Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00643
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2012
Parcel: 25101 BB01400
Jurisdiction: Tigard
Site address: 12100 SW GARDEN PL, BLDG# 4
Project: Ricoh Subdivision: CROW PARK 217 Lot: 2
Project Description: (1) sign lighting
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Contractor: CASCADE SIGNS & NEON Owner: WALTON CWOR PARK BC 8 LLC
• KINNEE SIGNS INC BY CTMT - WALTON RE TAX
PO BOX 7268 4678 WORLD PARKWAY CIR
SALEM, OR 97303 ST LOUIS, MO 63134
PHONE: 503 - 378 -0012 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 11/08/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 11/08/2012 $8.14 .
Electrical
Type of Use: COM •
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98.
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 all other applicable law. All work will
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 Center. Those rules are set forth in OAR
952- 001 -0010 through R 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332..23344.
Issued By: 0 � `^-4 Permittee Signature: Oa ,4 PPU C_A -ri 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.
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Electrical Permit Application I SE ONLY
RECE V FOR OFFICE . i y ��,� -
City of Tigard Permit No.: �jt.�2.D0a1 dD�l�
.71 • 13125 S W HaII Blvd., Tigard, OR 97223 • an Review
Phone: 503.718.2439 Fax: 503.598.1960 NO V 0 5 2012 Date/By: Other Permit:
T I C A R D Inspection Line: 503.639.4175 Date Ready/By: 53 See Page 2 for
Internet: www.tigard -or.gov Notified/Method: Supplemental Information
TYPE OF woman, nftiG DDflftt PLAN REVIEW
ddition /alteration/replacement L „ n I � J � TY � ^ i' please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction 2 A
❑ Demolition ❑Other: ^" (M 0 Service or feeder 400 amps or more 0 Building over three stories.
S 1 U where the available fault current ❑ Marinas and boatyards. V
CATEGORY OF CONSTRUCTION U exceeds 10,000 amps at 150 volts or ❑ Floating buildings. (
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural O
❑ 1- and 2- family dwelling aeo ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or 14
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 , "1 -3 ",
Job no.: Job site address: 1 it 0 0 SVd GgLQ/U LQ.I ' 91.4_62- Ido or more more. occupancy.
Six or more residential units. 0 Recreational vehicle parks.
City /State/ZIP: ,5,1/4„,4 u tC ❑Health-care facilities. 0 Supply voltage for more than
( ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: I? 1 co N ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: P _ i , 2 3 to C A Description I Qt I Fee. I Total I •
4 New residential single- or multi- family dwelling unit.
131dt 4 - (W� 3-t1 Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map/parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
�"� Limited energy, multi - family 7500 2
'f n 1CAL .. 4 2li i S i 1 k.O� 5N c. W 1 r� Z(CoH Sic residential (with above sq. ft.)
L Services or feeders installation, alteration, and/or relocation
Cer,r.,t, t f -}Z) .Q ( S� p & d-v- crd) C.ij\, , t, .F 200 amps or less 100.70 2
❑ PROPERTY OWNER I TENANT 201 amps to 400 amps 133.56 2
K, 401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
• Address: I ' (W tSW GOl/ /� p Over 1,000 amps or volts 552.26 2
r Temporary services or feeders installation, alteration, and/or
City/State /ZIP: �" qA a t 91 2.2-; relocation
Phone: (503) ( 3 _ 0 t S , Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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 ex tension, per panel
Owner signature: / Date: A. Fee for branch circuits with
awPPLICANT I ❑CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: CS _ S c . _ . + C,v NI C151,-.- B. Fee for branch circuits without
0 - / y I- service or feeder fee, first 56.18 2
Contact name: LI S&_ tC.i a v‘-e..9.- branch circuit
Each add'l branch circuit 7.42 2
Address: P 3 Lax - 1 21, g Miscellaneous (service or feeder not included)
S _ (J p r qi 3 r 1 Each manufactured or modular
City /State /ZIP: V(A y - ( 1pe � V dwelling, service and/or feeder 67.84 2
Phone: ( D3) 3 7 g "DU Z Fax: : (S'Zj3) 3( 41 Ft Reconnect only 67.84 2
E -mail: I ' Pump or irrigation circle 67.84 � 2
`S '( CaS "� — S f -' C Sign or outline lighting 1 67.84 (� / i t 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: C�� Q - S - ^ �� ea1,� panel, alteration, or extension. Page 2 2
_ d' „ s Each additional inspection over allowable in any of the above
Address: 12 O 03 1 l t _ P g J U Additional inspection (t hr min) 66.25/ hr
City /State/ZIP: r^ Q �, Me � -� 9 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (50 3-7 g -00 Z Fax: ( 5 63 3 6L - glgi Inspections for which no fee is 90.00 / hr
, I Electrical Lic.: 3c, Suprv. Lie.: / specifically listed (/2 hr min)
CCB Lic.:
�p ` Yk1 1 3\p - cis P (0S—q -S i G ELECTRICAL PERMIT FEES
Suprv. Electrician si a I r , required: j`� f`� ?l1 i 1 Subtotal:
...,-..- Plan review (25% of permit fee):
Print name: LS A K i N WE£ Date: 1 I /21 12_, State surcharge (12% of permit fee): g. %'4
L TOTAL PERMIT FEE: - 1 5-q
Authorized signature: II � - This permit application expires if a permit is not obtained within 180
days ater Print name: Lt C K_ i N �e� Date: I l Zl i Z • Number of inspect a l l o w ed been per permit. as complete.
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