Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00533
T E G AR D 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/13/2012
Parcel: 1 S127DD00100
Jurisdiction: Tigard
Site address: 9730 SW CASCADE AVE 100
Project: Shane Company Subdivision: CORAL COMMONS CONDO Lot: 14
Project Description: (3) sign illuminations
Contractor: FORESS SIGN & MANUFACTURING LLC Owner: GM SHANE LLC
30255 HWY 34 MAX R BROWN LLC ET AL
ALBANY, OR 97321 PO BOX 3552
ENGLEWOOD, CO 80155
PHONE: 541 - 928 -5858 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 09/13/2012 $203.52
Specifics: 1 ea 12% State Surcharge - 09/13/2012 $24.42
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $227.94
Re • uired Items and Reports (Conditions)
/i " •
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 wil
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 Cent . Those rules are set forth in OAR
952- 001 -0010 through 00 ,952-001-0090. You may � obtain a of the rules or direct questions to OUNC by calling 503.232.1 or 1. 0.332 44.
Issued By: C�'�i �^_a Permittee Signature: �Q
•
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 603.639.4175 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.
5 \'I u(.. -- ooiLIO,
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received Q Date/By: / / . D) E'�/ea. -40533
Permit No .:
lig ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
-
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TI G AR D Inspection Line: 503.639.4175 Date Ready/By: Sufis: ® 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 w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition E Other: Sign where the available fault current
❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
building less amps grail other a exceeds alga ons. ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory g amps for all other installations. buildings.
❑ Multi- family ❑ Master builder E Other: Sign ❑ 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 ", "l -3 ",
Job no.: I Job site address: 9730 SW Cascade Dr. IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: Shane Co. ❑ Service or feeder 600 amps or more.
job site: FEE SCHEDULE
Cross street/directions to
J Description I 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'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.)
Illuminated Sign Limited energy, multi - family 75.00 2
g residential (with above sq. ft.)
I Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 133.56 2
1 I 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 exchange, according to ORS 447, 449, 670, and 701.
Branch circuits– new, alteration, or extension, ter 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: Foress Sign & Mfg LLC B. Fee for branch circuits without
service or feeder fee, first 56.18 2
, Contact name: Farra Snook branch circuit
Each add'I branch circuit 7.42 2
.Address: 30255 Hwy 34 Miscellaneous (service or feeder not included)
Each manufactured or modular
_(ity/State /ZIP: Albany, OR 97321 67.84 2
dwelling, service and/or feeder
';_Phone: (541) 928 -5858 Fax: : (541) 928 -9068 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
_E - mail: fsnook @foresssign.com
Sign or outline lighting 3 67.84 203.52 2
` ` CONTRACTOR Signal circuit(s) or limited- energy
' Business name: Same panel, alteration, or extension. Page 2 _ 2
Each additional inspection over allowable in any of the abov
Address: Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) S/ ci Fax: ( ) Inspections for which no fee is 90.00 / hr
� a� sa � , s pecifically listed (V2 hr min)
CCB Lic.: 144386 Electrical Lic.: 57 SIG Suprv. Lic.: P DO ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: I°(I (1q ? Subtotal: 203.52
Plan review (25% of permit fee):
Print name: Louis F. Snook II Date: 9/13/12 State surcharge (12% of permit fee):
• / TOTAL PERMIT FEE: A02 Q
Authorized signature: �/�/,tlf, .
— This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
- Print name: Date: • Number of inspections allowed per permit.
I: uilding \Permits\ELC- PermitApp,doc 07/01/10 44046t5T(II /0S /COM/WEB
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