Permit (29) 1 CITY OF TIGARD ELECTRICAL PERMIT
7 COMMUNITY DEVELOPMENT Permit#: ELC2016 00260
TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/03/2016
Parcel: 2S102CB03200
Jurisdiction: Tigard
Site address: 9975 SW FREWING ST 210
Project: Accident Care Subdivision: FREWING'S ORCHARD TRACTS Lot: 21
Project Description: (1)sign lighting.
Contractor: VISION SIGNS LLC Owner: MASSIH LLC
16127 NE THOMPSON ST BY PIERROUZ YASAVOLIAN
PORTLAND, OR 97230 8 BECKET ST
LAKE OSWEGO, OR 97035
PHONE: 503-442-1195 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/03/2016 $67.84
Specifics: 1 ea 12%State Surcharge- 05/03/2016 $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. ATT : . • egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 .010 through OA' •. -001 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3 .2 4'
Iss ed By: I /� �L� Permittee Signature:
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 App11CaitrfCEIVEP
FOR OFFICE USE ONLY
KrCity Tigard DaceiBed ^ � //-OOv
of q �� ( may, Permit g: �O
13125 SW Hall Blvd.,Tigard,OR 9727f Plan Review
Phone: 503.718.2439 Fax: 503.59419450 4 7.016 Date/By: Related Permit#: 644010l4—C re il/
T IGA RD Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for
® Internet: www.tigard-or.gov ITV . '( Notified/Method: Supplemental Information
TYPE t PLAN REVIEW
Now construction D Other:oi17dlteratidn/replacement 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 TYPE
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
El1-and 2-family dwelling . Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family '---IMaster builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: A I Vil Job site address: .> c) `i ' 2t lav l tV' 100HP or more.
g 7 V V �I ❑..A„ .,E„ ..l 2„ ..1 3„
City/State/ZIP: {� `} G y 7 ❑Six or more residential units. occupancy.
To a�rt R V t� 7 ❑Health-care facilities.
,1 ❑Recreational vehicle parks.
Suite/bldg./apt.#: ( d Project name: ALC i��M /n0,R .- ❑Hazardous locations. ❑Supply voltage for more than
V ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
-- Description 1 Qty. I Each 1 Total I "
q q W� S W rl�t fltjl(�' ' �� New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'l 500 sq.ft.or portion 33.92 1
l DESCRIPTION OF WORK Limited energy,residential
/-ed (ii it.11,11€/ 1 y� �,��` (with above sq.ft.) 75.00 2
T1 t c°a��f ifS r�/-/! �SY 6� GZ11 left Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: ' /e a /1 G z y A�,0 I l ct 200 amps or less 100.70 2
Address: /�q(7/ I X,j r 201 amps to 400 amps 133.56 2
C� yl `� "" hie I 401 amps to 600 amps 200.342 I
City/State/ZIP: / p 2
it,41]� (� /� /�r �3 601 amps to 1,000 amps 301.04 2 Over 1000 ams or volts 552.26Phone:(�Q3) '�� ��� � Fax:( ) , P 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 e ange,according to ORS 447,449,670,and 701./ 201 amps to 400 amps 125.08 2
Owner signature: Date: 3//7//,t_ 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: above service or feeder fee,
��Si Ont l � each branch circuit 7.42 2
Contact name: Tern VS ✓ B.Fee for branch circuits without
7��. service or feeder fee,first 56.18 2
Address: 1c�a `7 /V F 146 �f t6� > branch circuit
City/State/ZIP: I Each add'l branch circuit 7.42 2
�v JR /!�� d �� �17�2 3 D Miscellaneous(service or feeder not included)
Phone:(sj',' 44! - 1/ 4 Fax: :( -03) r7..�_ �0,� 0/ Each manufactured or modular 67.84 2
Email: ! 7 S dwelling,service and/or feeder
// �r F.
7-cm V > �� C C/�1 Reconnect only 67.84 2
fCONTR4CR ' ' Pump or irrigation circle 67.84 2
Business name: 1 I g ;231AS' j / C Sign or outline lighting I 67.84 47�y 2
Address: //'/ .� 7 ��,1LLLF /( 4nn�Z — pinna, Iter tions)or lextensionergy ❑ See Page 2 2
(G u� �(% panel,alteration,or extension.
City/State/ZIP: Cgd f evA `( G" Each additional inspection over allowable in any of the above
'/ 7,�3o Additional inspection(1 hr min) 66.25/hr
Phone:6-e3 ) „5/1.4,2 _ `/‘i Fax:( ) Investigation(1 hr min) 90.00/hr
..! j/ Industrial plant(1 hr min) 78.18/hr
Email: (/jj fl Ar , e 8 Inspections for which no fee is
90.00/hr j
2
viaO/
CCB Lic.: )7 � - Electrical c.: _. Suprv.Lie.: /7G r specifically listed('h hr min)ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: • (i— / Subtotal: (Q 7. $`t
Print name: Date: ❑Plan Review Required(25%of permit fee):
....iS State surcharge(12%of permit fee): 1(• /
Authorized signature: •,/ TOTAL PERMIT FEE: 75.9'
This permit application expires if a permit is not obtained within 180
Print name: �� A_/ III Date: /)7 1�� ` days after it has been accepted as complete.
/ /f' * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
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
9975 SW FREWING ST 210, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00260
Jeff Grove
Violation Summary:
Inspector Contractor