Permit r
CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2014-00061
E G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2014
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Parcel: 1S 136DCO2504
Jurisdiction: Tigard
Site address: 7301 SW DARTMOUTH ST
Project: Lumber Liquidators Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: 1(1)sign lighting for wall sign.
Contractor: RUDNICK ELECTRIC SIGNS LLC Owner: AMERICAN INDUSTRIES INC
1625 WASHINGTON ST 1750 NW FRONT AVE STE#106
OREGON CITY, OR 97045 PORTLAND, OR 97209
PHONE: 503-655-2610 PHONE:
FAX: 503-980-7919
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 02/11/2014 $67.84
Specifics:
1 ea 12%State Surcharge- 02/11/2014 $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 ue• su• - to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do - in accordance with a••roved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day . ATTENTION: Oregon la -•w -s ou to follow the rules adopted by the Oregon Utility Notification Center. Th se rules are set forth in OAR
95 -001-0010th .ugh OAR 952-�-0090. • ay obtain a copy he rules or direct questions to OUNC by calling 503.23 87 1 • 332.234
Issued By: _� �i �t Permittee Signature: •_ I ��� �"m�
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 Apr)ilea>il0 FOR OFFICE USE ONLY
City of Tigard EVI�l "DeB �� i/ - plQ
Permit No.:
Eri
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
4oEB 1 1 2014 Other Permit:
Phone: 503,639.4171 Fax: 503.598.19 Date/B : Oth la See Page 2 for
TIGARD Inspection Line: 503.639.4175 Date Ready/By:
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
7l PE OF PLAN REVIEW
�m1r,minim
New construction ❑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 stories.
f❑ 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 75 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORM N ND LOCATION ❑Addition of new motor load of ❑"A","E","1-2","1-3",
1 `l�- ,, ,�,�j.� 100HP or more. occupancy.
Job no.: Job site address: Ci; �Otr"CYN.I11(r'-'v ` ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: '' - Q -772 ❑Health-care facilities. ❑Supply voltage for more than
■�� �`\ 4 C� > ❑Hazardous locations. 600 volts nominal.
6.1,4j00.4.- „. k j ❑Service or feeder 600 amps or more.
Suite/bldg./apt.no.: Project name:
��++��^^ 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: I Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
\ � Limited energy,multi-family 75.00 2
.. k- . (, \ 'C,kti, s� �\�q,�r, Cl residential(with above sq.ft.)
)) '(� ' Services or feeders installation,alteration,and/or relocation
v 200 amps or less 100.70 2
El 201 amps to 400 amps 133.56 2
PROPER IN OWNLR 1 I I:N.�N 1'
” 401 amps to 600 amps 200.34 2
Name: �Vy .c ^ �t ' ^C"-c4' k._ 601 amps to 1,000 amps 301.04 2
Address: ' C I\✓`0. � Over 1,000 amps or volts 552.26 2
,� Temporary services or feeders installation,alteration,and/or
City/State/ZIP: `,has Q ` �Z7 c relocation
Phone:( ) 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
al APPLICANT ® CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: S r�� B.Fee for branch circuits without
-?...A.)&4\.‘e Elee.-�r. S service or feeder fee,first
Contact name: e- ea,, branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: , ..0zs- S1, Miscellaneous(service or feeder not included)
Each manufactured or r modular
City/State/ZIP: Oar ('`t'''�j_�\ (N-40�S dwelling,service and/or feeder 67.84 2
Phone:(SOS ) U5`S 16 Fax: :(Sp3 ) at gel - II,1`‘ Reconnect only 67.84 2
a� Pump or irrigation circle 67.84 2
E-mail: Sveve a,R,+sJ...A. k,,,C5, CytS ..e.5- Sign or outline lighting \ 67.84 (p 2
CONTRACTOR O Signal circuit(s)or limited-energy
Business name: ��ee}S�� panel,alteration,or extension. Page 2 2
QiL� Each additional inspection over allowable in any of the above
Address: ‘1.0?� l Q o Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: C L Investigation(1 hr min) 66.25/hr
L�� I Industrial plant(1 hr min) 78.18/hr
Phone:(� )Uss - ip Fax:(43:5-S) 9eb - " Inspections for which no fee is 90.00/hr
specifically listed('/:hr min)
CCB Lie.: 1`e'�S Electrical Lie.: CL.S Suprv.Lic.: .V. 5M -i ELECTRICAL PERMIT FEES
7�t(fir la�i/7y Subtotal: [�_T,CS q
Suprv.Electrician sign re,required:.._ --'4-'-"��r_� (25%fir- I'r 1 Plan review(25/o of permit fee): -----
Print name: rk �0 kil , Date: Z_64— Iy State surcharge(12%of permit fee): g. /q
r ... 1 TOTAL PERMIT FEE: '7S g
Authorized signature .... ....____ of G`_ This permit application expires if a permit is not obtained within 180
's days after it has been accepted as complete.
Print name: 5-E- � Date: -�-0{— 1y • Number of inspections allowed per permit.
i\Building\Permits\ELC-PermitApp.doc 07/01/10 440-4615T(1 l/05/COM/WEB