Permit (58) CITY OF TIGARD ELECTRICAL PERMIT
r'111II.' COMMUNITY DEVELOPMENT Permit#: ELC2016 00809
Date Issued: 10/27/2016
T f GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 I
Parcel: 1 S 135BC00700
Jurisdiction: Tigard
Site address: 10795 SW CASCADE AVE
Project: Arcadia Sign Permit Subdivision: None Lot: None
Project Description: Sign lighting for(1)Illuminated wall sign.
Contractor: SECURITY SIGNS INC Owner: CASCADE FUTSAL LLC
2424 SE HOLGATE BLVD 5010 NE OREGON ST
PORTLAND, OR 97202 PORTLAND, OR 97213
PHONE: 503-546-7114 PHONE:
•
FAX: 503-230-1861
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 10/19/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 10/19/2016 $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 R 952-001-0090. ain a co•; • e ru- - •irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
L�',/
Issued By: � � i = Permittee Signature: e3,
zd.; ,...9" ..:.),
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 -OltFOR OFFICE USE ONLY
''' Received ,` 1
City of Tigard Date/By: U /t Permit#: &G ^l it'—.0-eb
III - v 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review v (rt.•!XL✓ W p
Phone: 503.718.2439 Fax: 503.598.1960 t I C'' Date/By: Related Permit#:,Z,�(� i to
Inspection Line: 503.639.4175 ;3 1. 1 y Date/By: Juris: H See Page 2 for
TIGARD
Internet. www.tigard-or.gov 'ti'G L' tfied/Method Supplemental Information
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[n New construction ❑Addition/alteration/r-� ny Please check all that apply(submit 2 sets of plans w/items checked):
t ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
, - t ,taw_* to Ham` 1 «, -- { exceeds 10,000 amps at 150 volts or El Floating buildings.
❑ 1-and 2-family dwelling L Commercial/industrial ❑Accessory building tens to ground,or exceeds 14,000 ❑commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other ❑Fire pump. 0 Installation of 150 KVA or
H:11711"1:;'41:
u) _ �1° al''' ! - "l` ❑Emergency system. larger separately derived
n?'1 ❑Addition of new motor load of system.
Job#: S� I Job site
addddress: /079 $4) 100HP or more. ❑"A",°°E","1 2",°°1-3",
City/State/ZIP: 7/ ,e0 9722_3 ❑Six or more residential units. occupancy.
/ ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: / ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: -hi; a - Jr-7,Z-A„,,-..i.4
�!' ��` Lf .tc i `iii`
i /1�`����/ �./'I Description Qty. Each Total
Cij /V,i� �C..l� /L(� New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
.... ' _
w Ea.add'1500 sq.ft.or portion 33.92 1
r
i' * ' ki s� 5q� ua c ,i � Limited energy,residential
IN CT71/L i) jJ/,/�1 e/✓1�f7,� ��// </6/1,/ (with above sq.ft.) 75.00 2
7�/71� �i.0 r tG/7<<-- l/C� d Limited energy,multi-family
75.00 2
eyv Q, 7 9r' /
K / �/,-"t /.. s�'1 ET— residential(with above sq.ft.)
, ! `�C t Renewable Energy 0 See Page 2
," e, . 'r 41Services or feeders installation,alteration,and/or relocation
Name: 11- WC- r(,57C._- j 'j 200 amps or less 100.70 2
Address: 5131/C NE- Diee401/4157- 201 amps to 400 amps 133.56 2
/��/ 401 amps to 600 amps 200.34 2
City/State/ZIP: / ) 7Z/b 0 epit 17243 601 amps to 1,000 amps 301.04 2
Phone:( ) I 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,r(n or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
rr
Owner signature: W Date: 401 amps to 599 amps 168.54 2
li ,ir ir ,, i _ I,` ` t 3 I,,"iot, „ t , `41 ! Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:SECURITY SIGNS,INC above service or feeder fee,
7.42 2
each branch circuit
Contact name:CYNDI STOCKS B.Fee for branch circuits without
service or feeder fee,first
Address:2424 SE HOLGATE BLVD branch circuit 56.18 2
City/State/ZIP:PORTLAND,OR 97202 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)546-7102 Fax: :(503)230-1861 Each manufactured or modular 67.84 2
Email:permits@securitysigns.com
dwelling,service and/or feeder
(� _ Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name:SECURITY SIGNS,INC Sign or outline lighting ( 67.84 (_s',)541 2
Address:2424 SE HOLGATE BLVD Signalnl, le circuit(s)ioor extension. 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:PORTLAND,OR 97202 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)546-7102 Fax:(503)230-1861 Investigation(1 hr min) 90.00/hr
Email:permits@securitysigns.com
Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
rCCB Lic.: 122809 Electrical Lic -- -0C Suprv.Lic.: 383-SIG specifically listed e/2hr min)
vt moi..= ' t,- I�; , • d Y rr ,'u ,t c
Suprv.Electrician signature,required: / �.
w l— / Subtotal: (P 7-iSy
Print name: MARC LINDQUIST I Date: `�/`/�//0 CI Plan Review Required(25%of permit fee):
/// �/ State surcharge(12%of permit fee): i. �'7
Authorized signature: TOTAL PERMIT FEE: '7 ' '
This permit application expires if a permit is not obtained within 180
Print name: CYNDI STOC S Date/0/244 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB