Permit CITY.OF TIGARD ELECTRICAL PERMIT .
P • ' COMMUNITY DEVELOPMENT Permit ft: ELC2013 -00051
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/06/2013
T I [; A R n 9 Parcel: 1 S136AD06502
Jurisdiction: Tigard
Site address: 10935 SW 68TH PKWY .
Project: BLITZ SPORTS PUB Subdivision: WAY LEE Lot: 1
Project Description: Sign lighting for (1) wall sign.
Contractor: CARRICK ELECTRIC Owner: TIM BECKER
4875 NW KAHNEETA DR 10935 SW 68TH PKWY
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE: 503 - 591 -8474 PHONE: 503 - 719 5157
FAX: 503 -645 -8273
FEES
Quantity Description Date Amount
Specifics: 1 ea Sign or Outline Lighting 02/06/2013 $67.84
1 ea 12% State Surcharge - • 02/06/2013 $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. Specialty Codes and all other applicable law. All work will
be done in a • - - 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. ATTE , ION: Oregon -w = • ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 0 through OAR 952% 1 -0094. u may obtain a copy of the rules or direct questions to OUNC by calli . .1987 or 1.800.332. 344.
Issued = Permittee Signature: — - r`.aT:Ki el IF
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' J , - An. ,..--- Date:
LICENSE NO.
Call 503.639.4176 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.
Jan 1713 01:13p Smyth 7077475757 p.3
, RECEIVED -
Electrical Permit Application role OFFICE l :SE ()NIA •
• City of Tigard 11 2013
JAN mut 1 m �Permit 5- Y a
Peit No.: �, ✓
III • (3125 SW Hall Blvd., Tigard, OR 97223 ��pp��
r _
O • Phone: 503.718.2439 Ft= 503.598.191 M( 011 ❑ TIGARD Other Permit:
Inspection Line: 503.639.4175
T; GA RD Inlcrtlet www tigard or.gov BU ILDING DNISIO . :.-
hair S See Page 2 for
Supplemental Information
TYPE OF WORK • PLAN REVIEW
el New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w; iamns checked below):
El Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the availabk fault current ❑ Marinas and boatyards.
• CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
El -and 2- fatally dwelling ® Commercial /industrial less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 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 ❑ -q" - ^ -t_2 ' -1.3
Job no.: Job site address: 10935 SW 68 Parkway I 0011 or mom. occupancy.
❑ Six or more residential mots. ❑ Recreational vehicle parks.
City / State/ZIP: Tigard, OR 97223 0 Health-care facilities. ❑ Supply voltage for more than
' ❑ Hazardous locations 600 volts nominal.
Suite/bldgJapt. no.: Project name: Blitz 99W Sports Pub ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SC>3EDULE
Descripioo I Qty. I Fee. i Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: [ Lot no.: 06502 1,000 sq. R or less 168.54 4
Tax map/parcel no.: lS136AD Fa add') 500 sq. ft. or portion 33.92 t
Limited energy, residential 75.00 2
DESCRIPTION OF WORK • (with above sq. tt)
Limited energy, multi - family 75.00 2
Connect sign to existing circuit residential (with above sq. ft)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ® TENANT 201 amps to 400 amps 133.56 2
Name: Tim Becker 401 amps to 600 amps 20034 2
601 amps to 1,000 amps 301.04 2
Address: 10935 SW 68 Pkwy Over 1,000 amps or volts 552.26 i 2
City/State/ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)7195157 I Fax: ( ) 200 amps or less 59.36 1 I
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 12
Branch circuits- new, alteration, or extension. per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ®"CONTACT PERSON above brunch circuit eeder fec, 7.42 2
•
Business name: Carsick Inc B. Fee for branch circuits without
service or feeder fee. first 56.18 2
Contact name: Alison Smyth branch circuit
Address: 4875 NW Kahneeta Dr. Each acid'] branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Portland, OR 97229 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 591 I Fax: : ( } Reconnect only 67.84 2
E - mail: Doug@carrickioCeom Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting X 67.84 //� ?(i 2 .
• Signal circuit(s) or limited - energy ' " r
Business name: Carrick Inc. panel, alteration, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: same as above Additional inspection (I hr mm) 66.25/ hr
City / State/ZIP: Investigation (I hr min) 6625 / hr
Industrial plant (I hr min) 78.1 & / hr
Phone: ( ) • Fax: ( ) Inspections for vvhirh no fee is
N - I specifically listed (1', hr min) 90.00/ hr
CCB Lic.: 120169 iIIif Electrical Lic. - 439c -. Suprv. Lie.: 2293
29s !' /I ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: �pl. V'
/
e: K6j` /` Plan review (25% of permit fee):
> kS ( et rr r
Print nam Date: I - 1 - r - 1 State surcharge (12% of permit fee): b/.07,
Authorized signature: `��1".,-- This permit TOTAL PERMIT FEE: .7_5-
applies] expires if a permit is not obtained within t
I Print name: t S Coln, - , � 4 D ate: I / 1 7 t' days after it has been accepted as complete.
• Number of inspections allowed per permit.
i AlluldingWermintELGPermitAyp.doc 0741/10 440 57(11/05/C004/WEB