Permit CITY OF TIGARD ELECTRICAL PERMIT
_ COMMUNITY DEVELOPMENT Permit #: ELC2013 -00667
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/09/2013
Parcel: 2S102CB03200
Jurisdiction: TIGARD
Site address: 9975 SW FREWING ST
Project: United Urgent Care Subdivision: FREWING'S ORCHARD TRACTS Lot: 21
Project Description: Sign lighting for (2) wall signs
Contractor: VISION SIGNS LLC Owner: MASSIH LLC
16127 NE THOMPSON STREET BY PIERROUZ YASAVOLIAN
PORTLAND, OR 97230 8 BECKET ST
LAKE OSWEGO, OR 97035
PHONE: 503 - 442 -1195
PHONE: 503 - 704 -4240
FAX:
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 12/09/2013 $135.68
Specifics:
1 ea 12% State Surcharge - 12/09/2013 $16.28
Electrical
Type of Use: COM
Class of Work: ALT
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 other applicable law. All work will
be done i ccordance With a pproved plans. This permit will expire if work is not started within 160 days of issuance, or if work is suspended for more the 180
days. ENTION: Oregon law requires ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 0010 thro gh OAR 952 -001 1091 ou a • btain a copy of the rules or direct questions to OUNC by calling 503.232.1 • : • :$0. •2.2 .
Issue By: — � _ - �� ■•1. Permittee Signature:
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 A lic G DIVE® FOR OFFI('IT 1 `I 1\1 1
City of Tigard ' 1 4MP1 Datee / / t/� /,, ( ,vi Permit No.: ��Gl.49/ - G��nlo
II • 13125 SW Hall Blvd., Tigard, OR lop 5 2013 Plan Review Other Permit: � / di, , . e�
Phone: 503.639.4171 Fax: 503.598.1960 Date /B y.
T I G ARD Da R B Iuris S See Page 2 for
Inspection Line: 503.639.4175 CITY ( Ready /By: / Al /).—./ Supplemental Information
I WARD Internet: www.tigard-or.gov 1 t v1 Notified/Meth
' i ' i
TYPE
PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below).
New construction ction ❑ Addition/alteration /replacement ❑S ervice or der 400 amps or more 0 Building over three stories.
fee
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
CATEGORY OF CONSTRUCTION less to ground, or exceeds 14,000 0 Commercial -use agricultural
Accessory building a mps for all other installations buildings.
1711 1 - and 2- family dwelling (� Commercial /industrial ❑ rY g ll th
❑Installation of 75 KVA or
` ❑ Fire pump.
❑ Multi family ❑Master builder ❑Other: larger separately derived systen
❑Emergency system. 6 P� y
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ". "1-2", "1-3
100HP or more. occupancy.
A Q � /� l Job site address: ( J �� 5 � I �j��' y}(f „7:,74 j.- ❑Recreational vehicle parks
Job no.: d ' 1 f ❑ Six or more residential units ❑ Health -care facilities. ❑ Supply voltage for more than
y g
Clty/State /ZIP: 9 600 volts nominal.
„ a �/ Service s locations - or feeder 600 amps or more.
l U� `f J Project name: A 1 fm � ❑ H � „„ ii ❑ Service o
Suite/bldg./apt. no.: I 0 C
t/ �+2t%' FEE SCHEDULE
Description I Qty. I Fee. I Total
Cross street directions to job site:
( New residential single - or multi - family dwelling unit.
9 , •,J I ih (�( , J /4 <I ( A � rt lJ p C 1, YT G if Includes attached garage.
L s 1.000 sq. ft or less 168.54
Subdivisi �N /� t '(/� 11 on: Lot no.: Fa. add'( 500 sq. ft. or portion 33.92
Tax map /parcel no.: Limited energy, residential 67.84
DESCRIPTION OF WORK (with above sq. ft.)
Limited ey, multi - family 84
-eyp� e , / residential enrg feeders above sq ft. )
67
�/ n !Y11 01 E{ e f i /n!M ( { �� f� !/L Services or feede installation, alteration, and/or relocation
(\ 200 amps or less 100.70
e TY OWNER l)4i �� 201 a mps to 400 amps 133.56
ya PROPERTY OWNER TENANT
401 amps to 600 amps 200.34
/ / 601 amps to 1,000 amps 301.04
Name � �� f: Alai , t: / ii,Qlt o f D ll JL p
+l Pi Over 1,000 amps or volts 552.26
Address: /l aa n ,`I , cr / v
y '! �, S J W {001‘,,,, Q Temporary services or feeders installation, alteration, and /or
�J � C/742 '
City/State /ZIP: /, J ag relocation
59.36
' 200 amps or less
Phone: (5;3 ) `70� �f i/ [ Fax: ( ) 201 amps to 400 amps 125.08
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54
intended for sale, lease, rent, or exchange, according to ORS 447. 449, 670. and 701. Branch circuits new, alteration, or extension, per panel
Date: A. Fee for branch circuits with
Owner signature: above service or feeder fee.
_ 7.42
❑ APPLICAN I XCONTACT PERSON each branch circuit
J �( B. Fee for branch circuits without
Business name: V r /din f� 4s5 / service or feeder fee, first 56.18
branch circuit
Contact name: 1, ///1711 Each add'l branch circuit 1 7.42
Address: / 6 , 1 02 7 N C / l c,,,./, -,.,0
Ct 'd " Miscellaneous (service or feeder not included)
rs n Each manufactured or modular
City /State /ZiP: loin / a n, ri Oh- q / 7 a / 3 [ .) dwelling, service and/or feeder 67.84
_ Reconnect only 67.84
Phone: (.51 3) 4/,# _ ii Fax: : ( ) Pump or irrigation circle 67.84
n j
E -mail: 1 c(ht e i) Siia S' . (, Lrfil1i j•3ign or outline lighting ; 67.84 /,'• " 4' f5
ONTRACTOR Signal circuit(s) or limited - energy
1 panel, alteration, or extension. Page 2
Business name: ` 1 5, Din _ � jd/ i_ c / Z L Each additional inspection over allowable in any of the Om
/92 N C/ , / Additional inspection (l hr min) 66.25/ hr
Investigation (I hr mm)
Address: 1.4.-- �� //Jj1��alfl r` 66.25/ hr
n �7
City/State /ZIP:
A R It / 4,, ` vJ /3� Industrial plant ( hr min) 78.18/ hr
inspections for which no fee is 90.00/ hr
Phone: /� y,Z `� 9 I Fax: ( ) � specifically listed ('/z hr min)
CCB Lic.: 00 I Electrical Lic.: Suprv. Lie.: /•7,6 , r ELECTRICAL PERMIT FEES
/4 / 1 1 N / d Subtotal: /j r 44
Suprv. Electrician - ure, required: � / Plan review (25% of permit fee):
Print name: P „f l A �, • `l Date: ��/ /� 1, 11
State surcharge (12 °/4 of permit fee). /(p • :+t
d V4 / TOTAL PERMIT FEE: 5/ . � . Ap
Authorized signature: This permit application expires if a permit is not obtained within
days after it has been accepted as complete.
/� / (7/
Print name: J a �
ti /biz � f / , f * Number of inspections allowed per permit.
L\Buildmg Perm itsNF,LC- PamrtApp doc 10/01/(14
a40- 4615T(1 t /os/COM/WEB
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
9975 SW FREWING ST, TIGARD, OR, 97223
Commercial - Electrical
140 Sign installation
2014-02-26 00:00:00
ELC2013-00667
PASS
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
9975 SW FREWING ST, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
2014-02-27 00:00:00
ELC2013-00667
PASS - No C of O
Violation Summary:
Inspector Contractor