Permit p CITY OF TIGARD ELECTRICAL PERMIT
`• ' • COMMUNITY DEVELOPMENT Permit#: ELC2014-00605
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/29/2014
Parcel: 1 S134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 700
Project: JetSet Coffee Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: Wall sign on raceway.
Contractor: SECURITY SIGNS INC Owner: ROBINSON, CONSTANCE A
2424 SE HOLGATE BLVD BY KILLIAN PACIFIC LLC
PORTLAND,OR 97202 500 EAST BROADWAY, STE 110
VANCOUVER,WA 98660
PHONE: 503-546-7114 PHONE:
FAX: 503-230-1861
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 10/28/2014 $67.84
Specifics:
1 ea 12%State Surcharge- 10/28/2014 $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.=s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ _ _ i r Permittee Signature: .
Aar
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
CityReceived
of Tigard Permit No.: —
N
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.639.4171 Fax: 503.5 COPEAV Date/B : Other Permit: le 0/y_ ,-)
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: 1_u 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: L_.1 L Supplemental Information
TYPE OF WOR>BjC,, 1 �` yrt PLAN REVIEW
❑New construction ®Addition/alteration/reta�c t Pali Please check all that apply(submit 2 sets of plans w/items checked below):
,,A, I ^� ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ['Other: 101,SV.p 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
El Emergency system. larger separately derived system.
❑A
Addition of new motor load of ❑"A","E","I-2","1-3",
Job no.: Job site address: 10(I 5 W N Irv\bl t AV!_ loo or or omore. occupancy.
creation. parks.
❑Six or more residential units. ❑Recreational vehicle azks.
City/State/ZIP: T� f� / Z_ 61_1_ 0 Health-care facilities. 0 Supply voltage for more than
�- ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: A G Project name: J t-1 Sca ... 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qu'. I Fee. I Total I
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 67.84 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 67.84 2
O VV_ W 0k I 1 1 V residential(with above sq.ft.) 1
Services or feeders installation,alteration,and/or relocation
*Mount Only* 200 amps or less 100.70 2
❑ PROPERTY OWNER I gr TENANT 201 amps to 400 amps 133.56 2
Name: Qk �` C - _- 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: l 0)((C S' w l j0.41,tc A N/Q/ '--(J() Over 1,000 amps or volts 552.26 2
T 1 %, 1 Temporary services or feeders installation,alteration,and/or
City/State/ZIP: Q___ 0\7-22?v J 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
ar APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit _
Business name:Security Signs B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Contact name:Melissa Hayden branch circuit
Each add'l branch circuit 7.42 2
Address:2424 SE Holgate Blvd Miscellaneous(service or feeder not included)
City/State/ZIP:Portland,OR 97202 Each manufactured or modular 67.84 2
Y dwelling,service and/or feeder
Phone: (503)546.7114 Fax: :(503)230.1861 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:Melissa @SecuritySigns.com •Sign or outline lighting � 67.84 (+,7,f y 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:Security Signs panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address:2424 SE Holgate Blvd Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
City/State/ZIP: Portland,OR 97202 Industrial plant(1 hr min) 78.18/hr
•
Phone:(503)546.7114 Fax:(503)230.1861 Inspections for which no fee is 90.00/hr
specifically listed(1/2 hr mm)
CCB Lic.: 122809 Electrical Lic.: 26560CLS Suprv.Lic.: 383SIG ELECTRICAL PERMIT FEES
Subtotal: 1; 7. gel
Suprv.Electrician signature,required: Plan review(25%of permit fee):
Print name: Marc Linguist Date: State surcharge(12%of permit fee): r /t(
TOTAL PERMIT FEE: .�.75 _I d
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Melissa Hay n Date: * Number of inspections allowed per permit.
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