Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00391
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/10/2013
Parcel: 1 S134BC00600
Jurisdiction: Tigard
Site address: 12390 SW SCHOLLS FERRY RD
Project: Kiss Car Wash Subdivision: 1993 -057 PARTITION PLAT Lot: 2
Project Description: (1) sign lighting
Contractor: CUSTOM SIGN CO INC Owner THOMPSON, DENNIS C
9316 SW 12TH DRIVE 9295 SW ELECTRIC ST
PORTLAND, OR 97219 TIGARD, OR 97223
PHONE: 503 - 201 -8469 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 07/10/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 07/10/2013 $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. ' NTION: Oregon - • requ'•• ou to follow the rules adopted by the Oregon Utility Notification Center. Those rule are It forth in OAR
952 -0a -0010 throw. h OAR 952 -001 % • 0. Yo may obtain a copy of th rules or direct questions to OUNC by calling 503.232. 987 or 1.800.3 .23 .
Iss = d By: / Permittee Signature: Y _ S1 I y � 1,
OWNER INSTALLATION ONLY Cu ( N 1 " ( V\ v P.
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 Application FOR OFFICE USE ONLY
City of Tigard Date/By: / ! o f 2 _Q7 Permit No.: f � J C. C/ 3c
I II q 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
C • Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
IA G A R a Inspection Line: 503.639.4175 Date Ready/By: Sufis: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN 'REVIEW
N ew 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 150 KVA or
JOB SITE INFORMATION AND' LOCATION ❑ Emergency system. larger separately derived system.
r , nn --'' ❑ Addition n
ddition of new motor load of ❑ "A ", "E ", "t -2 ", "1 -3 ",
Job no.: Job site address: 12370 5t4) SCti(;ll� liry W Irmos. occupancy.
❑
/ ❑Sixix or or more residential units. Recreational vehicle parks.
City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Kiss Intl Wksh Sckdl' Jd y ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:ki.c4 Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
N OI k Zta (,4c STre e 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
Limited energy, multi- family 75.00 2
I e\ e e( ' (fir; in — tAfek.1 I & n \l Si k residential (with above sq. ft.)
v I Renewable Energy ❑ See Page 2
k' C i e w 45 lI c t Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER 'I . ❑ TENANT 200 amps or less 100.70 2
11' 201 amps to 400 amps 133.56 2
Name: WAS 6 v- WAS ScArAlsigt Alry P P
401 amps to 600 amps 200.34 2
Address: am 0 5 (4J S . k '(tS 4 v VA , 601 amps to 1,000 amps 301.04 2
r Over 1,000 amps or volts 552.26 2
City/State /ZIP: '"h �Iaf ci 0 IiCibh T1 7_2-3 Temporary services or feeders installation, alteration, and /or
relocation
Phone: r ) Fax: ( ) 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
❑ APPLICANT . I . ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: C C each branch circuit
S J� In C ACIt/rvj � � B. Fee for branch circuits without
Contact name: —rje service or feeder fee, first
q � t/`� ��t ( �l 1 " 1 � branch circuit 56.18 2
Address: 63I ( 5 lib- Each add'I branch circuit 7.42 2
City/State /ZIP: CO (AAA Ad 0 q17'14 Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (S'� Z� (_ Nog Fax: : ( ) Reconnect only 67.84 2
E -mail: `I0461 0
g l(il1 bar- 4N - C — x Cal"-1 Pump or irrigation circle 67.84 2
1 CONTRACTOR Sign or outline lighting / 67.84 (07 2
Business name: ` �A� Signal circuit(s) or limited- energy See
Cu \ • • � � � Q �� � C panel, alteration, or extension. Page 2 2
Address: at ' l � "l S(, / \2 -Vs OI Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: b v_ d o ��]] O0 v` 1 . iq Investigation (I hr min) 66.25/ hr
Phone: 6.3 ) 20 I - ott eq 1 Fax' ) 7/t b si Industrial plant (1 hr min) 78.18 / hr
l9 y Inspections for which no fee is 90.00/ hr
CCB Lic.: " ( " - Electrical Lic.: Li -13 5 i l Su rv. Lic.: 26 d5 specifically listed C: hr min)
4/9 ELECTRICAL PERMIT .FEES
Suprv. Electrician signature, required: -4 €53 ` o Subtotal: (, 7 " 5'
Print name: -\-od ( PY \\,�
l 1 Date: ? —1 G - (3 Plan review (25% of permit fee):
{�� �� ' 1 State surcharge (12% of permit fee): g. /et
Authorized signature: �,� _ _ 2 i TOTAL PERMIT FEE: 75. F
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \ Building\ Permits \ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440- 4615T(t 1 /05 /C M/WEB
( 2 5 ' 9 °)
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552.26 2
❑ Heating, Ventilation and Air Conditioning OAR 918- 309 -0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva— no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is
charged at an hourly (1 hr min) 66.25/ hr
Inspections for which no fee is 90.00/ hr
specifically listed (%a hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building\ Permits \ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12390 SW SCHOLLS FERRY RD, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
2013-12-09 00:00:00
ELC2013-00391
PASS - No C of O
Violation Summary:
Inspector Contractor