Permit yr, CITY OF TIGARD ELECTRICAL PERMIT
'"�! I ' COMMUNITY DEVELOPMENT Permit#: ELC2015-00705
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/01/2015
Parcel: 2S103DD01200
Jurisdiction: Tigard
Site address: 13970 SW PACIFIC HWY
Project: Chevron Subdivision: MELROSE Lot: 7-8
Project Description: Sign lighting for(1)freestanding sign.
Contractor: JIM CARTER ELECTRIC LLC Owner: CAIN PETROLEUM INC
4996 FORSYTHIA DR 4512 SW KELLY AVE
SPRINGFIELD, OR 97478 PORTLAND,OR 97239
PHONE: 503-514-6812 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 09/01/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 09/01/2015 $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 she 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 ob in a copy of the rue r direct questions to OUNC by calling 503.2322.1987 or 1.800.332.734/^4
Issued By: � .�f Permittee Signature: !G_�•"—„„✓,Y^l C/
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 ON I 1
City of Tigard 5D Received - ' /5 07T Permit#:
III 13125 SW Hall Blvd.,Tigard,OR 9722 �\I Plan Review l �+
• Phone: 503.718.2439 Fax: 503.5 1 Date/By: Related Permit#: `(,�ad(S"':.cd }�r
Inspection Line: 503.639.4175 n %OS Ready Date/By: Avis: ® See Page 2 for
I IliA1:1> (.
Internet: www.tigard-or.gov (� Notified/Method: ,( Supplemental Information
TYPE OF WORK`,` 1.‘G,e.Q 0 PLAN REVIEW
❑New construction [YI Addition/alteratigpiA l V 1%)' Please check all that apply(submit j�sets of plans w/items checked):
❑New c Demolition construction
❑Other: tt E -1` °•�^ El Service or feeder 400 amps or more ❑Building over three stories.
s., where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling Of Commercial/industrial ❑Accessory building less to ground.or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: ❑Eire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
3 I� ❑Addition of new motor load of system.
Job#: Job site address: Y ylJ /244e4>`LG J 100HP or more. ❑
City/State/ZIP: I er 1 2 �/ ❑Six or more residential units. occupancy.
T? p ❑Recreational vehicle parks.
// ❑Ilealth-care facilities. P
Suite/bldg./apt.#: Project name: Ch6 1/at) ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qtc. I Each i I otul I '
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54
Ea.add'I 500 sq.ft.or portion 33.92 I
.i
DESCRIPTION OF WORK Limited energy,residential
D) ( fl ce c-5-- )--1 (with above sq.ft.) 75.00 =
/� C � Limited energy,multi-family 75.00
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:
601 amps to 1,000 amps I 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation _
Owner installation:This installation is being made on property that I own which is not _200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
/ /�� A.Fee for branch circuits with
Business name:-...„ � ./ Gl�T/1.L above service or feeder fee,
7.42 2
each branch circuit _
Contact name: �i m 6 B.Fee for branch circuits without .
���� . service or feeder fee,first 56.18
Address: rf 1 a branch circuit
City/State/ZIP: c J n O/ O 2 7!t 7 , Each add'I branch circuit 7.42
,p� Miscellaneous(service or feeder not included) ,
�L
Phone:ay ) J/y- ri Ar z. I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Sky dive y 2
�Q,i >°���'rlkz l/D� Reconnect only 67.84
/ C NT CTOR Pump or irrigation circle 67.84 A 2
Business name:�i m (41,...k...„ �! C Sign or outline lighting - _! 67.84 `7,8 f 2
4 11 r Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: f .�.}�i� panel,alteration,or extension. g
City/State/ZIP: fl C�� 7• G� !� Each additional inspection over allowable in any of the above
' y Additional inspection(I hr min) 66.25/hr
Phone: l t ) 5) _6431 Z I Fax:( ) Investigation(I hr min) 90.00/hr
Email: ud we 5, �'C� �;) d,pyV) Industrial plant(1 hr min) 78.18/hr
/ Inspections for which no fee is 90.00/hr
CCB Lic.: z2LI3 o Electrical ie.C�0/7 / Suprv.Lic.: 5)3 15 specifically listed(v hr min)
Suprv.Electrician s �i�,required: ?�f"+ to It r(4 ELECTRICAL PERMIT FEES 7�
p e9 '�N""�M 1 1 Subtotal:J�7.11
Print name:tai � /V1 a,_€r I Date:el-/--0j5 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): S>. Pt
Authorized signature: TOTAL PERMIT FEE: 1 75- It
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I Building'Pmnits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Descript I Q*. j Each I Total 1
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70
5.01 to 15 kva 133.56 2
1=1 Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26
I I Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.25/hr I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specificall■ listed(:hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
I l Boiler Controls
Li Clock Systems
n Data Telecommunication Installation
Fire Alarm Installation
HVAC
U Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling
l I Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015