Permit II CITY OF TIGARD ELECTRICAL PERMIT
IN a: ' .. COMMUNITY DEVELOPMENT Permit #: ELC2013 -00345
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/03/2013
Parcel: 2S 101 DA00101
Jurisdiction: TIGARD
Site address: 13190 SW 68TH PKWY 200
Project: In Focus Subdivision: VARNS ACRES Lot: 9
Project Description: Sign lighting for (1) illuminated wall sign, 12' x 2.5.
Contractor: SECURITY SIGNS INC Owner: PACIFIC NW PROPERTIES LIMITED PA
2424 SE HOLGATE BLVD STERN FAMILY LIMITED PARTNERSHIP
PORTLAND, OR 97202 STERN, HELEN R REVOCABLE TRUST
6600 SW 105TH AVE #175
BEAVERTON, OR 97008
PHONE: 503 - 546 -7114 PHONE:
FAX: 503 - 230 -1861
FEES
Quantity Description Date Amount
Specifics: 1 ea Sign or Outline Lighting 07/03/2013 $67.84
1 ea 12% State Surcharge - 07/03/2013 $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 ordanc 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. AT NTION: Orego law re ' es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
10 th ough OAR 952 0 090. Y ay obtain a copy of the rules or direct questions to OUNC by can. 4' .232.1987 or 1.800.332.2344.
Issued Permittee Signatur II • .. ' di • ' °
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.
Electrical Permit Applica ><t '
IVED FOR OFFICE USE ONLY
Cit y of Tigard .' 5'1 2013 Received /,,
Cf" ��j p PermitNo.: hil(J d /L Zv
M3
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: SO Date /B eF TIGARD Date/B : Other Permit:
TI G A R D Inspection Line: 503.639 UILDING DIVISION Date Ready /By: Juris: See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
IX 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: 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 ", "I -2 ", "I -3 ".
Job no.: Job site address: / 3/ p $ GT.t, IOO or more. occupancy.
/ Q Le C. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ,ae4 U .,,,„ e"'. 97ee� / ❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: �� kr.. Ge6..r ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 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
; •---1. - L energy, multi-family 75.00 2
C
, „ ) > residential (with above sq. ft.)
U Y � - � v x Services es 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 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, per panel
Owner signature: Date: A. Fee for branch circuits with
va APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: (' B. Fee for branch circuits without
G zt� /� ..r,, w1 service or feeder fee, first 56.18 2
Contact name: ) • ,4 branch circuit
'e 4I-r4 / ' �l y �L�/� Each add'I branch circuit 7.42 2 ,'
Address: 292 y _co , / ,.e_ 1jz Miscellaneous (service or feeder not included)
_ �f Each manufactured or modular
City /State /ZIP: ,'5 ,,rt 7 --/„.„, a 172 O 2 dwelling, service and/or feeder 67.84 2
Phone: (re? ,212- y .7 2 Fax: : ( )
Reconnect only 67.84 2
/ Pump or irrigation circle 67.84 2
E - mail: e ///1k 0 re LuJ J . Lases Sign or outline lighting ! 67.84 77. 6 2
CONTRACT '�� Signal circuit(s) or limited- energy
•
Business name: panel, alteration, or extension. Page 2 2
wreL £f I' /7) 4I, /r/, j,I C Each additional inspection over allowable in any of the above
Address: 2- 92 Y .r /iw iip,. / Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Ap, / ..� �� 9 7 2422
Investigation p (1 ruin) 66.25/ hr
++'' �i �'C Industrial plant (I I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed (th hr min)
CCB Lie.: 12 2, o f Electrical Lie.: uprv. Lie.: 583 .-r., ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / ,Z4- 51ooe_L6 Subtotal: 6 7 ` -
/ -..---.. Plan review (25% of permit fee): � L
•
Print name: A1Q / ,
L L `, f Date: G �f.., J, State surcharge (12% of permit fee): ¥' / T
L /, TOTAL PERMIT FEE: 75 • 5' 8
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: y Date: / days after it has been accepted as complete.
�e 6 r /�q / ace., J C7 /?,/J Number of inspections allowed per permit.
1:\ Building \Permits \ELC- PermitApp.doc Mini/to 440 4615T( I I /05 /COM/WEB