Permit p CITY OF TIGARD ELECTRICAL PERMIT
1114. • • COMMUNITY DEVELOPMENT Permit#: ELC2015-00586
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2015
T t
GAR D g Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15989 SW 72ND AVE
Project: Dominos Pizza Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Sign lighting for(1)wall sign.
Contractor: GARRETT SIGN CO INC Owner: PACIFIC REALTY ASSOCIATES
811 HARNEY STREET ATTN: N PIVEN
VANCOUVER,WA 98660 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 360-693-9081 PHONE:
FAX: 360-693-5948
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 08/05/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 08/05/2015 $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 a ance wi -pproved 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. ATT TION: Oregon I es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0 10 througg' OAR 952-8: -0090. V may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1• •r 1.80'332.2344.
Issued 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 Application FOR OFFICE USE ONLY
Received �i e. /�- M TO/
City of Tigard
Date/By: 7 0�? /� Permit No.: GL lw TO,
• 13125 SW Hall Blvd.,Tigard,OR 97223 ' - " '"°" Plan Review
E. Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 JUL 2 9 2015 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OFF'f}/QRK,,, `r,,1 PLAN REVIEW
'
Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction ❑ Addition/alteration/replacement
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ®Other:Sign 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 150 KVA or
JOB SITE INFORMATION AND LOCATION
13 Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","1-3",
Job no.: Job site address: 15989 SW 72nd Ave IOOHPorrnore. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name:Domino's Pizza ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: mescripliio. 1 Qty. I Fee. I Total 1 *
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'(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
Installation of(11 single faced illuminated fascia signs. residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services oir feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ® TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:Domino's Pizza 401 amps to 600 amps 200.34 2
Address: 15989 SW 72nd Ave 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Tigard,OR 97224 Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
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
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
® APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:Garrett Sign Company each branch circuit
B.Fee for branch circuits without
Contact name:Jesse Taylor service or feeder fee,first 56.18 2
branch circuit
Address:811 Harney Street Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP:Vancouver,WA 98660
Each manufactured or modular 67.84 2
Phone:(360)693.9081 Fax: :(360)6933948 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:jesse(ii)garrettsign.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting I 67.84 ` 7.9# 2
Business name:Garrett Sign Company Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 _ 2
Address:811 Harney Street Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Vancouver,WA 98660 Investigation(I hr min) 66.25/hr
Phone:(360)693.9081 Fax:(360)693.5948 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 66826 Electrical Lc.: 7-21 LS uprv. Lie.:7CyySt('l specifically listed('/Z hr min)
�� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: K-- , .� Subtotal: J.c
1
} Plan review(25%of permit fee):
Print name: I L ( /; ,�) Da 7/1 U I e
/ J State surcharge(12%of permit fee): `J--r
Authorized signature: TOTAL PERMIT FEE: 7c- . (7
Print name: , Date: 7-2�_
This permit application expires if a permit is not obtained within ISO
clays after it has been accepted as complete.
' Number of inspections allowed per permit.
1:\Buil ding'Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-46 15T(J t I05/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
15989 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00586
Chip Barnett
Violation Summary:
Inspector Contractor