Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00324
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/29/2012
TIGE4FR • g Parcel: 1S136DCO2504
Jurisdiction: TIGARD
Site address: 7275 SW DARTMOUTH ST 160
Project: Benitoite Nails Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Sign lighting
Contractor: GRAPHIC D'SIGNS LLC Owner: AMERICAN INDUSTRIES INC
9125 NE SANDY BLVD 1750 NW FRONT AVE STE #106
PORTLAND, OR 97220 PORTLAND, OR 97209
PHONE: 503 - 256 -2064 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/29/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 05/29/2012 $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 rul:s are set forth in OAR
952 - 001 -0010 through R 95 -1 - ) 01 - 1090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232./ 98 ?or 1.800 32.23.4.
Issued By: / , - Permittee Signature: - ' A A A^
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 v ' FOR OFFICE USE ONLY
City of Tigard ± - °:,!f ,,,Rece 5•? Z-
Permit No.: / K. /oZ Q03Os f
Date/By: �� /
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ; q 9
I : Phone: 503.718.2439 Fax: 503.598.1960 MAY 2 9 2012 DateBy: Other Permit:.6 /J O /� ' 0009'
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE' OF WORT4J1 DIN ; DIVISION PLAN REVIEW
❑ New construction ❑ Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items 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 INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address:
fi� 7 c S - 100HP or more. occupancy.
,i��tc I,a 0 SW . bard vh.bk14) S ' ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ` ❑ Health - care facilities
0 Supply voltage for more than
C) ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: B i ; o t 'N /- l L ❑ Service or feeder 600 amps or more.
FEE 'SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
g � ` Dc W' Mi g `k) i
New residential single- or multi- family dwelling unit.
1J 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 75.00 2
.DESCRIPTION OF WORK (with above sq. ft.)
/� 1 P Limited energy, multi- family
01\L l A ,- V FifY \/\ W Y. Sir 0 GJQA/+ 1 residential (with above sq. ft.) 75.00 2
t U 4 / Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ,❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
(� 1
Name: j7b7 Lj��.l,l 1, �� tr(* 1 'v�-nlM^-r1(r amps P
1 q 6 01 am s to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) I F ax: ( ) 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 I ❑ CONTACT PERSON- above service or feeder fee, 7.42 2
each branch circuit
Business name: Oct �� Pt \ n_ n / 1: l 6 r S , B. Fee for branch circuits without
Vt l . service or feeder fee, first
Contact name: T
... � T\ / A ll{.1� branch circuit 56.18 2
t t\/ �l 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: (13) o9' -79 _ZO C24 Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting l 67.84 2
• CONTRACT,QR Signal circuit(s) or limited- energy
C‘ ^ panel, alteration, or extension. Page 2 2
Business name:
��1. Q 7 n t ( / J S t C1 \ LL C i Each additional inspection over allowable in any of the above
Address: ct Q ,K . Additional inspection (1 hr min) 66.25/ hr
12, ,�- 7�•lnnn wwl\lA
Q l Investigation (1 hr min) 66.25/ hr
City/State/ZIP: �
6 t''4 at 0 $C. , 7 2. 7,-0 Industrial plant (1 hr min) 78.18/ hr
Phone: cm) a _ „ 2_ 0 6 /4 _ Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (/, hr min)
CCB Lic.: pS"4 -4 Lic.: jr, 1 Suprv. Lic.: 714. ` ELECTRICAL .PERMIT FEES
Suprv. Electrician signature, r q d / "Y 7/ r O / / / / S k'? r
,e./ /t),/,6 Plan review (25% of permit fee):
Print name: k i � C' n � Date: State surcharge (12% of permit fee): t. / y
l { i V
1 Authorized signature: I f
/176/ IVA\ TOTAL PERMIT FEE: '7S', 8'
� This permit application expires if a permit is not obtained within 180
/ ^6 ,—_ 24.12:_. days after it has been accepted as complete.
Print name: A � I �. Date: r,/J/ Number of inspections allowed per permit.
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I' Building PermitsELC- PermitApp.doc 07/01/10 4 4615T( 1 1/05 /COM/WEB / ��
el-
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
❑ O utdoor Landscape Lighting*
❑ P rotective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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