Permit CITY OF TIGARD ELECTRICAL PERMIT
s • COMMUNITY DEVELOPMENT Permit#: ELC2015-00130
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/14/2015
Parcel: 1 S136DCO2504
Jurisdiction: TIGARD
Site address: 7295 SW DARTMOUTH ST
Project: Western Bikeworks Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: Sign lighting for(1)wall sign.
Contractor: SECURITY SIGNS INC Owner: AMERICAN INDUSTRIES INC
2424 SE HOLGATE BLVD 1750 NW FRONT AVE STE#106
PORTLAND, OR 97202 PORTLAND, OR 97209
PHONE: 503-546-7114 PHONE:
FAX: 503-230-1861
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 04/02/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 04/02/2015 $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 o 11110 or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / - 'ttee Signature: r
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
City of Tigard F.CEIVED Received ;i.5-- Is` !1 r-- Permit No.: 4,-(_,(10 t)_ 1:ic,
Date/By: �`/
13125 SW Hall Blvd.,Tigard,OR Plan Review
= Phone: 503.718.2439 Fax: 503.598.1960 201CJ Date/By: Other Permit: uP}o i s- UL�4 7
T I G A K D Inspection Line: 503.639.4175 FEB 2 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov �F TIGARD
Notified/Method: 7-3><,, Supplemental Information
TYPE OF{�iNC DIVISION PLAN REVIEW
❑New construction Addition/algratlon/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
❑ I-and 2-family dwelling IM 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 ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E", '1-2","I-3",
Job no.: 1 Job site address: '42/5 5 'ri ivi o u�k 100HP or more, occupancy.
5 0 Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: I r a'251 0 61-7 223 ❑Health-care facilities. ❑Supply voltage for more than
f ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name:WQS.,,Q ryl 3 IIL W or ks ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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'I 500 sq.ft.or portion 33.92
Tax map/parcel no.: Limited energy,residential 7500 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
O"C— (i\) 1 I S((�(/1 m oi, 6+ o n I`,f residential(with above sq.ft.)
U _I Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I TENANT 201 amps to 400 amps 133.56 2
Name: ,g,F.-_- (i('IG r L 401 amps to 600 amps 200.34 2
����rn I v`� f� 601 amps to 1,000 amps 301.04 2
Address: 15 4 k) Va 1/+Ww(4+-1,■ Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: T I` C.rc.{ Oa Ct9-223 relocation
/
Phone:( ) I Fax:( ) 200 amps or less 59.36 I
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
APPLICANT I CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Su_(A Irk ()I' 12 S B.Fee for branch circuits without
^� service or feeder fee,first
Contact name: Mt1 i SSG (ai ( h branch circuit 56.18 2
I� ( I Each add'I branch circuit 7.42 2
Address: V..12"1 SC. /4G -1.e_ "eI V - Miscellaneous(service or feeder not included)
City/State/ZIP: �O r G nd2 -1----2GZ Each manufactured or modular
dwelling,service and/or feeder 67.84 2
- U f
Phone:(76?� 5 Lib I I I Fax: (L� ) 2.3 0 - I D//y_I Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: MO I'S A S WA C(+13c,I(�KS. CO l�t�, Sign or outline lighting I 67.84 T �'y 2
CONTRACTORl_J1 Signal circuit(s)or limited-energy
•Business name: CtL(/i r I +-L, S i vi S panel,alteration,or extension. Page 2 2
"I Each additional inspection over allowable in any of the above
Address: 2'12LI j I ,( [U Additional inspection(I hr min) 66.25/hr
City/State/ZIP: g G i-F 14 K t1 G t1��/2—
Investigation(I hr min) 66.25/hr
/ Industrial plant(I hr mm) 78.18/hr
Phone:(c03) y Ij I Fax:( ) Inspections for which no fee is
�j specifically listed('A hr min) 90.00/hr
CCB Lie.: 12,-2;60 I I Electrical Lie.:3r, 51 & Suprv. Lic.: ELECTRICAL PERMIT FEES
/ Subtotal: G 7. ${J
Suprv. Electrician signature,required: r Plan review(25% permit fee): -
Print name: Date: State surcharge(12%of permit fee):
TOTAL PERMIT FEE: ' ,9P
Authorized signature:
/_or This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I:\Building\Permits\ELC-PermitAppdoe 07/01/10 440-4615T(II/05/COM/WEB