Permit q CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00577
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/03/2012
Parcel: 1 S 135BA00102
Jurisdiction: TIGARD
Site address: 10164 SW WASHINGTON SQUARE RD
Project: Hannah Pet Clinic Subdivision: MYERS ESTATES Lot: 5
Project Description: (1) sign lighting for interior sign.
Contractor: INTEGRITY SIGNS OREGON Owner: PPR SQUARE TOO LLC
PO BOX 88 PO BOX 847
HUBBARD, OR 97032 CARLSBAD, CA 92018
PHONE: 503 - 981 -3743 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 10/03/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 10/03/2012 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permit is iss ed 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 cordance h 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. AT NTION: Oregon law -q• res you to follow the rules adopted by the Oregon Utility Notifi - • Center. Those rules are set forth in OAR
952 -001 -r /10 thrA ugh OAR 952 r 1 -00 90 �u may obtain a copy of rules or direct questions to OUNC by callin 4-.3,232.1987 or 1.800.3 2.2344.
Issued :y: �� �[ Permittee Signatur -. ' . i', n i
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 1 "•= - .' - '17.if . :; . v.r . : poR oFFIcu. 1 si.: ()Nix
City of Tigard , I C eived 'IP c /C Permit No.: ZAG,AaAg-,065
.0 atc/B :
IN 13125 SW H Ph
all Blvd., Ti ,,.;iii
gard, OR 97223 Pla Review
I :' • Phone: 503.718.2439 Fax: 503.598.1960 OCT 0 2 2012
Date/B : Other Permit
I it_i m-: I. ) Inspection Line: 503.639.4175 Date Ready/13y: JuriS: Ef See Page 2 for
h1temet: www.tigard-or.gov CiTY 0;-' JIGARD Notified/Method: Supplemental Information
o-.4ii:, ' ,,,., „ 4
„ S:±4;,V4M,F,iiiiiitittwitt :;:iNA::•.:`..::
\k,117,-.Z 'iTee: .:. ‘,...* 6;`..:,,.:. c.v-o--..... 4` ..,:r0% - .:4:f $ , ! t ; :6 ...2W;
• El New construction 0 Addition/alteration/replacement . Please check all that apply (submit 2 sets nf plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories,
0 Demolition 15 Other: / 4./■.) where the available fault current 0 Morioas and boatyards.
; 9: ,.',‘ k'..f0 exceeds 10,000 amps at 150 volts or El Floating buildings.
ig'.4 -- I!';.:,,:r. - . 7 :qt40.• , :i:•:•:::'•:::-: • • 4w4•L'3'.
• • •2:-inc.:41ti.r.;7u
-- • — ''''. .. 105 to ground, or exceeds 14,000 0 Commerclat-use agricultural
0 1 - and 2-family dwelling Commercial/industrial 0 Accessory building amps for all other installations. buildings,
El Multi-family Master builder 0 Other: ID Fire pump. ID Installation of 75 KVA or
larger separately derived system.
•" ' erTs ..;:',..." ' '' it . Y elr 4 . •"'- 711.KFAIV,V4 •.:•• .: 1 '•' • : • Z •:,..:•••:''..,--;., ° 6tacr ° Item-
;•ikv..-. . ?I .._19g. • ,.. ,v-t...c.t•-'11,TIT.-, :.,:-. - "....._. 0 Addition of new motor load of 0 "A", ''E" "1-2".1 -3",
Job no.: Job site address: i Oi / 4 St kfa k st pj 10013P or more
0 Six or more resid.ential wits. occupancy.
0 Recreational vehicle parks.
['supply voltage for more than
City/State/71P:--1 ,.-4 115R._. El Health facilities.
1 0 Hazardous locations. 600 volts nominaL
Suite/bldg./apt. no.: 1 Project name: c A IA .0,,,, D Service or feeder go amps or more.
._:;i:;.•,,•- .4
Cross street/directions to job site: Description I Ty. I Fee. I' Total j *
New residential single or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 108.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: • • Limited energy, residential
75.00 2
".'..4';:'..",.:-....if,e..;:g;;h;;..:..... kili*O,A.. '‘..'''. ''i 0.,.:1.:••i ..:;i:...::....:..,•-• (with above sq. ft.)
Limited energy, multi-family
75.00 2
_
A 0— li a ri. 1 . Oa L— — 0 . residential (with above sq. ft.)
i Services or feeders inatalltion, alteration, and/or relocation
• 200 amps or less 100.70 2
' .gild,L.:V3 .'.‘,..--•:.•,:,,...-: i• A '-‘.... 4\ .1:3AiNNAil .... • ;::• ''..kt '-', 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: W , r / 7 47. /")) 7 ..
( - ,....".-e--,1-.C. 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/Z1P: relocation
Phone: ( ) • [Fax; ( ) 200 amps or lest 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
1 68, 2
intended for sale, lease. rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 54
Branch circuits - new, alteration, or extension, per panel
Owner signature: • Date: A. Fee for branch circuits with
z) "4'
fee, 7A2 2
. ,
Business name
• ._ „O n_. SSP] ..i _,_ . B. Fee for branch circ uits without
service or feeder f first
56,18 2
Contact name,: jL branch circuit _
— Each add' I branch circuit 7.42 2
Address: 7k — Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State : r - i iit t ,_/ uz _ A ____I i q 70 <2..2 dwelling, service arilor feeder 67.84 2
Phone: O3 ) qp ,_ 37$(3 Fax: : 633) P2-J'/S3 Reconnect only 67.84 2
— Pam. or irrigation circle fil.R4 2
E - mail:
... .., Sign ir outline lighting I 67.84 G 7, 2
'..: ...V.:t.''. : : ' 7 ,tfrote•: . , - ,:::' ' ,' ... :;..,1': .:..,..•;•••" ‘... ••• • ..,:••
Business name: 1 panel, alteration, or extension. Page 2 2
A. 4 . , p :
Each additional inspection over allowable in any of the above
Address: P. ,4 . Z S4 e Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr tnin) 66.25/ hr
City/State/21P:„V 14 jus 4 ,6,._ q 7 6 3 a rodustritu plant (1 hr min) 78.18/ br
Phone: (A3) q -.,5■7 yt3 — Fax: (...S33 ) V.? -/.Z5' -/.Z5' insprxiium fur which no fee is
90.00/ lir
s • ificall listed 2 hr rnin
CCB Lic.: pciii-s Electrical Lic.: (f Suprv. Lic.: 0:7? -,5 I 6, _ *:' Atte ' . . CA ' .:. ''. '...' ,i;ds ',..':
Subtotal: 63 7 a
Suprv. Electrician signature, r . -- -=. 7 r- 7 -
...--- Plan review (25% of permit fee): •
---...
• ■ip
Print nati rl)/971F /.474-2,f S' Date: ,/ _ 0 _ p,.. . State surcharge (12% of permit fee): - .
......, -
TOTAL PERMIT FEE:
Authorized signature: • This permit application expires if a permit is not obtained within ISO - /
i days after it has been accepted as complete.
Print name; Date: ^ — Number of inspections allowed per permit.
•
ouatoin owo MU 440-4filsrcii/os/c0wwnn
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10164 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
2014-02-13 (null)
ELC2012-00577
PASS - No C of O
Violation Summary:
Inspector Contractor