Permit y u CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: ELC2013 00623
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718 2439 Date Issued: 10/21/2013
Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12266 SW SCHOLLS FERRY RD
Project: Dotty's Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Reconnect existing signage
Contractor: TUBE ART SIGNS&SPORTS DISPLAYS Owner: FW OR-GREENWAY TOWN CENTER LLC
4243-A SE INTERNATIONAL WAY PO BOX 790830
MILWAUKIE,OR 97222 SAN ANTONIO,TX 78279
PHONE 503-653-1133 PHONE.
FAX 503-659-9191
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 10/21/2013 $67 84
Specifics:
1 ea 12%State Surcharge- 10/21/2013 $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 accordance with 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. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-0010 •thro •AR 952-00 '090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 2 .1987 or 1 800 332 2344
Issued By: i/ i� d/ ' Permittee Signature:r
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.
• ectrical Permit Application FOROFFLCE USE ONLY
Received g �a3
' City of Tigard r--- Date/B �O %/ /5 Permit No' /J
" 13125 SW Hall Blvd.,Tigard,px„ i,ENE;,I Plan Review
-. : : .- Phone. 503 718.2439 Fax' 59 :-I�960 t- " Date/B Other Permit
T I'GA•R D Inspection Line. 503.639.4175 Date Ready/By lens El See Page 2 for
lntemet: www.tigard-or.gov OCT 21 2013 Notified/Method Supplemental Information
TYPE OE,WyiISc TIriARR PLAN REVIEW
❑New construction ®Addition/aiteratio' J epiacesnerttkl Please check all that apply(submit 2 sets of plans w/items checked below)
(iUlLi Jllyl' /t V iJl'J ❑Service or feeder 400 amps or more ❑Building over three stories
❑Demolition ❑Other: where the available fault current ❑Mannas 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.
❑Addition of new motor load of ❑"A","E","I-2","l-3",
Job no.: 121023 Job site address: 12266 SW Scholls Ferry Rd 100HP 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:Dotty's ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site:SW Scholls Ferry Rd&SW Springwood Dr 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 1
Tax map/parcel no.:R983537 Limited energy,residential 75 00 2
DESCRIPTION OF WORK (with above sq ft)
Limited energy,multi-family 75 00 2
Re-connect existing signage residential(with above sq ft)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER LI 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:( ) 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, i er panel
® APPLICANT ❑ CONTACT PERSON A Fee for branch circuits with
above service or feeder fee, 7 42 2
Business name:Tube Art Group each branch circuit
B Fee for branch circuits without
Contact name:Jessica Kosmas service or feeder fee,first 56 18 2
branch circuit
Address:4243-A SE International Way Each add'I branch circuit 7 42 2
City/State/ZIP:Milwaukie,OR 97222 Miscellaneous(service or feeder not included)
Each manufactured or modular 67 84 2
Phone:(503)6531133 ex 1217 Fax: :(503)6599191 dwelling,service and/or feeder
Reconnect only 67 84 2
E-mail:jkosmas @tubeart.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 1 67.84 '7$y 2
Business name:Tube Art Group Signal circun(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:Same As Above Each additional inspection over allowable in any of the above
- - Additional inspection(1 hr mm) 66 25/hr
City/State/ZIP: investigation(1 hr min) 66 25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) 78 18/hr
inspections for which no fee is 90 00/hr
CCB Lic.: 70956 Electrical Lic.: 37554CLS Suprv.Lic.: 366SIG specifically listed(%3 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal' 67-$3
Print name: Ken Schultz 7 Date: 10/21/2013 Plan review(25%of permit fee). �-
State surcharge(12%of permit fee): g./y
Authorized signature: i / i i TOTAL PERMIT FEE. 75.9g
Print name: Jessica Kosm.s Date: 10/21/2013 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
1\Building\Permits\ELC_PermiiApp_ELR_ERE doc Rev 05/21/2013 440-4615T(11/05/COM/WEB
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
n Audio and Stereo Systems* 15 01 to 25 kva zoo 34 2
ElAlarm 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
n 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
nEach additional inspection over allowable in an�f the above:
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr mm)
Inspections for which no fee is 90.00/hr
specifically listed(%3 hr mm)
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
n Clock Systems
❑ Data Telecommunication Installation
H Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ 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 Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12266 SW SCHOLLS FERRY RD, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
2014-02-25 00:00:00
ELC2013-00623
PASS - No C of O
Violation Summary:
Inspector Contractor