Permit CITY OF TIGARD ELECTRICAL PERMIT
A _ COMMUNITY DEVELOPMENT Permit #: ELC2012 -00183
T [GAR I? 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9573 SW WASHINGTON SQUARE RD B06
Project: The Limited Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Sign lighting.
Contractor: VANCOUVER SIGN COMPANY INC Owner: PPR WASHINGTON SQUARE LLC
2600 NE ANDRESEN RD #50 BY THOMSON PROPERTY TAX SERVICES
VANCOUVER, WA 98661 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 360 - 693 -4773 PHONE:
FAX: 360 - 693 -2747
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 03/30/2012 $67.84
Specifics: 1 ea 12% State Surcharge - 03/30/2012 $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 OAR 952- 001 -0090. You may obtain a copy of r = .questions to OUNC by calling 503.2 .1987 or 00.3 .2344.
Issued By: — ins Perm ittee Signature: 3 �_
• 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.
•
Electrical Permit Applicatio . - .,,,, `� FOR OFFICE USE ONLY
City of Tigard , � ��
• � „n _ {. DateB j Permit No.: �a( \11—
13125 SW Hall Blvd., Ti g ard, C ' � . _3 iN0 I lit
C Phone: v
Plan Review
711 one: 503.639.4171 Fax: 503.598. I �� .�\ �� � Received
Date/B : Other Permit: I ro 1
T I G A R D Inspection Line: 503.639 r\ ® k r c 0 -3 1 Date Ready /By: ® page 2 for
Internet: www.tigard - or.gov V `? Notified/Method: r Supplemental Information
'TYPE OF WO \ PLAN REVIEW
• Dia New construction ID Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wArerns checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ 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- 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 INFORMATIO I r LOCATION ❑ Emergency system larger separately derived system.
0 Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: cc 0 l IoOHP or more. occupancy.
/ . • d IA) [4.4...6 Reel , ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: P t1 ''/ Z more than
lt1 C t'lan r[il J i - 0 R c l ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: B 4, Project name: Till... L t Itv tk Ca ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
,` 1 - J
' AAA New residential single- or multi - family dwelling unit.
W & i t Vta�-trq sp( o /v e. k1 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
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
r it Limited energy, multi - family 67.84 2
111 uwu A P lz gn residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I isi TENANT 201 amps to 400 amps 133.56 2
Name: ' 401 amps to 600 amps 200.34 2
�!� j I t>e 601 amps to 1,000 amps 301.04 2
Address: ci 5 P, s b W A4 I ( . j qi p r � Over 1,000 amps or volts 552.26 2
City /State/ZIP: P ` �A G t h . - 3 Temporary services or feeders installation, alteration, and/or
w 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
14 APPLICANT 1 a CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: v0.Yl.4 otA u eAN Si�(1 B. Fee for branch circuits
without service or feeder fee, 56.18 2
Contact name: AE ;,L S r ,try7 /� first branch circuit
Address: 2(000 AIF Ar riA&se n /€L so Ea ch add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Vay1,G0 u_ki e- J A 986 / 1 I Each manufactured or modular 67.84 2
Phone: (3 (.o) Get '177 3 /��{ � Fax:: ( 360 ) , Z7 y 7 Rec onnne, nect t service only and/or feeder
Reconnect 67.84 2
E -mail: L (- \ f A/15 ! �hLO. LO 1� Pump or irrigation circle 67.84 2
ONTRACTOR Sign or outline lighting (, 67.84 6, g-1 2
Business name: � Vf Signal circuit(s) or limited - J
/AAln LI.VPif Si energy panel, alteration, or
Address: n extension. Describe: Page 2 2
2to00 Ale Ane Rd, SQ
City / State/ZIP: ,, `` Each additional inspection over allowable in any of the above
V i(yj, G O t 1��J �S� (.� �l $ �n G f Per inspection 66.25
Phone: ( 360) log 3 417 Fax: (360) 64'3 27417 Investigation per hour (I hr min) 66.25
CCB Lic.: a Electrical Lic.: 37 _ �f � 6 G Su . Lic.: 5 5/ 6 Industrial plant per hour 78.18
������. ELECTRICAL PERMIT FEES
Suprv. Electrici stg required: i % 515 Subtotal: [o• g�
Print name: g Date: . 3 � o// Z Plan review (25% of permit fee): —
�� /^^^ State surcharge (12% of permit fee): • til
Authorized signature: 7 TOTAL PERMIT FEE: 7 5-, �r
i This permit application expires if a permit is not obtained within 180
e
Print name: f .r , m
QV � CIt Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
l:t Buildingpermits \EI.C- PermitApp.doc 10/01/09 440- 46t5T(tI /05 /COM/WEB