Permit i;
- '4 CITY OF TIGARD ELECTRICAL PERMIT
` - 2 COMMUNITY DEVELOPMENT Permit #: ELC2013 -00269
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/13/2013 r
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15957 SW 72ND AVE
Project: Bikram Yoga Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
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Project Description: (1) sign lighting
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Contractor: INTEGRITY SIGNS OREGON Owner: PACIFIC REALTY ASSOCIATES
PO BOX 88 ATTN: N PIVEN
HUBBARD, OR 97032 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 981 -3743 PHONE: 503 624 -6300
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/13/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 05/13/2013 $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 - • i. - ith 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. • ENTION: Oreg.• la, : ir= you to follow the rules adopted by the Orygarf • =t!•n Center. Those rules are set forth in OAR
952 -0 %1 -0010 through OAR 9 001 -009; may obtain a copy of the rules or direct questions to OUNC by calling •' 2.1987 or 1.800.332.2344.
Is ed By: ► �= O ../..A.—...&.—..1 _ � — � Permitte- • .. . - °! .:. , . /
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:
s
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. 'L
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Electrical Permit ApplicatioRECEIVE FOR OFFICE USE ONLY
Received G -mod if
City of Tigard DateB : 611/12111M, Permit No.: 3 9
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
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Phone: 503.718.2439 Fax: 503.598.194jAY 1 3 2013 DateB : Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF [ )LUNG 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: S I ( 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
❑ I- 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 ". "I -2 'l -3 ".
Job no.: Job site address: n [- C I , 100HP or more. occupancy.
/5 7 J �L J 7 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: � 1`c, �� J ❑Health -care facilities. 0 Supply voltage for more than
VJ c ► ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: LB k �I AIt 1'Yl \ /On CV ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qtv. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
o , t Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add' 1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: '
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
. na.e x 0 L;r - u vs , residential (with above sq. ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
I __B CONTACT PERSON A. Fee for branch circuits with
r above service or feeder fee,
7.42 2
Business name: \ each branch circuit
in �l i �1 Ch S on 0 B . Fee for branch circuits without
�
Contact name \ ( 1.`1,l 0 J service or feeder fee, first
1 branch circuit 56.18 2
Address: 9t. Aar Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State/ZIP: ri I ( A- �h ^ �� ( � ` �U a Each manufactured or modular
r `� 2
I dwelling. service and/or feeder
Phone: 813 Q -3'7 4 ^ Fax: : 6 2 3 ) , vd _ E I S3 Reconnect only 67.84 2
E JQ,y Iprtn e i n -I e Q i 5 S ( ! s l 6 Pump or irrigation circle 67.84 2
CONTRACTOR J outline lighting I 67.84 7. 'L 2
Business name: al circuit(s) or limited-energy
�5 h (n S o p (t1ti.) panel, alteration. or extension. Page 2 2
Address: J Each additional inspection over allowable in any of the above
Additional inspection (I hr min) 66.25/ hr
City /State /ZIP:
Investigation (I hr min) 66.25/ hr
Phone: ( ) Fax: ( ) Industrial plant (I hr min) 78.18 / hr
Inspections for which no fee is 90.00/ hr
CCB Lic.: p y IS - s - Electrical Lic.: L D LS a0 Suprv. Lic.: 3qt_ SI to specifically listed ('/ hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Subtotal: 6 7.
Print name: T ixP a IA �A C Date: fi _ D `) Plan review (25% of permit fee):
l J d State surcharge (I 2% of permit fee): g , r`i
Authorized signature: TOTAL PERMIT FEE: -7S 9 6'
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \ Pumas \Et.C_I'ermitApp_040913.doc 440- 4615T( I I /115 /COM/WEB