Permit kl, 6 1,012.).-- 0004
II . ;- CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 00193
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/05/2012
T
Parcel: 1 S126CA01000
Jurisdiction: TIGARD
Site address: 9009 SW HALL BLVD 115
Project: Sports Clips Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
' Project Description: (2) sign lightings.
Contractor: INTEGRITY SIGNS OREGON Owner: CAFARO NORTHWEST PARTNERSHIP
PO BOX 88 PO BOX 422
HUBBARD, OR 97032 FLORHAM PARK, NJ 07932
PHONE: 503 - 981 -3743 PHONE:
FAX:
FEES
Quantity Description Date Amount
2'ea Sign or Outline Lighting 12/05/2012 $135.68
Specifics:
1 ea 12% State Surcharge - 12/05/2012 $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 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 enter: Those - rule are set forth in OAR
952- 001 -0010 through OAR 952-001-0090, You may obtain a of the rules or direct questions to OUNC by calling 503 987 or .800.332. 34 .
Issued By: ,���t�l,Q�/ *e/ �-�+�1 Permittee Signature: n
Y
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.
•
•
• OL) 000... , , ' '
Electrical Permit Application R ECEI VE FOR OFFICE USE ONLY
City of Tigard S aui y : ��
Plan R / Permit No.: ��
Er I
• 13125 SW Hall Blvd., Ti ard, OR 97223 y 5 iew
Phone: 503.718.2439 Fax: 503.598.1960 APR 3 2012 Date/By: ceived
Other Permit:
Inspection Line: 503.639.4175 Date Ready fury: 65 See Page 2 for
TIGARD CITY OF TIGARD N otified/Met d: // Supplemental Information
Internet: www.tigard- or.gov � pp
1 yip 14ifn7rta�
TYPE OF WO N L .J. .s4...• PLAN REVIEW
14.kIew construction ❑ Addition/alteration/replacement l e ( i 5'1/7 Please check all that apply (submit 2 sets of plans w /items checked below):
_ tat ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: Z l � where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION SliP exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder Other: 5 •jt,/ ❑ 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 ". "1 -2 ", "1 -3 ",
Job no.: Job site address: `, .p IOOHP or more. occupancy.
9 �O� + L` 8,� � � 0 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: �� � ❑ Health-care facilities. ❑ Supply voltage for more than
,, �� / ��/1 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no 1 / ` J Project name: ❑ Service or feeder 600 am p s or more
1" p �f / FEE SCHEDULE
Cross street/directions to job site: */ l— ,6 yl /� e � T J Description I Qtm. I Fee. i Total
I (�C 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 I
Tax map /parcel no.:
Limited energy, residential
75.00 ,
DESCRIPTION OF WORK (with above sq. ft.)
_ Limited energy, multi - family 7500 -, ` . /i . / 1 4 / /1 '), 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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
y relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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 -
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
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
13usiliess name: "4, 1 B. Fee for branch circuits without
j ���� C � service or feeder fee, first 56.18 2
r
Contact name: �� y 19 7...e.,/,/,,,e,...„/ branch circuit fT
Each add'1 branch circuit 7.42 2
Address: 9(9 Ap 0 r Miscellaneous (service or feeder not included)
,/'� Each manufactured or modular
#� City /State /ZIP: ✓ ",,,,..1.3 ",,,,..1.3 r / � ?2 ,- 9 , 3 � dwelling, service and/or feeder 67.84 2
Phone: :0 ) - /a ) 1 79'/ Fax: : ( ) ' — Reconnect only 67.84 2
l 'Z <3 -
Pump irrigation circle 67.84 2
E - mail: S
Sign or r o ne lighting � 3, j 48' 67.84 � 2
CONTRAC R Signal circuit(s) or limited- energy
Business name: �H�i1 / ly 7 ` 1 l ., 4N-1 panel, alteration, or extension. Page 2 2
f! ' Each additional inspection over allowable in any of the abov
Address: Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr
,� 1 1-"' specifically listed (t /2 hr min)
4/603 Lic.:/ / 95/ / 66' Electrical Lic.: t ' i J � 5uprv. Lic.: c y 9q 5 ', ELECTRICAL PERMIT FEES
[ ��/ ` Subtotal: ('✓ 6
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): 'b • of
TOTAL PERMIT FEE: /57 f . 94,
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Dale: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01 /It) 440 - 4615'1'(11 /05 /COM/WEB