Permit CITY OF TIGARD ELECTRICAL PERMIT
g COMMUNITY DEVELOPMENT Permit#: ELC2015-00154
Date Issued: 03/12/2015
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101 BD00100
Jurisdiction: Tigard
Site address: 7650 SW BEVELAND RD 200
Project: Womens Healthcare Associates Subdivision: 1994-025 PARTITION PLAT Lot: 2
Project Description: Sign lighting for(1)sign.
Contractor: RUDNICK ELECTRIC SIGNS LLC Owner: PNWP LLC#2
1625 WASHINGTON ST PO BOX 2206
OREGON CITY,OR 97045 BEAVERTON, OR 97075
PHONE: 503-655-2610 PHONE:
FAX: 503-980-7919
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 03/12/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 03/12/2015 $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.f the-mks or direct questions to OUNC by calling 50 .1987 or 1.800. 32.2344.
Issued By: ��.�— _ Permittee Signature:
4111/j11111•0
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 �`l�� 10I(OF1.1( I 1 sr: O\I
City g �� �i DateBB 6) I Aar Permit No.: _ - 0 s Aa A
Ci of Tigard
13125 SW Hall Blvd.,Tigard,OR 9 Plan Review
■ Other Permit: ,.=i
Phone: 503.639.4171 Fax: 503.59 960 'P Date/B : �✓ .-,/
T I G A R D Inspection Line: 503.639.4175 ^^((�� �j Date Ready/By: Jur ® See Page 2 for
Internet: www.tigard-or.gov Mr1` U Notified/Method: Supplemental Information
TYPE OF WO ��`� ,. PLAN REVIEW
WifNew construction ❑Addition/alteratieD1 Please check all that apply(submit 2 sets of plans w/items checked below):
Vv`�
❑Demolition ❑Other. %UW ❑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
❑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: �-2) (� \ �+ 100HP or more. occupancy.
��� �Q J� �]p> Zi(l 1� Jet ❑Six or more residential units. ❑Recreational vehicle parks.
Ci /State/ZIP: �_ - „" q-„Z7-1-4 ❑Health-care facilities. ❑Supply voltage for more than
tY �,CwQt► 2 600 volts nominal.
❑Hazardous locations.
Suite/bldg./apt.no.: Project name: /'j-&_rc- /- ❑Service or feeder 600 amps or more.
i ►u cal FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee- I Total
New residential single-or multi-family dwelling unit.
Set,c e., .:5 c c_+a le1�^ .,� L'c Includes attached garage.
Subdivision: 7A►� Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add-1500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Vn` I 3-V V` T ( t� vn �� .Q Limited energy,multi-family
residential(with above sq.ft.)
75.00 2
Services or feeders installation,alteration,and/or relocation
li-Db c L 0 200 amps or less 100.70 2
,X'PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name:
ik .a'l� 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: Q- -}-F Temporary services or feeders installation,alteration,and/or
Y 7���^ 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
0r APPLICANT I CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: l&kial CJO� ��c....4_C tC.� �t v _ L�� B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Contact name: S 1 A branch circuit
G i Each add'l branch circuit 7.42 2
Address: 6, k a A CFA Miscellaneous(service or feeder not included)
City/State/ZIP: x t (R— �-1-�Q" Each manufactured or modular 67.84 2
Y ���. V dwelling,service and/or feeder
Phone:(5t" ) (DSS _'? . 0 +: : :(s.t.3) Reconnect only 67.84 2
` Pump or irrigation circle 67.84 2
E-mail: Set Ct).c�Acili.oiee itt- c c;, .�.M' Sign or outline lighting 1 67.84 C 7.pi 2
CONTRACTOR s Signal circuit(s)or limited-energy F
t panel,alteration,or extension. _ Page 2 2
Business name:
iglu C �� C t Each additional inspection over allowable in any of the above
Address: t1.0095" t3 t v` Additional inspection(1 hr min) 66.25/hr
� Investigation(1 hr min) 66.25/hr
City/State/ZIP: �� t� �
p,.� Industrial plant(1 hr min) 78.18/hr
Phone:(�b?j)(�jS(`^'� Fax:(Sa,3) 3�� q1q Inspections for which no fee is 90.00/hr
` specifically listed(/2 hr min)
CCB Lic.: '1`b658F, I Electrical Lic.: LLS-4. 1 Suprv.Lie.: tken '„ ELECTRICAL PERMIT FEES
Subtotal: ea>-r`7
Suprv.Electrician signature,required Plan review(25%of permit fee):
Print name. t..- ` Date: .-I t State surcharge(12%of permit fee): J
'Mb l TOTAL PERMIT FEE: 75�
Authorized signature:
This permit application expires if a permit is not obtained within 180
� � days after it has been accepted as complete.
Print name: <AI:, ��`�` Date: /lf is • Number of inspections allowed per permit1:\Building\Permits\ELC-PermiilApp.doc 07/01/10 440-4615T(11/05/COM/WEB