Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIV
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Request Permit Action
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TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tiurd-or.gov 201¢
BUILD IN`` I CARD
TO: CITY OF TIGARD GDiVjS10N
Building Division Services Supervisor
13125 SW Hall Blvd.,Tigard,OR 97223,
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner Applicant ❑ Contractor ❑ City'Sta V19 y •r •
(check one)
Ord End.11
REFUND OR Name: ^ �' ,i A. P t tk, )
INVOICE TO: (Business or Individual) Q- f-r S •�y� 031
Mailing Address: 1 )c Piro`+r t e (L131.
City/State/Zip: 4.1. . &L. - 02_
Phone No.: siAL tlect - 2-'kkAt O 5 .% - .R$c`
S 5
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 041 0>0 n ��
CANCEL/VOID PERMIT APPLICATION. f A 1t`f Li 05
REFUND PERMIT FEES (attach copy of original receipt and provide explanation be ow .
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
n REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: -EL c.--Z .- 1A - Ob 2AD
Site Address or Parcel #: ' o o83 .Pet/ bao,A.....5 re_iftx\tilik
Project Name: L PG „ci� -L-- takt,L.,2_ oet,v..5
Subdivision Name:
Lot #:
EXPLANATION: a elct (gunLCA Yore;C CA" c-t)( yv, coet2t_
( Ov1Cc. Y1?-1�-& -6 4/ -`- VC esi i>d� u� . �oav,s
raNet(1n
Signature: =_ Date: ":1 / 'ley l
Q �
Print Name: Arl ( y -' Fr-e eI-e „ 6.?.,Fy ' - /3. 57
Refund Policy F. / li -Si _ 6.3
1. The Community Development Director or Building Official may authorize the refund of: 47 6 0 . 78' XS r a CJ
a) any fee which was erroneously paid or collected.
b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80%of the land use application fee for issued permits.
d) not more than 80%of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80°A of the building permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Rte to S s Admin: Date 7fitEMEIWALM Rte to Bld. Admin: Date 712742l B 4F
Refund Processed: Date it/At By ..a Invoice Processed: Date By
Permit Canceled: Date7/7vkY By, Parcel Tag Added: Date By
Receipt# Date / Met od _ Amount$
1:\Building\Forms\RegPermit Action_062614.doc
CITY OF TIGARD ELECTRICAL PERMIT
s • COMMUNITY DEVELOPMENT Permit#: ELC2014-00240
T I G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/21/2014
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 310
Project: Umpqua Bank Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Sign lighting for retrofit of existing wall sign.
Contractor: E S&A SIGN&AWNING Owner: G&S FC LLC
89975 PRAIRIE RD 16083 SW UPPER BOONES FERRY RD,
EUGENE, OR 97402 STE
TIGARD, OR 97224
PHONE: 541-485-5546 PHONE:
FAX: 541-485-5813
FEES
Quantity Description Date Amount
Specifics: 1 ea Sign or Outline Lighting 05/21/2014 $67.84
1 ea 12%State Surcharge- 05/21/2014 $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 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 may obtain a copy of - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �_ _� •ermittee 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 RECEIVE FOR OFFICE I ',I t►N I 1
City of Tigard Received III. Permit No.•Date/B : '��� _ i
;�i • 13125 SW Hall Blvd.,Tigard,OR 97223 MAY O 7 2014
Plan Review / '0 a a Pe
I Phone: 503.718.2439 Fax: 503.598.1960 MAY : Other •L__=-�„`if„`vim
T 1 G A R D Inspection Line:ga 3.63 4175 CITY OF TI GA R D Date Ready/By: Supplemental Page 2 for
Internet: www.ti rd-or. ov ��yy Notified/Method: Information
TYPE OF WBIIkkJ/NN J DIVISION PLAN REVIEW
❑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.
❑ 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 rAl 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.: I Job site address: t _ IOOHP or more. occupancy.
I�b3 g u 2Q c tr k)rOv D L. I�t ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: e-- ❑Health-care facilities. ❑Supply voltage for more than
`� �� + �� ZZ ❑Hazardous locations. 600 volts nominal.
Suite/bldgJapt.no.: /D Project name:uon Ip I A a Q-ot ❑Service or feeder 600 amps or more
tt' t FEE SCHEDULE _
Cross street/directions to job site: T 1 \ "1" /1 v Description I Qty. I Fee. I Total I •
L /'-� 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'/500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential 75.00
DESCRIPTION OF WORK Aillii (with above sq.ft.)
r Limited energy,multi-family 75.00
V -k+ f(1-14,5 c f1 residential(with above sq.ft)
�LET���� p Services or feeders 0 See Page 2
�� 5}Cs� Services or feeders installation,alteration,and/or relocation
PROPER O R (A]
❑ TENANT �S /Z ' oo amps or less 100.70 2
t 55 vied 5 ZI 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: t 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:(C Fax: relocation
- , • 6- 200 amps or less 59.36 1
• , • + 't :This installation is being made on property t a : 't which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exc .1 -, :, .s .' • a' •' 449,670,an' -'
401 amps to 599 amps 168.54 2
Owner signature: Date: . - .ch circuits-new alteration,or extension, ter anel
APPLICANT I ❑ CONTACT PERSON A.Fee or. :.ch circuits with
above service or feeder fee,
Business name: 9 a l _ each branch circuit 7 4,
` 1ghti/ !� B.Fee for branch circuits without .-
Contact name: i, h� -ed�.vl h service or feeder fee,first
56.18 2
�,.qr� branch circuit
Address: 0 1,"L I c 'Prlbl j ,,--, , Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
( �� O Z Each manufactured or modular 67 84 2
dwelling,service and/or feeder
Phone:( Zq/��L! Fax..�Lt` ) L�$f1 — �j5� - Reconnect only 67.84 2
E-mail: -e_d eal►bci✓1 Icv Q�GL,S/4/1.5• f OVki Pump or irrigation circle 67.84 2
At Li CONTRACTOR „, Sign or outline lighting J 67.84 2
Business name: !/5 g-A 5'�h AF'LLC NI■ Signal lterat(s)orlimited-energy ` See'
panel,alteration,or extension. Page 2 2
Address: ct-q_! 75---- --pyDL,r f , , Each additional inspection over allowable in any of the above
City/State/ZIP: �I Additional inspection(1 hr min) 66.25/hr
ty CI— erlite -- Investigation(I hr min) 66.25/hr
Phone:(541)4C1S S(asc co, I Fax:(rye.() A( ( -5s.A fo Industrial plant(1 hr min) _ 78.18/hr
t - Inspections for which no fee is 90.00/hr
CCB Lie.:��2J(;.l Q J Electrical Lie.: 3-a..,$Suprv.Lic.: 5( 4 SZ� specifically listed('V:hr min)
Suprv.Electrician signature,required - ELECTRICAL PERMIT FEES
/
!�� Subtotal: (7_ �Y
hove, Date: ,f Plan review(25%of permit fee):
Pont name:G4 (�j5 C lT State surcharge(12%of permit fee): J , /y _
Authorized sign u • TOTAL PERMIT FEE: 75' S2
This permit application expires if a permit is not obtained within 180
Print name: r A n h e. F er iee-1 G - Date: � , days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 05/21/2013 440-4615TO1/05/COM/WEB
r
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
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
nBurglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
n 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
n Vacuum Systems* >100 kva-no additional charge 0.0 3
n Other: Each additional inspection over allowable in any of the above:
Each additional inspection is
charged at an hourly(1 hr mm) 6625/hr I
Inspections for which no fee is 90.001 hr
specifically listed(%hr min)
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
nAudio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
El Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems: C
*No licenses are required. Licenses are required
for all other installations
I ABuilding\Permits\ELC_PennitApp_ELR_ERE.doc Rev 05/21/2013