Permit I �� CITY OF TIGARD ELECTRICAL PERMIT
I I . COMMUNITY DEVELOPMENT Permit#: ELC2015-00644
T!GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/16/2015
Parcel: 2S 101 BA00101
Jurisdiction: TIGARD
Site address: 7500 SW DARTMOUTH ST 130
Project: Icon Nails&Bar Subdivision: WEST PORTLAND HEIGHTS Lot:
Project Description: Sign lighting for(1)wall sign.
Contractor: VISION SIGNS LLC Owner: WAL-MART REAL ESTATE BUSINESS TR
16127 NE THOMPSON ST BY PROPERTY TAX DEPT STORE 5935-00
PORTLAND,OR 97230 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 503-442-1195 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 09/16/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 09/16/2015 $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. ATTE N: Oreg•• law • ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00 0 throuth OAR 95 1'. -0091 Y- may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19: • :00.33 2344
�1 Z,
Issued y: 'o' / Permittee Signature: ti "
— 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 j
SIGNATURE OF SUPR.ELEC' - ` I . ►�f�(L.Q`-- CAS Date: C�,6/,c—
LICENSE NO. / 749 • / ,
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 t 1I Oil
-_-;•q 1.,0(5'
E C _i i/ Received �j ` `aJ i Permit No.: `&)eog
City of Tigard Date/By. I7 �l �l�`�/
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit:
I Phone: 503.639.4171 Fax: 503.598A;.4 1 3 2015 Date/By Ohs a See Page 2 for
Inspection Line: 503.639.4175 Date Ready/By: l 0 See Page 2 forormatioa
I I�i A RD Notified/Method:
Internet www.tigard-or.gov ��
w tom,, Y l4 CITY (►� , x
Please check all that apply(submit 1 sits of plans w/items checked below):
i■ New construction ❑ Addition/alteration/replacement ❑Service or feeder 400 amps or more ❑Building over three stones.
❑Other: where the available fault current ❑Marinas and boatyards
• Demolition exceeds 10,000 amps at 150 volts or ❑Floating buildings.
xaw� ,r r t (` y..OF CONSTRUCTION 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 0 Other: of 75 KVA or
❑Fire pump.
lar er s el derived systen
❑Emergency system. �andt g y
F 4 ';',i-',•,' ` -4 AM SITE INFORMATION AND LOCATION El Addition of new motor load of ❑"A","E ')-2"•"1-3
_ / �� 100HP or more occupancy
302/ 1 7 � S AR 4.11(m L ❑Recreational vehicle parks
lob no.: Job site address:' //` ❑Six or more residential units
❑Health-care facilities. ❑Supply voltage for more than
City/State/ZIP: It O R '1 7,2 3 ❑Hazardous locations. 600 volts nominal.
r � /� 0 or feeder 600 amps or more.
Suite/bldg./apt.no.: 3 Project name: Ga�t Nplt1f 1f �i1 FEE SCHEDULE
Dncdption I Qty. I wee. I Taal (
Cross street/direction job site:
S OU 9 A A/ QKp ` '
C 72 /P New residential single-or
multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft or less 168.54 Ea.add'I 500 sq.ft.or poportion 33.92
Tax map/parcel no.: '
Limited energy,residential 67.84
(with above sq.fl_)
a r t.,f, DESCRIP ION rOF WO / Limited energy,multi-family 67 84
/ C7� ��(�! {�( r7sC�t OA Zeal rvices or eede above sq ft.) _
!^` alh�J ? / I{ Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70
Pi PROPERTY OWNER
I ❑ TENANT 201 amps to 400 amps 133.56
Name. fny, s-11/� {i 401 amps to 600 amps
200.34 601 amps to 1.000 amps 301.04
� 1 Over 1,000 amps or volts 552.26
Address: ']/ A R Q KP Temporary services or feeders installation,alteration,and/or
City/State/ZIP: 6-5 j1 d Q/� �7 3 relocation
n 200 amps or less 59.36
Phone: �3 r — O/6a2� Fax:( ) 201 amps to 400 amps 125.08
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.54
intended for sale,lease,re ,or exchange,according to ORS 447,449,670.and 701. Branch circuits—new,alteration,or extension,per panel
Date: ///‘/./ A.Fee for branch circuits with
Owner signature: above service or feeder fee, ,
CONTACT PERSON 7 4`
-' ❑ AP CANT I each branch circuit
B Fee for branch circuits without
Business name: v)f��� ��/h�/ service or feeder fee,first 56.18
an Uc branch circuit
Contact name: / Each add'I branch circuit 7.42
Address: ,642 �� T` Miscellaneous(service or feeder not included)
0 `� dach mgnseaciceed dr modular 67.84
City/State/ZIP: i)�1A/K 7 dwelling,service and/or feeder
Reconnect only 67.84
Fax: :( ) 67 84
Phone:(f��) ��/g Pump or irrigation circle
chin( J U)y), Sign or outline lighting 1 67.84 0�
E-mail: v' � ti S'• C 4'n'`
f':-..: (,ONTRACTOR Signal circuit(s)or limited-energy
�;•� Page 2
panel,alteration,or extension
Business name: v�Sro� St*] tx F, .0 e If Each additional inspection over allowable in any of the abot
(� Additional inspection(I hr mm) 66.25/hr
Address: /�'�� N �� ad, D Investigation(1 hr min) 6625/hr
City/State/ZIP: 6A N € 47. 30 Industrial plant(1 hr mm) 78.18/hr
Phone: // 9_5' l Fax: ) Inspections for which no fee is 90A0/hr
��) g Z I specifically listed l%3 hr min)
(� l electrical Lie.: 76 I Suprv.Lie.: 6i sl� E fRl ..
CCB Lic.: f'OaQ a` I Subtotal: 67 qy,
Suprv. Electrician sign e.required: Plan review(25%of permit fee): �/-
/1 Date: 7/16 /f State surcharge(12%of permit fee): D iii-
Print name: ��V f f-�d ��R/� ! / TOTAL PERMIT FEE: ��•�(o
Authorized signature: d' This permit application expires if a permit is not obtained within
,r days after it has been accepted as complete.
Print name: S' Dale: 7/f 6/17 • Number of inspections allowed per permit
ode U / /
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440-4615T11 I/OS/COM/WEB