Permit Ilir
CITY OF TIGARD ELECTRICAL PERMIT
I , COMMUNITY DEVELOPMENT Permit#: ELC2016-00219
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2016
Parcel: 1 S136CC00100
Jurisdiction: Tigard
Site address: 8200 SW PFAFFLE ST
Project: Westside Christian High School Subdivision: None Lot: None
Project Description: Sign lighting for one illuminated wall sign on the south elevation.
Contractor: SECURITY SIGNS INC Owner: WESTSIDE CHRISTIAN HIGH SCHOOL I
2424 SE HOLGATE BLVD BY DAVIS, DANIEL A, PRESIDENT
PORTLAND, OR 97202 8200 SW PFAFFLE ST
TIGARD, OR 97223
PHONE: 503-546-7114 PHONE:
FAX: 503-230-1861
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 03/31/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 03/31/2016 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTE • : Ore"• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00 0 through OAR 95 001-..!*. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. 87 or 1.800.332. •44.
t
Issued :y: A... i_ t ...d Permittee Signature: ..iii' / e..-
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
r
Electrical Permit Application FOR OFFICE USE O\I,Y
DECEIVED !Eiew
Permit No.: �(_- t -[:lUA!el
13125 SW Hall Blvd.,Tigard,OR 9723
• ! Other Permit /�
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: av C(Q�D�'�
T I G A R O Inspection Line: 503.639.4175 MAR 21 2016 Date ReadyBy: J� Fel See Page 2 for
Internet www.tigard or.gov Notified/Method: Supplemental Information
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New construction ❑Addition/altera io replacement Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
`� � ,r d' C4 T',�F D`C� S�UCTT6N '$ yrs � r exceeds 10,000 amps at 150 volts or
0 Floating buildings.� °' --'
"" '" less to ground,or exceeds 14,000 ❑Commercial-use agricultural
0 1-and 2-family dwelling !'Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 75 KVA or
v ,N ,r` k. ❑Emergency system. larger separately derived system.
dn j 0:0071N'FoR114AT10 n LOCATION ❑Addition of new motor load of ❑"A" "se "1-2" "1-3"
�r �.�,,, r=, r s a :�_�,
Job no.: �.49 I Job site address: 0200 � f'f ��' . 100HP or more. occupancy.
f /rn 0 Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: Pi -ld 17223 ❑Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations 600 volts nominal
Suite/bldg./apt.no.: I Project name: ,)T /QE C? s7717jI E.' ervlce or feeder 600 amps or more.
Cross street/directions to job site: Description I Qty. I Fee. ► 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'I 500 sq.ft.or portion 33.92 1
Limited energy,residential
,,, PZaf w,.e „ate» it ''{c, E...,a+ti ra,ONI OF`WORK . r .d- �,,+,' *y ..>.i�7 -::,: (with above sq.ft) 75.00 2
� /�' / � �� invited energy,multi-family
!/C�5/f'Li L ZC/nLL 8/5-/2249,t( D/( /`/ i...2 residential(with above sq.ft.) 75.00 2
/ ( / /� / Services or feeders installation,alteration,and/or relocation
6i6/6//A( id 7 � 2 e/i1--6/-24 H J r rCL� /i 200 amps or less 100.70 2
s `0�OPERTY #. �� fIZTENLAT� � , 201 amps to 400 amps 133.56 2
amps to 600 amps 200.34 2
Name: `_ `/— 577/9-A( 50-110-Y64%1
amps to 1,000 amps 301.04 2
Address: g7.�") /7/1f_r_-- 5-T Over 1,000 amps or volts 552.26 2
n �yz� Temporary services or feeders installation,alteration,and/or
City/State/ZIP: i(/ C relocation
Phone: ( ) Fax:( ) 200 amps or less 59.36 1
Owner installation:This in tallation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease rept/or xchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
vv//���y// Branch circuits-new,alteration,or extension,per panel
Owner signature' Date: A.Fee for branch circuits with
t ,sAPLCk ;Y , I CO-NTACT. PON ' s` aebaobrsaenrvi
chceciouder fee,
7.42 2
Business name: SCURITY SIGNS,INC B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Contact name: CYNDI KRACKE branch circuit
Each add'l branch circuit 7.42 2
Address:2424 SE HOLGATE BLVD Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP: PORTLAND,OR 97202dwelling,service and/or feeder 67.84 2
Phone: (503)546-7102 Fax: : (503)230-1861 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail permits@securitysigns.com Sign or outline lighting ' 67.84 2
'- . it` CONTRA-07.00.':::'.:,...i:',7,-,
- - � �- � ����t�-�'. -* � � -. Signal circuit(s)or limited-energy
Business name:SECURITY SIGNS,INC panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address:2424 SE HOLGATE BLVD Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:PORTLAND,OR 97202 Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:(503)546-7102 Fax: (503)230-1861 Inspections for which no fee is 90.00/hr
specifically listed('/s hr min)
CCB Lic.: 122809 Electrical Lic.: •,,-.CLS Suprv.Lic.: 383SIG 0ECrRICAL pER1iirrnES ,. _ s
Subtotal:
Electrician signature,required:
/I-
Suprv. Plan review(25%of permit fee):
Print name: MARC LIND I i Date: c f/bl/�j State surcharge(12%of permit fee):
/�./ TOTAL PERMIT FEE: 75- 1g
Authorized signature: 4/7„7e. / This permit application expires if a permit is not obtained within 180
66
Print name: CYNDI KRACKE I Date: !o</��/// l/6 days after it has been accepted as complete.
Number of inspections allowed per permit.
1:A Building APermits\ELC-PermitApp.doc 117/01/10 447-4615T111/05/COM/WEB
CITY OF TIGARD FEE AND PAYMENT HISTORY
E # _ 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
ELC2016-00219 - 8200 SW PFAFFLE ST, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Sign or Outline Lighting 220-0000-43103 $67.84 $67.84 $67.84
12%State Surcharge-Electrical 100-0000-24001 $8.14 $8.14 $8.14
Totals for Fees $75.98 $75.98 $0.00 $75.98
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
Total P encs: _ _. $0.00
Balance Due: $75�8
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
8200 SW PFAFFLE ST, TIGARD, OR, 97223
Record Type:
Commercial - Electrical
Inspection Type:
199 Electrical final
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
January 17, 2017 at 12:22:37
PM
Record ID:
ELC2016-00219
Inspector:
Chip Barnett
Contractor