Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00704
T t G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/13/2012
Parcel: 25101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY
Project: Clear Channel Subdivision: VARNS ACRES Lot: 9
Project Description: (1) branch circuits to install unistrut on beams above the T bar ceiling
Contractor: HOLLYWOOD LIGHTS, INC. Owner: TRIANGLE POINTE LLC
5251 SW MCLOUGHLIN BLVD. 901 NE GLISAN ST, #100
PORTLAND, OR 97202 PORTLAND, OR 97232
PHONE: 503 - 232 -8855 PHONE:
FAX 503 - 232 -8505
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 12/13/2012 $56 18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/13/2012 $6 74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62 92
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 rf 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 OAR 2 001 -009 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: a � �C PermitteeSignature: Oti- 4 P PL / 0 /L
` 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.
Dec. 12. 2012 1:19PM Hollywood Lights inc No. 2377 P. 1
Electrical Permit l ApplicatioRE E 1 1. oR oFFIC:L LISE ON L
City Tigard 0'c I De Pen L ` -
h' g �„ : t� l 3 I �- � Vii— e�ld• bp - 70f
" 1 13125 SW Hall Blvd.. Tigard, OR 97223 nn PlanRetiety
M . Phone: 503.7182439 Fax: 503.598.196V E C 1 2012 O 1 Z DateJB Other Permit
f I t : A it 13 Inspection Line: 503.639.4175 Dam Rcady/By: brig El See Page 2 for
Internet: www,ligard- or,gov CITY OF TIGARD Notified/Method: 'rt ( Co Supplemental Information
4w °=r` 2 :b17 abiliDING DIVISION - : }" -. =- _PLA1V - i i1EN :. - . _ _.: ,
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sas of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ BuIIding over three stories.
❑ Demolition ❑ Other: wham the available fault canvas ❑ hfarinss and boatyards.
� : A; ' tr W = _
�, . ' - CATEGORY ON CONSTItI [1CI '1(0 1� ,-= �� , -_:_' - _,, -04 exceeds 10.000 amps as 150 voles or ❑ Floating buildings.
less so ground, or exceeds 14,000 ❑ Commercial use agricultural
❑ 1- and 2- family dwelling J Commercial/industrial Cl Accessory building amps for all otheriasiallatim.. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pomp. ❑ Installation 0(75 KVA or
µ JOB SITE INFORMATION AND l) !+• � r ( not dtr ,�; a - ' "` - ❑eiefg °noysystem larger separately derived system
. :. ,Y.I'Y, . , O Addition of new motor load of ❑ "A "E", .I -T' "1 -3-,
Job no.: I Job site address: 13333 SW 68th Pkway ` -. -� 10011P or more. mCuhy.
❑ Six or more residential traits. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts mammal.
Suite/bldg. /apt. no.: Project name: Clear Channel ❑ Service or feeder600 amps or mom
job site: PEE SCI�Dl1LE r e = $•: ,
Cross street/directions to
J Description I Qtr. I fee. I Taal I'
New residential single or nitdH- fanilly dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. ft. or less 168 54 4
Ea. odd'I 500 sq. a or portion 33.92 1
Tax mop /parcel no.:
_ Limited energy, residential
^I't r.1Z ''''te DESCRIPTION, AE: `YQRK : =' (with above sq. 0.) 75.00 2
"' Limited energy. multi- family
Install unistrut on beams above the T Bar ceiling, connect the beam residential (with above sq. II.) 75.00 2
Services or feeders installation, alteration, and/or relocation
mounted unistrut with 3/8 all thread to the power rail. 200 amps or less 100.70 2
• , t . i PROPERTY OWNER I ; =4;; Imo'; ® TENANT 201 amps to 400 amps 133.56 2
l — 401 amps to 600 amps 200.34 2
Name: Clear Channel Media & Entertainment 601 amps to 1.000 amps 301.04 2
Address: 13333 SW 68th Parkway Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
Cily /State/ZfP: Tigard, OR 97223 relocation
Phone: (503 ) 323 - 6635 I 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 Hllich is not -•
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 161.54 2
Branch circuits new, alteration, or extension, per panel
Owner signature: _ Date: , A Pee for branch circuits with
,,,:c.,,,,,, ❑ APPLIf,"ANt e=- _? ; ' ' I Lr = ® CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: Hollywood Lights, Inc. B. Pee for branch circuits without
service or feeder fee, first 1 5 6 .1 8 56.18 2
Contact name: Dan Gustafik branch circuit
• Each odd'! branch circuit 7.42 2
Address: 5251 SE McLoughlin Blvd. Miscellaneous (service or feeder not included)
Each manufactured or modular
City/Statc/ZIP: Portland, OR 97202 dwelling, service and/or feeder 67.94 2
Phone: (503 ) 232 -8855 Pox:: ( 503 ) 517 -8686 Reconnect only 67.54 2
E -mail: dan @hollywoodlights.biz Pump or irrigation circle - 67.84 2
Signor outline lighting 67.94 2
-• ,;t ,ti's'
CON TRACTOYt '.. -; • Signal circuit(s) or lumted -energy
Business name: Hollywood Lights, inc. panel, alteration, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: 5251 SE McLoughlin Blvd. Additional inspection (l lir min) 66.25/ hr
City/State/ZIP: Portland, OR 97202 Investigation (I hr rain) 66.25/ hr
Industrial plans (1 hr min) 7818/ hr
Phone: ( 503) 232 - 8855 ` e Fax: (503 ) 517 - 8686 Inspections for which no fee is 90.00/ hr
— specifically listed (%: hr min)
CCB Lic.: 78109 1(i 1 Electrical Lie.: 26-673 I Suprv. Lie.: 570 ELECTRICAL PE(th1IT , �' •
Suprv. Electrician signature, required: � t I tj Subtotal: 56.18
Plan review (25% of permit fee):
Print name: Dan Gustafik Date: 12/12/2012 State surcharge(12%e ofpermit fee): 6.74
TOTAL PERMIT FEE: 62.92
Authorized signature: This permit opplicgtion aspires if a perm not obtained «41hia 160
days after Il has been accepted as complete.
Print name: bate: • Number of inspections allowed per permit.
I :ltivames'Permita'SLC- Peam - aApp doe 07/01/10 445- 1615T(11/03/CO'.WWJi5