Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2013 00546
Date Issued: 09/16/2013
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718 2439 Parcel: 1 S136DB02400
Jurisdiction: TIGARD
Site address: 11642 SW PACIFIC HWY 140
Project: Rick's Barber Shop Subdivision: AZOIC TERRACE Lot: 1
Project Description: Installation of(1)branch circuit for business sign
Contractor: CRAINIC ELECTRIC CO Owner: CHAMPION, RONALD V& ROBERTA E
15812 SE BROOKLYN ST 16449 LEXINGTON CT
PORTLAND, OR 97236 LAKE OSWEGO, OR 97034
PHONE: 503-913-8005 PHONE
FAX 503-760-1787
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 09/16/2013 $56 18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/16/2013 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62 92
Required Items and Reports(Conditions)
This permit is issued • - • 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 ' •ance with appro • 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 ATT• 'TION: Oregon law req = you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-0',10 thro',gh OAR 952-001-0,'S Y•u m- obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued =y: _ Permittee Signature: C� �l1 C
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 .D. : CEIVED „OR OFFICE I. u12.ONLY
g Plan' 2: 2 //
IN
:. ' City of Tigard c D 16 2013 Date/By ( �� /3� Permit No �t/J'�57p
-u° 13125 SW Hall Blvd,Tigard,OR 97223
Review
Phone. 503.718 2439 Fax. 50 Date/By Other Permit.
?I G A R D Inspection Line: 503.639.4175 $��F TIGARD Date Ready/By Juris ® See Page 2 for
Internet' www.tigard-or.gov BUILDING DIVISION Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction A 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 stones
❑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 denved system
❑Addition of new motor load of ❑"A","E","I-2","l-3",
Job no.: Job site address: 0 I G 4 2 S...! PA-C.,( L 1,r I Six or or more R occupancy r
Q J ❑Six or more residential units ❑Recreational vehicle parks.
City/State/ZIP: /toy.RW O� ®„ �,. ❑Health-can:facilities. ❑Supply voltage for more than
❑Hazardous locations 600 volts nominal
CA ldg./apt.no.: /4,0 Project name: t`, 1 i `5 [12�/� ' ® ❑Service or feeder 600 amps or more.
K,5 nD1a• FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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
(with above ft.) 75 00 2
DESCRIPTION OF WORK ( sq. ) ,
Limited energy,multi-family/n'I2-i %/ ,e Sot 1( Si6� residential(with above sq.ft.)
75 00 2
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:( ) I 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
❑ APPLICANT I ❑ CONTACT PERSON A Fee for branch circuits with
above service or feeder fee, 7 42 2
Business name: Q/4/97AP iC C,C-=C-i-M--'C (....`;') each branch circuit
B Fee for branch circuits without Q
Contact name: service or feeder fee,first 56.18 (p /a 2
branch circuit
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67 84 2
Phone:( ) I Fax: :( ) dwelling,service and/or feeder
Reconnect only 67 84 2
E-mail: Pump or irrigation circle 67 84 2
CONTRACTOR Sign or outline lighting 67 84 2
Business name: l:/a,,u/L , is 'c aro Signal circuit(s)or limited-energy See
panel,alteration,or extension Page 2 2
Address: /512_ (3QQokj fB�/ ,)e, 0€ 97230 Each additional inspection over allowable in any of the above
/ Additional inspection(I hr mm) 66 25/hr
City/State/ZIP:
�
i 3 Investigation(1 hr min) 66.25/hr
Phone:(J v3 9, 8 0€)3 I Fax:( ) Industnal plant(1 hr mm) 78 18/hr
Inspections for which no fee is
CCB Lie.: 1 b 9 5 Electrica o.: C 01 f Suprv.Lic.: 4 830. specifically listed(%hr min) 90 00/hr
Suprv.Electrician s ELECTRICAL PERMIT FEES ,l
p stare,reggi d: S-�¢ Subtotal: r6, (?1
q Plan review(25%ofpermit fee).
Print name:�J•'/L(/i� 3�/-tz Date: ,/3, �/3
State surcharge(12%of permit fee): ee.7S/
Authorized signature: TOTAL PERMIT FEE.
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
P6rg C)_3-,(1 2 0/3 -- 000 5a9