Permit (37) CITY OF TIGARD ELECTRICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit#: ELC2016-00374
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/09/2016
Parcel: 25101 BB01400
Jurisdiction: Tigard
Site address: 12176 SW GARDEN PL
Project: Fastsigns Subdivision: CROW PARK 217 Lot: 2
Project Description: Sign lighting for(1)sign.
Contractor: QUICKSILVER NEON AND SIGNS LLC Owner: ICON OWNER POOL 1 WEST LLC
2325 NW 154TH PL BY RYAN
BEAVERTON, OR 97006 PO BOX 460169
HOUSTON,TX 77056
PHONE: 503-626-7020 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/09/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 05/09/2016 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23.87 or 1.800.332.2344.
Issued By: C:=2)— ignature:�.��// //
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
,--
Electrical Permit Application SC) FOR OFFICE l'I( 1 I "l' ONLY i
City of Tigard CIS Received j'y
�6 Date Bv: ' ,♦/
4 13125 SW Hall Blvd..Tigard,0 Plan Review 021411 ,
Phone: 503.718.2439 Fax: 50 0 Na b Date/6v: IIMMINERIM
Inspection Line: 503.639.4175 o eady Date^$ 111=111 2
l fit,ii;1) p /a, rR y: ® Sec PaGc..for
Internet: www.tigard-or.gov \4\‘'',k O�4\Gi`�\0 •i NotifiedtMethod: Supplemental Information
TYPE OF WO Ari"t.. t I I PLAN REVIEW
0 New construction 0 Additionialterat tent Please check all that apply(submit j sets of plans w items checked):
[rather:
�^ y�r' J/ 0 Service or feeder 400 amps or more 0 I3uilding over three stories.
0 Demolition LL77 Other: 3 r .L/t f
where the available fault current 0 Marinas and boatyards
CATEGORY OF Cd&STRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1:31-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 0 Master builder 0 Other: IDFire pump 0 Installation of t50 KVA or
JOB SITE INFORMATION AND LOCATION ! ❑Emergency System. larger separately derived
Job Job ,`�,,�.{r �/ � } 0 Addition of new motor load of system.
}(SEtr'7.,r.'1fd L:.'4i(i�Lttii - ICIC €_ 10014Pormore ❑'q., ..F,. ..IZ.. ..13
City/State/ZIP: ( if t f +e f? G '7�� ❑Six or more residential units. occupancy
v 1 / 3 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg.iapt,#: ' Project name: .rot 5 fi 5I` /V
. `1 e, !S. 0 Hazardous locations. 0 Supply soilage for more than
+U{ 600 sous nominal.
0 or feeder 600 amps or more
Cross street/directions to job site: 1--1,1 j iji kii i FEE SCHEDULE
Description Qty. 1 Each i Total , '
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1.000 sq.ft.or less i 168,54 i
Tax map/parcel#: , ,
Ea.add'i 500 sq.ft.or portion i 33.92 i i
DESCRIPTION OF WORK Limited energy,residential
4 ' t t (with atxwe sq.ft.) 75.00
--ni .�t i t e Iia L-�' I 1 ('C&t ,51 ,\.f Limited energy.multi-family 75.00
residential(with above sq.ft.)
0 PROPERTY OWNER IId'7 EArANT 1 Renewable Energy 1 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: — t . j 200 amps or less 100 70 2
Address: ' 201 amps to 400 amps 133.56 2
LA 7 , ` ti (f(-� J�` � ) 401 amps to 600 amps 200.34
City/State/ZIP:P: / 0
6 G t L�l��, 7 601 amps to 1.000 amps 301.04
Phone:(50:) ,/l'e.. .. !`s'',3 Fax:( ) 1 Over 1.000 amps or volts 552.26 2
r' I Temporary services or feeders installation,alteration.and/or
Email i (1) 1IS et, c r ;r I
��t' 11''i t �(-.a r S }�'h� r co r� I relocation
Owner installation:Qthis installation is being made on proper, at I own which is not j 200 amps or less 59.36 i
intended for sale.lease.rem,or exchange.according to ORS 447.449.670,and 701. 201 amps to 400 amps 125.08 2
Owner signatu c.i. Aird.-'kl..._Z1 .i:. Hare: anJ� 401 amps to 599 amps 168.54 8.54 2
�
1Ti CONTACT PERSON PPLICANT i Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits Huai, t
Business name: above service or feeder fee. 7,12
each branch circuit
Contact name: c"' i C r B.Fee for branch circuits without
Address: service or feeder fee.first 56.18 2
branch circuit
City/State/ZiP: Each add'I branch circuit 1 742 2
Miscellaneous(service or feeder not included)
Phone:( ) 1I'a`::( ) I Each manufactured or modular
Email: ; dwelling,service andlor feeder 67 84 2
+ Reconnect only 67.84
CONTRACTOR 1 Pump or irrigation circle 67.84 2
Business name: ' ' v 4
� ( C �LA vi e I� x �� � � i Sign or outline lighting / 67.84 Gj _
) Signal circuit(s)or limited-energy ❑ See Page 2
Address:,23c�5 N uj ID/ 'th rpt g
iii���eee panel.alteration.or extension.
c �n/R Each additional inspection over allowable in any of the above
City/State/ZIP:
���+� Bea okri,151 ki ' " /�C ( ' 6 , Additional inspection(1 hr min) I 6625,hr
Phone:UC k. (c -7C.�..7CC Fax:( ) investigation(I hr mill) I 90.001 hr
Email i✓t i L le t5;''✓'„It , !V)L,.0; /4keiic.) Co)r' Industrial plant 11 hr min) 76.1 Si hr
1 Inspections for which no fee is
CCB Lie.:/k�`�7_5 L Electrical Lie.:4, 5A/, Suprv.I.ic.:771S/e� i specifically listed(!4 hr min) 90.UU'hr
Suprv. Electrician signature.required: I f
( ELECTRICAL PERMIT FEES
Subtotal:
Print name QtIL t t,-_,'p r✓ I Date:-/L--'L 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized sio ature: TO"IAL PERMIT FEE://79 -;II
� j Thin permit application expires if a permit is not obtained within 190
I Print name. t/,c,1s /& S r,� Date: •t '�L "/G days after it has been accepted as complete.
' Number of inspections allowed per permit
1dituiiding.Perrnits ELC P ,nitApp_6LR FAEdoc Rev 0617.2015 440-46:5T(1 i O5'COWWEB