Permit CITY OF TIGARD ELECTRICAL PERMIT
e COMMUNITY DEVELOPMENT Permit #: ELC2012 00581
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/04/2012
Parcel: 1 S 136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Sign lighting for (6) wall signs.
Contractor: SECURITY SIGNS INC Owner: FRED MEYER INC
2424 SE HOLGATE BLVD STORE #375
PORTLAND, OR 97202 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503 - 546 -7114 PHONE:
FAX: 503 - 230 -1861
FEES
Quantity Description Date Amount
6 ea Sign or Outline Lighting 10/04/2012 $407.04
Specifics:
1 ea 12% State Surcharge - 10/04/2012 $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 'act to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don n accordance wi approv • •lans. 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 I- requir =s ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 1 -0010 th ough OAR 95 001 -p090 ou may obtain a copy of the rules or direct questions to OUNC by calling 503.23. 7 0 1.8 .
Iss d By: ` l�jl/ _ • g Permittee Signature:
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 Applic NED FOR Drrich. USE ONLY
Received
City of Tigard Date/13 : y �, Permit No.: �(e ao /a — �)J
Ili • 13125 SW Hall Blvd., Tigard, OR 9UCj 0 4 2 0 1 2 Plan Review
M Other Permit. /
Phone: 503.639.4171 Fax: 503.59 1960 Date/B : �� �/
T 1 G A R D Inspection Line: 503.639.4175 c � 1 I ° -D Date Ready/By: luris: 10 See Page 2 for
�V1�7ty�
Internet: www.tigard- or.gov I[� �1� AC(ni�} Notified/Method: Supplemental Information
TYPE Cil 01 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 snips 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
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E "1 -2 ", "1 -3 ",
Job no.: I Job site address: I � loo or Oi more Recreational �1c C 1..1cai ❑ Six or more residential units. ❑Recreational vehicle parks.
City /State/ZIP: [ ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: - ' , "-1 ` , ef ts ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 67.84 2
UnC ekim residential (with above sq. ft.)
M f [ V�.\ , & Services or feeders installation, alteration, and/or relocation
*Mount Only* 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: ( ) I 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.
t 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: Security Signs B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Melissa Hayden branch circuit
Each add'l branch circuit 7.42 2
Address: 2424 SE Holgate Blvd Miscellaneous (service or feeder not included)
City/State/ZIP: Portland, OR 97202 Each manufactured or modular 67.84 2
Y + dwelling, service and/or feeder
Phone: (503) 546.7114 I Fax: : (503) 230.1861 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Melissa @SecuritySigns.com
Sign or outline lighting (_ 67.84 o'7,O 2
CONTRACTOR Signal circuit(s) or limited- energy V �
Business name: Security Signs panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 2424 SE Holgate Blvd Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Investigation (1 hr min) 66.25/ hr
ity /State/ZIP: Portland, OR 97202
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 546.7114 I Fax: (503) 230.1861 Inspections for which no fee is 90.00/ hr
specifically listed (th hr min)
CCB Lic.: 122809 I Electrical Lic.: 26560CLS I Suprv. Lic.: 383SIG ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: ip'). 0 9
Plan review (25% of permit fee):
Print name: Marc Linguist I Date: State surcharge (12% of permit fee): 1/t , B9
TOTAL PERMIT FEE: 1/1-5 , SS
Authorized signature: 1 T his permit application expires if a permit is not obtained within 180
Print name: Melissa Ha n Date: days after it has been accepted as complete.
Y N um b er of inspections allowed per permit.
1:\ Building \ Permits \ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB