Permit (39) n CITY OF TIGARD ELECTRICAL PERMIT
II ' COMMUNITY DEVELOPMENT Permit#: ELC2016-00225
T IARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/05/2016
G'
Parcel: 1S134BC00200
Jurisdiction: Tigard
Site address: 12198 SW SCHOLLS FERRY RD
Project: Baja Fresh Subdivision: None Lot: None
Project Description: (2)sign lightings
Contractor: RAMSAY SIGNS INC Owner: ATLAS GREENWAY LLC
9160 SE 74TH AVE 333 NW NINTH AVE, STE 1009
PORTLAND, OR 97206 PORTLAND, OR 97209
PHONE: 503-777-4555 PHONE:
FAX: 503-777-0220
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 04/05/2016 $135.68
Specifics:
1 ea 12%State Surcharge- 04/05/2016 $16.28
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $151.96
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 ether 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 w,rk is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent: . T ose rules are set forth in OAR
952-001-0010 through R 952-001-0090. Yo am a cop rules or direct questions to OUNC by calling 503.232.1,:7 or 1.:'0.332.344
Issued By: ' Permittee Signature: h.—
OWNER
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 `
City of Tigard "") e;.1.
te/ y: 3 t�3 I J(��y�, Permit#: �/)l6 .2 .�
13125 SW Hall Blvd.,Tigard,012 Z3 �I�E� DaPlan Review V
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 MAR 2 3 2016 Ready Date/By: furls: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
arW ,... _.. _ r;777:i RN/773
R flint
.,JA4e :s :a fi n
p New construction ill Additio d a I C.4ghtf8 ION Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
v ,c' (a� `'. ,€, 3> . .11:7:i-7: : _ ,*ASO'x exceeds 10,000 amps at 150 volts or ❑Floating buildings.
0 1-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-ttse agricultural
amps for all other installations. buildings.
0 Multi-family ❑ Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
.t , t , : y2 3; p t t, "l„yp; K� 0 Emergency system. larger separately derived
Job 4: Job site addreSS: 'I 5 / ❑Addition of new motor load of system.
1 , hc/ /L I00HP or more. ❑"A ,..E.. ..1.7.. ..1.3..
City/State/ZIP: III0111111111
❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 4 6,e. ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
' Cross street/directions to job site: 2 t d /2J— . r FEE SCHErt,.LE
Description I I Each I Total _J
New residential single-or multi-family dwelling unit.
Subdivision: Lot 4: Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
33.92 1
_ s Ea.add'I 500 sq.ft.or portion
•° iw a s, ... bs £i , ,: , F?-?,'. Limited energy,residential
75.00 2
jQ
/�✓�� J /� (with above sq.ft.)
vLimited energy,multi-family
75.00 2
�,i residential(with above sq.ft.)
e r Renewable Energy ❑ See Page 2
14 t' i ,' , Rr` Services or feeders installation,aleration,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 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 I
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
ilasw max. 4 Branch circuits—new alteration or extension, ter panel
gi '` 44 z ,,.�5*$`', ""`wt- ''-'`
t ''` .:7;
0 �., , , _
"" �` r' A.Fee for branch circuits with
Business name: above service or feeder fee, 7.4_2 2
each branch circuit
Contact name: B.Fee for branch circuits teirhoat
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
'� ,r,,.a i19 Pump or irrigation circle 67.84 2
Business name: IMA IIMITAIII Sign or outline lighting ., 67.84 4.15:6(2
'��'�L' I� � Signal circuit(s)alteration,
or limited-energyxesi ❑ See Page 2
Address: 41/Ma, panel,alteration,or extension. -
City/State/ZIP: �� I Each additional inspection over allowable in any of the above
AIOff Additional inspection(I hr min) 66.25/hr
y
Phone: 1� I� jr� S Investigation(I hr min) , 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/hr
CCB f i/ i, r t s tecifically fisted(/hr min)
Suprv.Electrician signature,required: ��� Subtotal: /3S toe ;
Print name: f� Date: • cO ❑Plan Review Required(25%of permit fee): .---1
State surcharge(12%of permit fee): l(0 .4 f'
TOTAL PERMIT FEE:
Authorized s 11 1i a !'
This permit application expires if a permit is not obtained within 80
Print name: n /� ati rw Date: 3f ,/. /I I (_ days after it has been accepted as complete.
( /!!� ✓ bf vv 1U * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ItR_ERE.doc Res 06/7/2015 44 46151"(II/05/('OM/WP13
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
12198 SW SCHOLLS FERRY RD, TIGARD, OR,
97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00225
Jeff Grove
Violation Summary:
Inspector Contractor