Permit n CITY OF TIGARD ELECTRICAL PERMIT
111111 14: - COMMUNITY DEVELOPMENT Permit#: ELC2013-00500
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/11/2013
Parcel: 1 S135BC00202
Jurisdiction: TIGARD
Site address: 10763 SW GREENBURG RD 110
Project: Mattress Closeouts Subdivision: HILLSBORO Lot: PTS 1-2
Project Description: Sign lighting for an 80 sq.ft.sign.
Contractor: MEYER SIGN CO OF OREGON Owner: BELANICH, ROGER M
15205 SW 74TH AVE 22020 17TH AVE SE#200
TIGARD, OR 97224 BOTHELL,WA 98021
PHONE: 503-620-8200 PHONE:
FAX: 503-620-7074
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 09/11/2013 $67.84
Specifics:
1 ea 12%State Surcharge- 09/11/2013 $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 - or•anc-with approved plans. This permit will expire if work is not started within 180 days of iss - ce, of if work is suspended for more the 180
days. A r ENTION: Orego law uires you to follow the rules adopted by the Oregon Utility Notifica ent jr.. Those rules are set forth in OAR
952-001 11010 through OAR 95 1-0090. u may obtain a copy of the rules or direct questions to OUNC by calling 5 .19;1'/or 1.800.3 .2344.
Issue. =y: Permittee Signature:
41/
/� _
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 Application FOR OFFICE USE ONLY
Received
City of Tigard Date/B : ■ '-i s/ n� Permit No.: .j ,� ,,.
11111 11 13125 SW Hall Blvd.,Tigard,OR 9.. � Plan Review
Phone: 503.718.2439 Fax: 51 "1. 0 , -, Date/B : Other Permit: ill _QQ As
V
Inspection Line: 503.639.4175 `` Date Ready/By:
.it.... ® See Page 2 for+' 0)41,Internet: www.tigard-or.govNotified/Method: ¢- Supplemental Information
ormation
�
TYPE OF WORK 6. %C.,
��`\`
PLAN REVIEW
El New construction El Addition/alterati i* ear 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:Sign where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONS l'RUCTION 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
El Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","1-3",
Job no.: Job site address: 10763 C SW Greenburg Rd I or more. occupancy.
❑Six x o or r more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: Mattress Closeouts ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description - I. Qty. ) 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'1 500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
Connect internally illuminated cabinet sign to existing electrical. residential(with above sq.ft.) _
Services 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: Mattress Closeouts/Ryan Lewis 601 amps to 1,000 amps 301.04 2
Address: 10763 C SW Greenburg Rd Over 1,000 amps or volts 552.26 2
City/State/ZIP:Tigard,OR 97223 Temporary services or feeders installation,alteration,and/or
y g relocation
Phone:(503)812-3272 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
® APPLICANT ® CONTACT PERSON above service or feeder fee, 7.42 2
_ _each branch circuit
B
Business name: Meyer Sign Co Fee for branch circuits without
- --- - . _ service or feeder fee,first
Contact name: Ellen Karnes branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: 15205 SW 74th Ave Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP:Tigard,OR 97224 67.84 2
dwelling,service and/or feeder
Phone:(503)620-8200 Fax: :(503)620-7074 Reconnect only 67.84 2
Pump or irrigation circle 67 84 2
E-mail: permits @meyersignco.com
Sign or outline lighting I 67.84 "7.iril 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name: Meyer Sign Co panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 15205 SW 74" Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Tigard,OR 97224 Investigation(I hr min) 66.25/hr
Industrial plant(I hr min) 78.18/hr
Phone:(503)620-8200 Fax:(503)620-7074 Inspections for which no fee is 90.00/hr
specifically listed(Yz hr min)
CCB Lic.: 64014 Electrical Lic.: 20-190CL Suprv.Lic.: 524 SIG ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: (o�,
Plan review(25%of permit fcc):
Print name: Carey Rhoads Date: 8/21/13 State surcharge(12%of permit fee): f- IN
TOTAL PERMIT FEE: 7tj.CO2
Authorized signatur
This permit application expires if a permit is not obtained within 180
Print name: Ellen Karnes Date: 8/21/13 days after it has been accepted as complete.
• Number of inspections allowed per permit
I:\Building\Permits\ELC-PermitApp.doc 07/01/10 440-4615T(II/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other Sign
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I.\Building\Permits\ELC-PermitApp doc 07/01/10