Permit CITY OF TIGARD ELECTRICAL PERMIT
'1 = COMMUNITY DEVELOPMENT Permit#: ELC2014-00313
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/19/2014
Parcel: 1S126BC01500
Jurisdiction: Tigard
Site address: 9000 SW WASHINGTON SQUARE RD
Project: Embassy Suites Subdivision:CONDO,THE SUPPLEMENTAL PLAT Lot: 25-4
Project Description: New wall sign,approximately 243 square feet,located on the north facing wall at 9000 SW Washington Square
Road.
Contractor: INTEGRITY SIGNS OREGON Owner: FO PORTLAND PROPERTY LLC
PO BOX 88 BY WINSTON HARTON HOLDINGS LLC
HUBBARD, OR 97032 745 FIFTH AVE 33RD FL
NEW YORK CITY, NY 10151
PHONE: 503-981-3743 PHONE:
FAX: 503-982-8153
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 06/10/2014 $203.52
Specifics: 1 ea 12%State Surcharge- 06/10/2014 $24.42
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $227.94
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. ATTENTIO • on law r=• -s you to follow the rules adopted by the Oregon Utility No — on Center. Those rules are set forth in OAR
952-001-0010 ugh OAR -00 6090 A u may obtain a copy of the rules or direct questions to OUNC by calling I .•tiP 87 or 1.800.3 .2344.
Issued By: � 1 t 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' �` .�✓c_` Date: /�
LICENSE NO. 499 dl
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
City of Tigard III +a f�► Permit No.: ` !K"Cb /• 13125 SW Hall Blvd.,Tigard,OR 97223 1�
■ Phone: Other Permit: I ,
hone: 503.718.2439 Fax: 503.598.1960 C
l;A K D Inspection Line: 503.639.4175 1 1 O Z t 'late Ready/By: runs. 65 See Page 2 for
Internet: www.tigard-or.gov ,,"1`t } Notified/Method: Supplemental information
TYPE OF WORK NOV���� PLAN REVIEW-
❑New construction Please check all that apply(submit 2 sets of plans w items checked below):
❑Addition/alteration/replacculcnt`+Q�
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition Other: 5( wo S 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
❑ i-and 2-family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑ A", 'E","1-2",'1-3
Job no.: Job site address: nn� S� (� l I DOHP or more. occupancy.
9 Lash l� 1`41 El Six or more residential units. ❑Recreational vehicle parks.
City/State/ZII ;,e._�_� �J ❑Health-care facilities. ❑Supply voltage for more than
�o'• Q 1 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: . 1� � � ❑Service or feeder 600 amps or more.
I FEE SCHEDULE
Cross street/directions to job site: SW(wa_ , pt I u„.1 Description I Qtv. 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')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
3 C ')'\ c 2
�\ J �` ht1t..� L �S�ry, J residential
` ` 4 ` c. ck-1 , b
Renewable Energy ❑ See Page 2
AJ Q�-� .5-Yul----1 Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER 1 ❑ TENANT 200 amps or less 100.70 2
I y F�
201 amps to 600 amps 133.56 2
Name: V'‘
0 Y1 1.+ a ��Z 401 amps to 600 amps 200.34 2
Address: Loa I n 601 amps to 1,000 amps 301.04 2
LV 1 h of s----(F–J. ,.... l ' �7 Over 1,000 amps or volts 552.26 t 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) I Fax:( ) relocation
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
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54
Owner signature: _ Date: Branch circuits–new,alteration,or extension,per panel
APPLICANT I ` —EJT5NTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42
Business name: M each branch circuit
�N JL�h l )A n B.Fee for branch circuits without
Contact name: Scii(I IQ A-QJ service or feeder fee,first 56.18 2
branch circuit
Address: Each add')branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
�� ci V f-3 �/ I dwelling,service and/or feeder 67.84 2
Phone: ) o ( -T-3 Fax: :( )
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Stgn outline lighting 3 67.84 ab3•
Business name: tiU �,} , S;_ nS gnat alteration,or limited-energy See
r"{! l�� panel,alteration,or extension. Page 2 2
Address: D , l�„ 8 Each additional inspection over allowable in any of the above
City/$fate/ P' I ' 0 1 3 Additional inspection(I hr min) 66.25/hr
"4 \LL. Q 1, / 7 a Investigation(1 hr min) 66.25/hr
Phone:(513 qg/ _3 7 43 I Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 'Oi,L/)ES"I Electrical Lie.: BLS Q0 I Suprv.Lie.:3Cy _(1 b specifically listed(!/._hr mini
` P ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:_ Subtotal: 03• s-2.--
Prirt>j �a�s Date: _ L_/.cl Plan review(25%of permit fee): 4
State surcharge(12%of permit fee): a4
Authorized signature: TOTAL PERMIT FEE: �g 1. .. .
This permit application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building'Permits,ELC_PermitApp_ELR_ERE.doc Rev 05 21 201 3 440-4615111 I/05/COM/WEB