Permit (47) CITY OF TIGARD ELECTRICAL PERMIT
� ' COMMUNITY DEVELOPMENT Permit#: ELC201600272
T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/05/2016
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9516 SW WASHINGTON SQUARE RD H05
Project: Ben Bridge Jeweler Subdivision: None Lot: None
Project Description: (1)sign lighting
Contractor: TUBE ART SIGNS&SPORTS DISPLAYS Owner: PPR WASHINGTON SQUARE LLC
4243-A SE INTERNATIONAL WAY PO BOX 847
MILWAUKIE, OR 97222 CARLSBAD, CA 92018
PHONE: 503-653-1133 PHONE:
FAX: 503-659-9191
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 04/05/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 04/05/2016 $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 acc. •= 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. ATT ION: Oregon aw re. ' -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0'10 through OAR 952-001-..90. ou may obtain a copy of the rules or direct questions to OUNC by calling 50 '2.1987 or 1.800.332.2344.
Issue By: � l iyJ Permittee Signature: k
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
City RECEIVE]) Date/of Tigard ed yQrir kjlaj Permit#: Ei,C de,16 QQ.,2 7,2_
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' • ' Phone: 503.718.2439 Fax: 503.598.1960 D11111
ateB : Related Permit#:
Inspection Line: 503.639.4175 / _
'• - i Ready Date/By: .tuns: ® See Page 2 for
1 <<' \E'P Internet: www.tigard-or.goviiii Notified/Method: Supplemental Information
TYPE It lli,ARLJ PLAN REVIEW
®New construction r=1 Addl /[f M Please check all that apply(submit 2 sets of plans w/items checked):
�fUGi I1�4.?a rwhere the available fault current ❑Mannas and boatyards.0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other: •••.'
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural I
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or N
JOB SITE"INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: 128170/2 Job site address�SW Washington Square Road 100HP or more. ❑"A".^E"."t -2 ^t-3",
City/State/ZIP:Tigard,OR 97223 96140 0 Six or more residential units. occupancy.
❑Recreational vehicle arks.
❑Health-care facilities. P 16N
Suite/bldg./apt.#:H05 Project name:Ben Bridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal. 1
Cross street/directions to job site:SW Greenburg Road FEE SCHEDULE
Description I Qty. I Each I Total I • 0
New residential single-or multi-family dwelling unit. Qt
Subdivision:Washington Square Mall Lot#:R2365 Includes attached garage. (I1
Tax map/parcel#: 1S1260000300 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Connect wall signs to existing circuitl
(with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:Ben Bridge Corp. 200 amps or less 100.70 2
Address:PO Box 1908 201 amps to 400 amps 133.56 2
•
--- 401 amps to 600 amps 200.34 2
City/State/ZIP:Seattle,WA 98111 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 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 ® CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Tube Art Group above service or feeder fee, 7 42 2
each branch circuit
Contact name:Deborah Tolke B.Fee for branch circuits without
Address:4243-A SE International Wayervice or feeder fee,first 56.18 2
bbranch circuit
City/State/ZIP:Milwaukie,OR 97222 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)653-1133 Fax: :(503)659-9191 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:dtolke@tubeart.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Tube Art Group Sign or outline lighting 1 67.84 67.Tref 2
Address:4243-A SE International WaySignalnel, lern or limited-energyxns
panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:Milwaukie,OR 97222 Each additional inspection over allowable in any of the above
__ Additional inspection(1 hr min) 66.25/hr
Phone:(503)653-1133 Fax:(503)659-9191 Investigation(1 hr min) 90.00/hr
Email: kschultz@tubeart.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 70956 Electrical Lic: 37554 CL Supry Lic.: 366 SIG specifically listed CA hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: w7. gel
Print name: Ken Schultz Date: 4/5/2016 0 Plan Review Required(25%of permit fee): -----
Authorized
surcharge(12%of permit fee): $./V
Authorized signature: w [ �� TOTAL PERMIT FEE: ?J1,9 g
/ This permit application expires if a permit is not obtained within 180
Print name: Deborah Tolke Date: 4/5/2016 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB