Permit •
•
p CITY OF TIGARD ELECTRICAL PERMIT
'`1 a COMMUNITY DEVELOPMENT Permit #: ELC2012 -00640
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/07/2012
Parcel: 1 S 136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer NW Style Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: (1) sign or outline lighting for sign
Contractor: TUBE ART SIGNS & SPORTS DISPLAYS Owner: FRED MEYER INC
4243 -A SE INTERNATIONAL WAY STORE #375
MILWAUKIE, OR 97222 1014 VINE ST •
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503 - 653 -1133 PHONE:
FAX: 503 - 659 -9191
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 11/07/2012 $67.84
Specifics:
1 ea 12% State Surcharge - .11/07/2012 $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 issued subject to the regulations contained in the Tigard Municipal Code. State of OR. Spe ialty 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 day- of issuance,. or if .pended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Not cation _Center. ,• -- are set forth in OAR
952- 001 -0010 through OA 9 2 -001- 090. You may obtain a copy of the rules or direct questions to OUNC by calling '43.23 :1987 or .TT 4. •
. Issued By: 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 503.839.4175 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
of Tigard RECEIV I ONLY
. eceived Permit No.: �,(�' '�/
u 13125 SW Hall Blvd., Tigard, OR 97223 plan Review C(
�i
' Phone: 503.718.2439 Fax: 503.598.1960 NOV 0 7 2012 Date/B : Other Permit: A a . OCGgf
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
Internet: www.tigard - or.gov CITY OF T�AQD Notified/Method: Supplemental Information
TYPE OF wthittILDING DIVISION 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 -2 ", "I -3 ",
Job no.: 119967 Job site address: 11565 SW Pacific Hwy
100H 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: Fred Meyer - NW Style ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Clothing Department inside Fred Meyer Description I Qtr. 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'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Connect (1) interior LED wall sign to existing branch circuit. 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
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: ( ) 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
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, l er 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) _
Ci /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( )
Fax :: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: dosterman @tubeart.com
Sign or outline lighting 1 67.84 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 (1 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 (V3 hr min)
CCB Lic.: 70956 Electrical Lic.: 37554c1s Suprv. Lic.: 366sig ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: Ken Sch Itz --"r� � , IIII Date: 11/7/12 State surcharge (12% of permit fee):
jar TOTAL PERMIT FEE: 1 S 40
Authorized signature: •
1� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Dan Oste Date: 11/7/12 • Number of inspections allowed per permit.