Permit •
CITY OF TIGARD ELECTRICAL PERMIT
a. COMMUNITY DEVELOPMENT Permit #: ELC2012 00439
T [GA R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/24/2012
Parcel: 25101 DA00105
Jurisdiction: Tigard
Site address: 13009 SW 68TH PKWY C
Project: Extended Stay America Subdivision: VARNS ACRES Lot: 9
Project Description: (2) sign or outline lighting
Contractor: RAMSAY SIGNS INC Owner: BRE /HV PROPERTIES LLC
9160 SE 74TH AVE TAX DEPTARTMENT
PORTLAND, OR 97206 EXTENDED STAY HOTELS
100 DUNBAR ST
SPARTANBURG, SC 29306
PHONE: 503 - 777 -4555 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 07/24/2012 $135.68
Specifics:
1 ea 12% State Surcharge - 07/24/2012 $16.28
Electrical
Type of Use: COM
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $151.96
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 9 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ifatti SLIAt Permittee Signature: CalLey ► —
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 Ina 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 ONLY
City of Tigard Received '74 41 /2, 4X Permit No.: Z l.,,e304
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone: 503.718.2439 Fax: 503.598.1960 Date /By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready /By: Juris: HI See Page 2 for
Internet: www.tigard- or.gov Notified/Method: /04, Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction Please check all that apply (subm 2 sets of plans w /items checked below): ® ❑ Addition /alteration replacement G6
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. P
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. (.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural C•
❑ 1 - and 2 family dwelling E Commercial /industrial ❑ Accessory building amps for all other installations. buildings. Ni
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or C>
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 "I -3 N
QTN ? 100HP or more. occupancy. I
Job no.: Job site address:
i?�OC�� S.W. (% K W I ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZII ki b OR. et122.3 ❑ Ha zardo u s fcation ❑ Supply voltage for more than
❑ HaTardous locations. 600 volts nominal. O<)
Suite/bldg. /apt. no.: Project name: E E mbz..b Jt A.4 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to ob site: Description
J Qtv. i Fee. I Total ....4)
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 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
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
(2 ) Sign Circuits 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
Name:
601 amps 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: ( ) 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.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
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: Sign or outline lighting Z 67.84 5 Qz . 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Ramsay Sign Co. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 9160 S.E. 74 AVE. Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: Portland OR. 97206 Investigation (1 hr min) 6625/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 777 - 4555 Fax: (503) 777 -0601 Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.: 63422 Electrical Lic.: 26 -106 c15 Suprv. Lic. 493 sig ELECTRICAL PERMIT FEES
5 4i"
Suprv. Electrician signature, required:� 0 4 :e"........._ .... ..j
Plan review (25% o Subtotae)l: : .3.
of permit fe
Print name: Phill Steiger IN ` L` ST E 1 c,- Date: 7/24 /2ii Z State surcharge (12% of permit fee): I L 24
TOTAL PERMIT FEE: 15" 1 94
Authorized signature: This permit application expires If a permit is not obtained within 180
days after It has been accepted as complete.
Print name: Date: \ P • Number of inspections allowed per permit.
�i
I:\ Building ermits\ELC- PermitApp.doc 07/01 /10 440- 4615T(I1/05 /COM/WEB •!
•
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*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling
Zr Other Sign Circuits
Total number of commercial systems: _
•
*No licenses are required. Licenses are required
for all other installations
L:\ Building \Permits\ELC- PermitApp.doc 07/01/10
411
1W
EXT ENDEDSTAY`HOTELS
Date: January 12, 2012 .
To Whom It May Concern)
I hereby authorize . '�- 5 , 5 and their
representative(s) to act as agents or�/our behalf to apply for sign permit(s), sign variance (s), and "to perform any sign
i g (s ) p Y
installation work at the below address:
Extended Stay America ()C 92---
/2 005 ,i1.cJ 6 ifkkin Mal
�8avel Lr 9 aa3
Sincerely,
Property Manager Name /Title: David Kellam — Director Of Exterior Sign Systems & Special Protects
Property Manager Street Address: 11525 North Community House Road, # 100
Property Manager City /State /Zip: Charlotte, North Carolina 28277
Property Manager Phone: (980) 342 -1
Property Manager Signature:
ExtendedStayAmerica Homestead Studio Suites StudioPLUS Deluxe Studios