Permit 3 • q CITY OF TIGARD ELECTRICAL PERMIT
11 1 :Y. COMMUNITY DEVELOPMENT Permit It ELC2012 00537
Date Issued 09/17/2012
T I GARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 1S136DB02600
Jurisdiction Tigard
Site address 11201 SW 72ND AVE
Project McDoanlds Subdivision AZOIC TERRACE Lot 1
Project Description Installation of (6) sign lightings
Contractor RAMSAY SIGNS INC Owner STEWART /BARI PROPERTIES LLC
9160 SE 74TH AVE STEWART TRUST
PORTLAND, OR 97206 BY US BANK
BOX 64142
ST PAUL, MN 55164
PHONE 503 - 777 -4555 PHONE
FAX
FEES
Quantity Description Date Amount
6 ea Sign or Outline Lighting 09/17/2012 $407 04
Specifics:
1 ea 12% State Surcharge - 09/17/2012 $48 84
Electrical
Type of Use COM
Class of Work ALT
Type of Const
Occupancy Grp
Total $455 88
Required Items and Reports (Conditions)
This permit is - - - b ect to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done accordance wi 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 • TTENTION Oregon - - Tres you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-1.1-0010 through OAR 952-1:1-0090 may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 B00 332 2344
Iss -d By Permittee Signature
r (�l 1.Q.d
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 FOP OFFICE USE ONLY
City of Tigard Received / Permit No
° 13125 S W Hall Blvd , Tigaid, OR 97223 Plan Review
` Phone 503 718 2439 Fax 503 598 1960 Date /By Other Permit �Q Oa��
TIGARD Inspection Line 503 639 4175 Date Ready /By Jura 0 See Page 2 for
Internet www tigard - 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 ❑ Other where the available fault current ❑ Mannas 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 /mdustnal ❑ 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 denved system
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", '1 -3 ",
c IOOHP or more occupancy
Job no Job site address
''� D�• 7 2 Ave ❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZiP ^ ❑ Health -care facilities ❑ Supply voltage for more than
T �/ Q �� 2'S ❑ Hazardous locations 600 volts nominal
Suite/bldg /apt no Project name ❑ Service or feeder 600 amps or more
FEE FEE SCHEDULE
Cross street /directions to job site Description I Qty I Fee I Total I
New residential single- or multi- famtlJ dwelling unit.
Includes attached garage.
Subdivision Lot no 1,000 sq ft or less 168 54 4
Ea add'I 500 sq It or portion 33 92 1
Tax map /parcel no Limited energy, residential
sq 75 00 2
DESCRIPTION OF WORK ( with above q ft )
I imited energy, multi- family 75 00 2
6 Si gvi C"' r p G 143 - residential (with above sq ft )
V 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
Temporan services or feeders installation, alteration, and /or
City/State /ZIP relocation
Phone ( ) Fax ( ) 200 amps or less 59 36 l
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 abov e service or feeder fee 7 4 2
e
S./ et each branch circuit
•
Business name � SQ{A6 IV1G B Fee for branch circuits without
I I5 service or feeder fee, first 56 18 2
Contact name TE ry y g ✓`DWK branch circuit
Each add'I branch circuit 7 42 2
Address q 160 5E 7i Th A Miscellaneous (service or feeder not included)
�1"1al�d • n r p n Each manufactured or modular
City /State /ZIP R
u {7 4 6 dwelling, service and /or feeder 67 84 2
Phone (603) `177 L 3 V Fax ( ) Reconnect only 67 84 2
E - mail �+ Pump or irrigation circle 67 84 / 2
Sign or outline lighting (0 67 84 Q y Of 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 (1 hr mm) 66 25/ hr
City/State /ZIP Portland OR. 97206 investigation (1 hr min) 66 25/ hr
Industnal plant (1 hr min) 78 18/ hr
Phone (503) 777 - 4555 Fax (503) 777 - 0601 inspections for which no fee is
specifically listed (V: hr mm) 90 00/ hr
CCB Lie 63422 Electrical Lic 26 -106 c Supry Lic 493 sig ELECTRICAL PERMIT FEES
Supry Electrician signature, required Subtotal D7 Osl
Plan review (25% of permit fee)
Print name Phtll Steiger A J Date State surcharge (12% of permit fee) qg g V
TOTAL PERMIT FEE 755 gg'
Authorized signature kJ( ` I his permit application expires if a permit is not obtained within 180
Print name Date * class after it has been accepted as complete
Number of inspections allossed per permit
I Bwldmg PeRnits PLC PermrApp doc 0% 01 10 440 4615T(I 10, COM \\'EB