Permit J p CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015 00222
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/21/2015
Parcel: 2S110AA02800
Jurisdiction: Tigard
Site address: 14055 SW PACIFIC HWY
Project: Elmer's Restaurant Subdivision: CANTERBURY PLACE,AMENDED Lot: 6A
Project Description: Sign lighting for(1)pylon sign.
Contractor: SECURITY SIGNS INC Owner: DANNA BROTHERS PROPERTIES LLC
2424 SE HOLGATE BLVD 9800 SE STARK ST
PORTLAND,OR 97202 PORTLAND, OR 97216
PHONE: 503-546-7114 PHONE:
FAX: 503-230-1861
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 04/13/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 04/13/2015 $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. les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. \
•
Issued By:.g..gas---)1 "--Ya�e. 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' 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 Appli cg�jQ�l`c1VE FOR OFFICE USE ONLY
City of Tigard ' Received
Date/By: 9 ( /6 ( H Permit No.:L f,�1,/5 6 ,2--
•1,11
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
M. Phone: 503.718.2439 Fax: 503:M19607 19607 i 01 5 Date/By: Other Permit:
Inspection Line: 503.639.4175
T I G A R D Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard-or.gov WI' Notified/Method: Supplemental Information
ypi.'V' t t' I KAU
T r1" tI I lT CI(1� PLAN REVIEW
❑New construction Addi't/ohtaheration/re�pl CCfllent 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 ®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","I-2","1-3",
Job no.: Job site address: 1I+055 Sr /: (� I00HP or more. occupancy.
NCI Yl �w ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: T %krp(( e)12... ° n t ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: El nur' ❑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: Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
�
j I,, Limited energy,multi-family 75.00 2
x/ e
Fd L.. S( �Vum✓r� o✓) 19 residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER air TENANT 201 amps to 400 amps 133.56 2
Name: L ►MQ r I f 401 amps to 600 amps 200.34 2
J 601 amps to 1,000 amps 301.04 2
Address: I 1_f 055 SE ?etc tct`c IA w 4 Over 1,000 amps or volts 552.26 2
City/State/ZIP: I (• A + 0 2. ql 2)/...9 Temporary services or feeders installation,alteration,and/or
1 relocation
Phone:( ) Fax:( ) 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 2
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
I APPLICANT I- ('CONTACT PERSON above service or feeder fee,• each branch circuit 7.42 2
Business name: S.f..C1.ir1'f S I ✓,S B.Fee for branch circuits without
S)� 1� n service or feeder fee,first 56.18 2
Contact name: 1 Ir1T {�1 branch circuit
2L11I_i S E N ( a�-� IJ I Val. Miscellaneous edd n branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
City/State/ZIP: V G r4 14 WI �VQ_ A1102- - Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone: 503 S t-. �- �I{,I ([03)1. O - I�/( Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: � i SSA S(C.A,tr S(' 14S • (O"t
Sign or outline lighting I 67.84 6 7 W 2
CONY CT a
Signal circuit(s)or limited-energy -
Business name: 5�U r('f 6 n J l panel,alteration,or extension. Page 2 2
n Each additional inspection over allowable in any of the above
Address: (jLj'v4 sE. 40( A4C "B(von Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: POr4'and /aD QI'`�7/►t2 Investigation(I hr min) 66.25/hr
I
v f� v' Industrial plant(1 hr min) 78.18/hr
Phone:(t563 ) V,1&• 1 114 Fax:(563 ) 2.3O - I sap! Inspections specically fo
lisr ted whi(i ch hr no mi fene)is 90.00/hr
fi
CCB Lic.: 117.01 Electrical Lic.:S$S 11 ; Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: I Subtotal: •�, �{
Plan review(25%of permit fee): .rte'
Print name: K/�•r ,/t('.I�'c,� Date: State surcharge(12%of permit fee): './V'
Authorized signature: l"IY 7 TOTAL PERMIT FEE: `7 S ��
��^ '1 l This permit application expires if a permit is not obtained within 180
Print name: /V t\1 S SQ {.J.!.Li 6 Il 1 Date: days after it has been accepted as complete.
ttl ttl"`^^^ VWWWii• 1 ' Number of inspections allowed per permit.
1:\BuildingPermits\ELC-PermitApp.doe 07/01/10 440-4615T(11/05/COM/WEB
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14055 SW PACIFIC HWY, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00222
Jeff Grove
Violation Summary:
Inspector Contractor