Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2014-00099
T I t;A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/04/2014
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9650 SW WASHINGTON SQUARE RD G15
Project: Young Art Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Sign lighting for(2)illuminated wall signs.
Contractor: VANCOUVER SIGN COMPANY INC Owner: PPR WASHINGTON SQUARE LLC
2600 NE ANDRESEN RD#50 PO BOX 847
VANCOUVER,WA 98661 CARLSBAD, CA 92018
PHONE: 360-693-4773 PHONE:
FAX: 360-693-2747
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 03/04/2014 $135.68
Specifics:
1 ea 12%State Surcharge- 03/04/2014 $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 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 through OAR 952-001-0090. You m- •• ='• co. • - • r'4=ct questions to OUNC by calling 503.232.1987 or .80 2.2344.
Issued By: _4010' 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 Application FOR OFFICE USE ONLY
Received
ilh City of Tigard Plan Review: I y�y_ �, _ik"O F��/,C.p�l k —QV Cd`t r
13125 SW Hall Blvd.,Tigard,Oli:, Plan Re Pe_
I Phone: 503.639.4171 Fax: 50 11 \N Date/By:
Other Permit:
II C. R I) Inspection Line: 503.639.4175 �p r Date Ready/By: -)(iris: 65 See Page 2 For
Internet: www.tigard-or.gov il i� �� Notified/Method: �J Supplemental Information
TYPE OF W PLAN REVIEW
New construction ❑Addition/alteration/replacement
Please check all that apply(submit 2 sets of plans w/items checked below):
❑ Demolition Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ 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
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: `�(0SD 5W 1,0ce_S�'lia y°11 S RA, Iixor or omore. Recreational`I � ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: y i J. O 7 Z Z ❑Health-care facilities. ❑Supply voltage for more than
G+ ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: 10 i.q't Act ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total 1
,, New residential single-or multi-family dwelling unit.
101 6 1:10-/t0 f1 Setae 'ems i Ail� Includes attached garage.
Subdivision: J Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax trap/parcel no.:
Limited energy,residential
DESCRIPTION OF WORK 'I (with above sq.ft.) 67.84 2
11 Limited energy,multi-family
67.84 2
(Z) ill Win matt/t / W Ai i Siy 6 residential(with above sq.ft.)
J 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
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone: ( ) Fax:( ) 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
Branch circuits-new,alteration,or extension,per panel _
Owner signature: Date: A.Fee for branch circuits with
above service or feeder fee,
each branch circuit 7.42 2
-
Business name: t�� B.Fee for branch circuits
aY1,f,ol�V�i� �1J'
n v without service or feeder fee,
Contact name: ih G f d, �'.t'D r m n 1 first branch circuit 56.18 2
Address: 2.600 A)1; A1'1.G1i 6 -1 p ,, At So Each add.'branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Voat Lo IAUP.p tolyk 18 621,I Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Phone:(36 0 ) 6q 3 21.77 3 Fax: :(260 ) /nq 3 7 7q 7 Reconnect only 67.84 2
E-mail: PGic1,SaVet/161001a). (-OM Pump or irrigation circle 67.84 2
J CONTRACTOR Sign or outline lighting (z') 67.84 139.(2'i 2
Signal circuit(s)or limited-
Business name: Vet Au)1 W p,(` '5 y) energy panel,alteration,or
d� 1 ��JJ 1 extension.Describe: Page 2 2
Address: 2600 N E �1 elt,�.5 P_ fyi # SO
City/State/ZIP: uct4s,,e)Live.,r 1.0 q gtp to I Each additional inspection over allowable in any of the above
-y Per inspection 66.25
Phone:(360 ) 61,3 It-773 Fax:(3(00 ) WI'6 2.7' /
Investigation per hour(I hr min) 66.25
CCB Lic.: er2 39 s Electrical Lic.:37_g46LS Suprv.Lic.: Industrial plant per hour 78.18
ELECTRICAL PERMIT
Suprv.Electrician sign ,required: Subtotal: *
Print name: Date: Plan review(25%of permit fee):
State surcharge(12%of permit fee): (.4. .y
Authorized signature: /\ _� _ TOTAL PERMIT FEE: /57. 1
Z �y �
n �1 This permit application expires if a permit is not obtained within 180
Print name: /�8 t!)V 51-0 r Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:1BuildingWermit s\ELC-PennitApp.doc 10/01/09 440-4615T(II/05/COM/WEB