Permit CITY OF TIGARD ELECTRICAL PERMIT
3 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00275
TI G A.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/10/2012
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: (3) sign lightings for interior signs.
Contractor: TUBE ART SIGNS & SPORTS DISPLAYS Owner: FRED MEYER INC
4243 -A SE INTERNATIONAL WAY 3800 SE 22ND AVE
MILWAUKIE, OR 97222 PORTLAND, OR 97202
PHONE: 503 - 653 -1133 PHONE: 503 - 232 -8844
FAX: 503 - 659 -9191
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 05/10/2012 $203.52
Specifics:
1 ea 12% State Surcharge - 05/10/2012 $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 • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accord. ce with app =ved plans. This permit will expire if work is not started within 180 days o 'ssuance, or if wo uspended for more the 180
days. ATTENTIO : Oregon law r•qui - - . •u to follow the rules adopted by the Oregon Utility Notif -lion Center. •se ales are set forth in OAR
952 -001 -0010 th • gh AR 952-001-00 ' I. You =y • •• : in a copy of the rules or direct questions to OUNC by calling 5• .23 1987 or : • •. 32. a • 4. •
• Issued By: • " / 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.
Electrical Permit Application FOR OFFICE USE ()N1.1' I.I'
City of Tigard RECEIVED Dae/B 5/� �11ZO PermitNo.: (_ ea—a) Q 75°'
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit: I , �� '
T G n R D Inspection Line: 503.639.4175 1 - ( 1 0 ;, 17 Date Ready/By: kris: RI See Page 2 for
Internet: www.tigard -or.gov Notified/Method: Supplemental Information
TYPE OF 44 OF TIGAR1D PLAN REVIEW
ING DIVISION Please check all that apply (submit 2 sets of plans w /items checked below):
® ❑ New construction Addition /a1 era to rep acemen
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: SIGN 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 ", "l -2 ", "1 -3 ",
Job no.: 118068 Job site address: 11565 SW Pacific Hwy I00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ Health facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Fred Meyer Jewelers ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Inside Fred Meyer store at 72 Hwy 99 Description F Qty. I Fee. I 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
Connect exterior wall sign & outline lighting sconces 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
401 amps to 600 amps 200.34 2
Name:
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 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 exchangc, 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 I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Tube Art Group B. Fee for branch circuits without
service or feeder fee, first
Contact name: Dan Osterman branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: dosterman@tubeart.com Sign or outline lighting 3 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: Tube Art Group panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 4243 - SE International Way Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Milwaukie, OR 97222 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 653 - 1133 Fax: (503) 659 - 9191 Inspections for which no fee is 90.00 / hr
specifically listed (14 hr min)
CCB Lic.: 70956 Electrical Lic.: 37554c1 prv. Lic.: 366sig ELECTRICAL PERMIT FEES
1 '' Subtotal: „�//SS J,.� a'
Suprv. Electrician signature, required: - t „ �" ( � Pla review (25% of permit fee): -
Print name: Ken Schultz , A O j a te: 5/ 8/12 St ate su rcharge (12% of permit fee): Lq i �
tir, Authorized signature: � / TOTAL PERMIT FEE: '7 �
This permit application expires if a permit is not obtained within 1S0
days after it has been accepted as complete.
Print name: Dan Oste Date: 5/8/12 • Number of inspections allowed per permit.