 I1• envo 3
Electrical Permit Applica it r CE VE D r(11z (1r1 „: „. 1;s1.: (1\1.,
/ . ■ P ermit No.:
City of Tigard D a S/ .� a 1oedt'oia - 00 /9�—
• 13125 SW Hall Blvd., Tigard, OR 97 ''.+ 0 3 2012 Plan Review
II Phone: 503.639.4171 Fax: 503.598.1:60' Date/3 : Other Permit:
Inspection Line: 503.639.4175 / �/ C 1 /� Date Ready/By: El See Page 2 for
l I C. n It D
Internet: www.tigard Ls! 1 1 01 Ai LJ Notified/Method: Supplemental Information
_ A � I ik.l
TYPE tYP” +D1 C D I O
PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit a sets of plans wfitems checked below):
12 Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
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- 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 ", "l -3 ",
Job no.: I Job site address: IU 01 c ;� Z n 1 or more. occupancy.
.+-+ ❑ Six ix or or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: I Project name: "� 0 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
P P Limited energy, residential
DESCRIPTION OF WORK
(with above sq. ft.) 67.84 2
Limited energy, multi- family 67.84 2
f n f , residential (with above sq. ft.) -
Services or feeders installation, alteration, and/or relocation
*Mount Only 200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ 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
ty relocation
Phone: ( ) I 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
r 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: Security Signs B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Melissa Hayden branch. circuit
Each add'l branch circuit 7.42 2
Address: 2424 SE Holgate Blvd Miscellaneous (service or feeder not included)
Portland, OR 97202 Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: (503) 546.7114 I Fax: : (503) 230.1861 Reconnect only 67.84 2
E Melissa@SecuritySigns.com Pump or irrigation circle 67.84 2
- mail: Melissa @Securi
i ce' Sign or outline lighting ' 67.84 /(7 SI 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Security Signs panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 2424 SE Holgate Blvd Additional inspection (1 hr ruin) 66.25/ hr
City/State/ZIP: Portland, OR 97202 Investigation (1 hr min) 66.25/ hr
IIrr Industrial plant (1 hr min) 78.18/ hr
P ne: (503) 546.7114 I Fax: (503) 2,;.3t11861 10 I I I I l 1 for which no fee is 90
specifically listed (i4 hr min) hr
I CB Lic.: 122809 1 /1, D Electrical i .: 26560CLS Suprv. Lic.: 383SIG ELECTRICAL PERMIT FEES
l " l / - Subtotal: 4 $ if
Suprv. Electrician signature, required: Plan review (25% of permit fee): —
Print name: Marc Linguist I Date: State surcharge (12% of permit fee): . / q
TOTAL PERMIT FEE: '75 . 9 f
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Melissa Hay n I Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
l: tBulding \Peimlts\ELC- PermiiApp.doc 10/01 /09 440- 4615T(11 /05/COM/WEB