Permit a CITY OF TIGARD ELECTRICAL PERMIT
I. COMMUNITY DEVELOPMENT Permit#: ELC2014-00174
i(A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/16/2014
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Parcel: 25101 AA07700
Jurisdiction: Tigard
Site address: 12520 SW 68TH AVE A
Project: Allstate Subdivision: WEST PORTLAND HEIGHTS Lot: 9-13
Project Description: Installation of sign lighting for(1)wall sign.
Contractor: HANNAH SIGN SYSTEMS LLC Owner: CHORUBY, PAUL N
1660 SW BERTHA BLVD 12520 SW 68TH AVE #A
PORTLAND,OR 97219 TIGARD, OR 97223
PHONE: 503-946-8373 PHONE:
FAX: 503-206-4900
FEES
Quantity Description Date Amount
Specifics: 1 ea Sign or Outline Lighting 04/16/2014 $67.84
1 ea 12%State Surcharge- 04/16/2014 $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 is issued t 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 ac ance with a ved 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. ATT TION: Oregon law requir-- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 throu.h OAR 952-001-,%•0. 'u •= obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 0 1.800.332 2344.
Issue By: Amid .�_ �7 its `Aiwa&/' 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 Applicati FOR OFFICE USE ONLY
City of Tigard ����1 " DateeByy: `f /4" Al c. Permit No. &4eai-p/er QQ 17 I
�D
IS -
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 N R 1 6 2014 Date/By: ether Permit.
1 i i Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov rn/� C ftleRr Notified/Method: Supplemental Information
TYPE Otr Gnil/KI )
PLAN REVIEW
ANew 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.
❑ 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 (5 A
❑ 1-and 2-family dwelling Liil 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","1-2","1-3",
Job no.: Job site address: IOOHP or more. occupancy.
z S-2.- St-j toe J'f Av c ❑Six or more residential units. ❑Recreational vehicle parks.
. 1
City/State/ZIP: t D z. 97 Z-2_ ❑Health-care facilities. ❑Supply voltage for more than
-r t�gt2� 3 ❑Hazardous locations. 600 volts nominal. 1
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more
QE FEE SCHEDULE O
Cross street/directions to job site: Description I Qty. I Fee. I Total f • f�
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'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
75.00 2
V S efJ C.l iZc.i 11-- residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER g TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: AufrfriE 401 amps to 600 amps 200.34 2
Address: /2-S2-ct Sc.J 6457. Auc ST-A 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: --J-1641_, t2_ 97 22-1 Temporary services or feeders installation,alteration,and/or
relocation
Fax:
Phone:( ) ( ) 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,per panel
® APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: Hannah Sign Systems LLC each branch circuit
B.Fee for branch circuits without
Contact name:David P Lanphere service or feeder fee,first 56.18 2
branch circuit
Address: 1660 SW Bertha Blvd. Each add'I branch circuit 7.42 2
City/State/ZIP:97219 Miscellaneous(service or feeder not included)
tY Each manufactured or modular
Phone:(503)946-8373 Fax::(503)206-4900
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting I 67.84 ("7,0 2
Business name:Hannah Sign Systems LLC Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 _ 2
Address: 1660 SW Bertha Blvd. Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:97219 Investigation(1 hr min) 66.25/hr
Phone:(503)946-8373 Fax:(503)206-4900 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 188772 Electrical ic.: CLS 11 Suprv.Lic.: 676S1G specifically listed('/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:j I Subtotal: 677. cc
Print name: David P Demuth Date: (./..-1 s--/ Plan review(25%of permit fee):
State surcharge(12%of permit fee): g. q
Authorized signature: TOTAL PERMIT FEE: 71j. q g'
This permit application expires if a permit is not obtained within 180
Print name: David P Lanphere Date: 4I—/S--7 y days after it has been accepted as complete.
* Number of inspections allowed per permit.
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