Permit , CITY OF TIGARD ELECTRICAL PERMIT
'111 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00254
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/02/2012
Parcel: 1 S136DCO2504
Jurisdiction: TIGARD
Site address: 7275 SW DARTMOUTH ST
Project: American Industries Wall Sign Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Sign lighting
•
Contractor: GARRETT SIGN CO INC Owner: AMERICAN INDUSTRIES INC
811 HARNEY ST 1750 NW FRONT AVE STE #106
VANCOUVER, WA 98660 PORTLAND, OR 97209
PHONE: 360 - 909 -1395
PHONE: 503 - 478 -6603
FAX: •
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/02/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 05/02/2012 $8.14
Electrical
Type of Use: COM
Class of Work: OTR
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. Speci- ' Co s 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 •f issua e, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility N••tification enter. Those rules are set forth in OAR
952- 001 -0010 through OA 9 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC - by - ing 503:23 '1987 -• 1.800. 3
Issued By: Permittee Signatur / 41 "L�
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.
Electrical Permit Application Deli OFFICE USE ONLY
.
Received 4„..-C,.30 ! O� ,' . :1 it
City of Tigard Dam Permit No.:
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/13 : Other Permit:
I" I G A It D Inspection Line: 503.639.4175 Date Ready/By: s: ® See Page 2 for
Internet: www.tigard- or.gov Notified /Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wfitems checked below):
❑ Demolition ❑ Other: ❑ where the available fault ❑ Marinas over three stories.
❑ Marins and boatyards. r
CATEG RY 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. l
❑ Multi - family ❑ Master builder ❑ Other: El Fire pump. ❑ Installation of 75 KVA or Oil
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. C I
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", k
Job no.: Job site address: �J ` . / /� t�,� �A IOOHP or more. occupancy.
I �� � �lA �K•�t r Y W �� ❑ Six or more residential units. ❑ Recreational vehicle parks. i...7
City/State/ZIP: l', �' y� /� ! 7 2 ❑ Haz d ou s fcaiion ❑ Supply voltage for more than
Kam°/ t J ( ❑Hazarou locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: --tr(p}io rt 9 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: d -72 �l Description W
Qty. I Fee I Total
/ y � New residential single- or multi- family dwelling unit.
/ 5 T ) j C l�� ' 1 Includes attached garage.
Subdivision: Pc- Lot no.:➢t(A 1,000 sq. ft or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Ni) t- Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft)
` /l Kw Limited energy, multi- family
�7� ■ iS1)( residential (with above sq. ft) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
Cif PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: P 601 amps to 1,000 amps 301.04 2
Address: (15 A / 7 7 f0 lo b Over 1,000 amps or volts 552.26 2
City /State /ZIP: T `G- , � T Q 7 ZOq Temporary services or feeders Installation, alteration, and/or
�t relocation
Phone: ( 5 8 ) 4 - 7 8 - 6 4 0 3 Fax: ( )Atill 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.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT A CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: 6- Co B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: / m L branch circuit
Each add'l branch circuit 7.42 2
Address: g 1.- 47 _ Miscellaneous (service or feeder not included)
manufactured or mular
City / State/ZIP: V Vi /
� dw service and/or feeder 67.84 2
Phone: (V) Cf j�' ( 3G� ` F Fa ax:: ( )/J (A- Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: N64
Sign or outline lighting i 67.84 2
CONTRACTOR C � p Signal circuit(s) or limited- energy '
464,1? C * 4 2 4 / zT ., e k+l cc)- panel, alteration, or extension. Page 2 2
Business name: Each additional inspection over allowable in any of the above
Address: M Additional inspection (1 hr mint) 66.25/ br
City/State/ZIP: � wit_ / Q z3k (� Investigation (1 hr min) 66.25/hr
W V" ` J( Industrial plant (1 hr min) 78.18/ lv
Phone: (Ai)) tq( 45 Fax: ( ) LOLIL ` Inspections for which no fee is 90.00 /hr
specifically listed (Ys hr min)
CCB Lic.: e D ig Z I Electri 1 Lido 0 / (Suprv. Lic.: ELECTRICAL PERMIT FEES
v / Subtotal: 1 814'
Suprv. EIE• . :1 ti e, required: � 1 Plan review (25% of permit fee):
Print name: ! f t i � ' / , N . 1 ' ate: �1� f e_.— State surcharge (12% of permit fee): +
• Authorized si afore: / �� i ".,,� TOTAL PERMIT FEE: '1 .*
1i . This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name Kit L Ct / Date: • inspections `/ Number of ins ens allowed per permit.
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
{ RESIDENTIAL WORK ONLY: .
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Oth `�
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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