Permit CITY OF TIGARD ELECTRICAL PERMIT
71112 ' COMMUNITY DEVELOPMENT
Permit#: ELC2016-00849
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/03/2016
T[ �' Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 130
Project: BFit Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: Lighting for new 5'monument sign.
Contractor: VANCOUVER SIGN COMPANY INC Owner: PACIFIC REALTY ASSOCIATES
2600 NE ANDRESEN RD#50 ATTN: N PIVEN
VANCOUVER,WA 98661 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 360-693-4773 PHONE:
FAX: 360-693-2747
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 11/03/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 11/03/2016 $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. ATTENT s Ore" law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00 through OAR 9' -0: -00.I u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued =y: A. 1k �. Si -, Permittee Signature: 411111M_• ! OL/6"71 "
i
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' �_
1 !� :�.all/I17ffi A• Date: ,t /7
LICENSE NO. & Q,.
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 Applicationv ^t ivy il FOR OFFICE USE ONLY
City of Tigard Receivd Date/Bea 6[ P. /la (D,.._/ Permit#: ez_e.9e/&--50$9
II
e 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 NO
2016
Date/B Related Permit#:
Inspection Line: 503.639.4175 N O V Gct+ Ready Date/By: Juris: ® See Page 2 for
T I G A R D Internet: www.tigard-or.govNotified/Method: Supplemental Information
TYPE OF WSISSY O .iG. t PLAN REVIEW
a gT- nI O Please check all that apply(submit 2 sets ofplans w/items
❑New construction ❑Addition/alt T dAtltf[t PP y checked):
Demolition
0 Service or feeder 400 amps or more ❑Building over three stories.
❑ ®Other:Sign 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 El Accessory building less to ground.or exceeds 14.000 ❑Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder ❑Other: 0 Fireum
p p. El Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION El Emergency system. larger separately derived
Job#: Job site address: Se uola Pkwy ❑Addition of new motor load of system.
9 I OOHP or more. ❑,.A„ „E „l_2„ ..1 1„
City/State/ZIP:Tigard,OR,97224 /5.576— ❑Six or more residential units. occupancy.
El Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#:)25 / 3v Project name: t Cy / -r- ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I o
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#:2S112DD01600
Ea.add'1500 sq.ft.or portion 33.92 I
L1 f A)4, /i/L DESCRIPTION OF WORK Limited energy,residential
1RstaIJ(1)illuminated monument sign. (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:Andrew R.Jones 200 amps or less 100.70 2
Address: 15495 SW Sequoia Pkwy 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR,97224 601 amps to 1,000 amps 301.04 2
Phone: (360)787-8099 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:Vancouver Sign Group above service or feeder fee,
7.42 2
each branch circuit
Contact name:Chris Brown B.Fee for branch circuits without
sAddress:2600 NE Andresen Rd,Ste 50 branch circuit t feeder fee,first
56.18 2
City/State/ZIP:Vancouver,WA,98661 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: (360)787-8099 Fax: : (360)693-2747 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:CBrown@vansignco.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Vancouver Sign Group Sign or outline lighting 1 67.84 67.84 2
Address:2600 NE Andresen Rd,Ste 50 circuits) ergy 1:1See Page 2 2
panelSignal,alteration,or or exlimited-entension.
City/State/ZIP:Vancouver,WA,98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(306)787-8099 Fax: (360)693-2747 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: CBrown@vansignco.com
Inspections for which no fee is 90.00/hr
CCB Lic.: 63951 Electrical Li .: 37-46CLS Suprv. ' .: 648SIG specifically listed(/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: j / ' . Subtotal: 67.84
Print name: Adam Wallis Date: 11/1/2016 ®Plan Review Required(25%of permit fee): '-16:5-6—
State
16:96State surcharge(12%of permit fee): 8.14
Authorized signature: TOTAL PERMIT FEE: �Z. r
// This permit application expires if a permit is not obtained within 180
Print name: Chris Brown Date: 11/1/2016 days after it has been accepted as co lete. ,pi
* Number of inspections allowed per permit. �s 7
I:A Building\Permits\E1.C_PcrmitApp_El,R_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15575 SW SEQUOIA PKWY 130, TIGARD, OR,
97224
Record Type: Record ID:
Commercial - Electrical ELC2016-00849
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor