Permit n CITY OF TIGARD ELECTRICAL PERMIT
a , COMMUNITY DEVELOPMENT Permit#: ELC2013 00598
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2013
Parcel: 2S102AA00905
Jurisdiction: Tigard
Site address: 12000 SW MAIN ST
Project: Sierk Orthodontics Subdivision: PAYLESS SHOPPING CENTER Lot: 5
Project Description: Sign lighting for(2)signs.
Contractor: MEYER SIGN CO OF OREGON Owner: HAAGEN,GARY L&CANDACE C TRS
15205 SW 74TH AVE 2514 SE 112TH AVE
TIGARD,OR 97224 VANCOUVER,WA 98664
PHONE: 503-620-8200 PHONE:
FAX: 503-620-7074
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 10/09/2013 $135.68
Specifics:
1 ea 12%State Surcharge- 10/09/2013 $16.28
Electrical
Type of Use: COM
Class of Work: •PvBH OTR
Type of Const:
Occupancy Grp:
Total $151.96
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 • = apalicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or i - '•rk •• /spended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent- . ho-_ Iles are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain. •• • .:rules or di •uestions to OUNC by calling 503.232.1•;7 or .800.: %4'344.
411111116 __Issued By e-----4— --- PermitteeSignature: -II�
�+ V
•" ER 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 11SE ONLY
City of Tigard '(0\ �\ ; Received ._ _
III +� Plaleive L PenmtNo' ea
13125 SW Hal I Blvd..d..Tigard,OR' � n:\.4 Plan Review.
Phone: 503.718 2439 Fax. 503.59 9GB` rno�`� Date/B Other Permit: 5 , i( —do!
T I G A K D Inspection Line 503.639.4175 ( ( ( Date Ready/By. luris r. See Page 2 for
Internet www.tigard-or.gov Oli` Notified/Method. Tr.-6, Supplemental Information
TYPE OF WOB t'�� It yeV, PLAN REVIEW
° Please check all that apply 0 New construction ®Addition/alterati � rgC[1!��� pp Y(submit 2 sets of plans w/items checked below)
QV ❑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: ❑File 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","1-2","I-3",
Job no.: Joh site address: 12000 Main St. IOOHP or more occupancy.
❑Six or 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: Sierk Orthodontics ❑Service or feeder 600 amps or more.
��'3 FEE SCHEDULE
Cross street/directions to job site: Hwy. 99 H d r S P Deseriplion T Qty. I Fee. 1 Total I •
ur JapOPt 15 New residential single-or multi-family dwelling unit.
t -� Includes attached garage.
Subdivision: ,� I G t,. 1-\ Lot no.: 1,000 sq.R.or less 168.54 4
V Ea add'I 500 sq.ft.or portion 33.92 I
Tax map/parcel no.:
Limited energy,residential
DESCRIPTION OF WORK (with above sq.t.) 75.00 2
Limited energy,multi-family 75 00 2
connect 2 illuminated sets of pan channel letters to existing electrical residential(with above sq R.)
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: Polly Sierk 601 amps to 1,000 amps 301.04 2
Address: 12000 Main St. Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: Tigard, Or 97223 relocation
Phone:( 503) 702-1157 I 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 401 amps to 599 amps 168.54 2
intended for sale,lease.rent.or exchange.according to ORS 447,449,670,and 701.
Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits trait
tEl APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name:Meyer Sign Co B Fee for branch circuits ivnhout
service or feeder fee,first 56.18 2
Contact name:Ellen Karnes branch circuit
Each add'I branch circuit 7.42 2
Address: 15205 SW 74111 Ave Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP:Tigard,OR 97224 dwelling,service and/or feeder 67 84 2
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 2 67.84 1 1,5(,% 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 74111 Additional inspection(I 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/Itr
specifically listed(V2 hr min)
CCB Lie.: 64014 Electrical Lie.: 20-190CL Suprv. Lie.: 524 SIG ELECTRICAL PERMIT FEES
Suprv. Electrician signature. required. Subtotal: . 5.(.4t-
Suprv.
�^ Plan review(25%of permit fee):
Print name: Phil Re olds/ • Bate: 10-2-13 State surcharge(12%of permit fee): ((p R
`�
Authorized signature: ,, TOTAL PERMIT FEE: (�I. 4(e
This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Print name: Tony McCormick Date: 10-2-13 r Number of Inspections allowed per permit.
I\Bwldmg\Permits\ELC-PermiuApp dm. nrnl'IS 440.4615T(1 I/05/COMIWEB .
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
12000 SW MAIN ST, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
2013-12-23 (null)
ELC2013-00598
FAIL
Not ready. Nobody on site
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12000 SW MAIN ST, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
2014-01-03 (null)
ELC2013-00598
PASS - No C of O
Violation Summary:
Inspector Contractor