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Permit p CITY OF TIGARD ELECTRICAL PERMIT g,- COMMUNITY DEVELOPMENT Permit #: ELC2012 -00580 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/04/2012 Parcel: 1 S136DB00201 Jurisdiction: Tigard Site address: 11565 SW PACIFIC HWY Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2 Project Description: Sign lighting for (2) signs. Contractor: TUBE ART SIGNS & SPORTS DISPLAYS Owner: FRED MEYER INC 4243 -A SE INTERNATIONAL WAY STORE #375 MILWAUKIE, OR 97222 3800 SE 22ND AVE PORTLAND, OR 97202 -2918 PHONE: 503 - 653 -1133 PHONE: FAX: 503 - 659 -9191 FEES Quantity Description Date Amount 2 ea Sign or Outline Lighting 10/04/2012 $135.68 Specifics: 1 ea 12% State Surcharge - 10/04/2012 $16.28 Electrical Type of Use: COM Class of Work: ALT 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 a other a. •licable law. All work will be done in - - • •ance • approved plans. This permit will expire if work is not started within 180 days o 'ssuance, or work is s s•ended for more the 180 days. • ' ENTION: Oregon -w requires you to follow the rules adopted by the Oregon Utility Notficati• . Center. •si rAr are set forth in OAR 952 -0 -0010 through OAR 9 301 •0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 +'.1987. r .:00 .3 3 / `• - -. Iss -d By: i = - - — v Permittee Signature: A w _ 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 FOR OFFICE USE ONLY Cl of Ti Or�� E n / n D05 j `J and Received Tigard r �� i / P ermit No.: G ( (/ t ` JQ 0 1 14 ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • /� Phone: 503.718.2439 Fax: 503.598.1960 Date : Other Permit 6, d ( go TI 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: 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: SIGN 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 ", "l - ", "I - ", Job no.: 119967 Job site address: 11565 SW Pacific Hwy I00HP 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.: Project name: Starbucks Coffee ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: tenant at Fred Meyer 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.) Limited energy, multi - family 75.00 2 Connect (1) exterior wall sign on east elev. & (1) exterior logo on south elev. residential (with above sq. ft.) 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 Name: 401 amps to 600 amps 200.34 2 601 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: ( ) Fa ( ) 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 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 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: Tube Art Group B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: Dan Osterman branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular City/State /ZIP: dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: dosterman @tubeart.com Sign or outline lighting • 2 67.84 ` '35 ' 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: Tube Art Group panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: 4243 - SE International Way Additional inspection (I hr min) 66.25/ hr City/State /ZIP: Milwaukie, OR 97222 Investigation (I hr min) 66.25/ hr Industrial plant (I hr min) 78.18/ hr Phone: (503) 653 -1133 Fax: (503) 659 - 9191 Inspections for which no fee is 90.00/ hr specifically listed (V2 hr min) CCB Lic.: 70956 Electrical Lic.: 37554c1s Su. . Lic.: 366sig ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Plan review (25 %of pe o e): r g5 .lp8 Print name: Ken Schu 0, 10/4/12 State surcharge (12% of permit fee): /L.. a g //e TOTAL PERMIT FEE: r! 5 Authorized signature: /• _ 180 1, This permit application expires if a permit is not obtained within q n 180 days after it has been accepted as complete. Print name: Dan Ost � Date: 10/4/12 �� � • Number of inspections allowed per permit.