Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Per
COMMUNITY ELC2015 00436
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/15/2015
TIGARD Parcel: 2S102AC00700
Jurisdiction: Tigard
Site address: 12550 SW MAIN ST
Project: All Tech 1 Subdivision: BURNHAM TRACT Lot: 1
Project Description: Sign lighting for a new 3 ft.x 6 ft.sign.
Contractor: RUDNICK ELECTRIC SIGNS LLC Owner: DOLAN&CO LLC
1625 WASHINGTON ST BY FLORENCE T DOLAN
OREGON CITY, OR 97045 4523 NE DAVIS ST
PORTLAND, OR 97213
PHONE: 503-655-2610 PHONE:
FAX: 503-980-7919
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 06/04/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 06/04/2015 $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
952-001-001 rough O•' 952-e. ?090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 32.1987 or 1.800.332.2344.
1 1 /
Issued A- _y " I��� Permittee Signature: , Q ., 4 Ifill f/ G`-"----"
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'
• '. aS -1 y.' — 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 t FOR OFFICE USE ONLY
City of Tigard V DateB� L
RFC' i
-•• 13125 SW Hall Blvd.,Tigard,OR 97223 kt" Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 'Z��S Date Ready/By: Awls: RS See Page 2 for
Internet: www.tigard-or.gov jus Notified/Method: -- --C Supplemental Information
TYPE OF WO' : III IIPLAN REVIEW
-X New construction ❑Addition/alteratio , .•iv! I ' Please check all that apply(submit 2 sets of plans w/items checked below):
1Y ❑Service or feeder 400 amps or more ❑Building over three stories.
El Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
" exceeds 10,000 amps at 150 volts or ❑Floating buildings.
CATEGORY OCONSTRUCTION-- ," less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling 0 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","I-2","l-3",
IOOHP or more. occulancy.
Job no.: I Job site address: 1Z5--5'-c_-) ��6.1) t.�°�n ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: '-c [� Z.Z ❑Health-care facilities. 0 Supply voltage for more than
, ❑Hazardous locations.
600 volts nominal.
n, .+(__1_ 0 Service or feeder 600 amps or more.
Suite/bldg./apt.no.: l Protect name: W `ECJ�
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'l 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 2
\ &_el S1 I`(< Sk Cg residential(with above sq.ft.)
`� \ Services or feeders installation,alteration,and/or relocation
�`p , 200 amps or less 100.70
2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
r 401 amps to 600 amps 200.34 2
Name: ` 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: QE_,C relocation
Phone:( ) 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
401 amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
l2 APPLICANT 1 P CONTACT PERSON above service or feeder fee, 7 42
each branch circuit `
Business name: t %I n B.Fee for branch r fee, without
service or feeder fee,first 56.18 2
Contact name: t Cp-t branch circuit
�'' l Each add'l branch circuit 7.42 2
Address: ll.Dos-- L 6. ,_0 , mil,. S-- Miscellaneous(service or feeder not included)
City/State/ZIP: ` t N) TT-CAC Each manufactured or modular 67.84 2
ty V� dwelling,service and/or feeder
Phone:(*) (...c:S - `b \\Fax: :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: -k QA - •_ t_ ' - -- r - '•AL.... ° Sign or outline lighting k. 67.84 (�`k RA 2
Signal circuit(s)or limited-energy
Business name: 6 , g y C t c panel,alteration,or extension. Page 2 2
3 f Qi kc Each additional inspection over allowable in any of the above
Address: ,L;`S- ,.\ i! eig. \ Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: \i, Investigation(1 hr min) 66.25/hr
�•a, , _L� �' &� a Industrial plant(1 hr min) 78.18/1u
( tic- ` Inspections for which no fee is
Phone:(S�) �7 J , 1 ax:( ) 90.00/hr
specifically listed('A hr min)
CCB Lic.: \ Q% I Electrical Lic.: (j -4 I Suprv.Lic.:—41-('LS`C-+ ELECTRICAL PERMIT FEES
Subtotal:
Suprv.Electrician signature,required: (..4,-1-
Plan review(25%of permit fee): sL J�....,.:,r=
Print name: Sie . ate: nt2 ( l`s State surcharge(12%of permit fee): rC,a y-k---)BV I(
TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtai within 180
1. — ��
� days after it has been accepted as comp)
Print name: -6 ` IA- (t r Date: ik , a Number of inspections allowed per permit.
l:\Buildingieermits\EL.C-�App.doc 07101/10 440-4615T(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
12550 SW MAIN ST, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00436
Chip Barnett
Violation Summary:
Inspector Contractor