Permit CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: ELC2017-00069
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/30/2017
I A It 1) g Parcel: 2S110AA00600
Jurisdiction: Tigard
Site address: 10650 SW MCDONALD ST
Project: Seven Eleven Free Standing Sign Subdivision: None Lot: None
Project Description: (1)branch circuit for pole sign. Sign lighting under ELC2016-00754
Contractor: PARAMOUNT ELECTRIC CO Owner: 7-ELEVEN INC
39085 PIONEER BLVD STE#203 BY TEXLAND PROPERTIES CORP
SANDY, OR 97055 TAX DEPT#16394
PO BOX 711
DALLAS,TX 75221
PHONE: 503-703-2571 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 01/30/2017 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/30/2017 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This per a' ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be d• e in accordance ''.h approved plans. This permit will expire if work is not started within 180 days of issua e, or if work is suspended for more the 180
day.. ATTENTION: Orego la .uires you to follow the rules adopted by the Oregon Utility Notifi -(.n 'enter. Those rules are set forth in OAR
95 -001-0010 through OAR 9 --001-00 You may obtain a co. of the rules or direct questions to OUNC by calling 50 987 or 1.800.332.2344.
� �1�I�<ued By: � , � Permittee Signature: l I_.al/
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:/ g4//7
LICENSE NO. z(ea-5 S
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 A 8 •lica *t I ., , Folz 0141(0.. i SI,0y1.1
4411
City of Tigard *. ' "� ) Received / Q ,
r ��
�. f.: oYJ
Date/B 1 Permit#:
11 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review�O
II Phone: 503.718.2439 Fax: 503.591.1W 0
�•A 3 0 ?U 1 Date/B : Related Permit#:
Inspection Line: 503.639.4175 3 Ready Date/By: Juris: H See Page 2 for
1 1 G A R D Internet: www.tigard-or.gov (( '�'" y Notified/Method: Supplemental Information
TYPE QF1W J F i kJAI. PLAN REVIEW
0 New constructiottAdditi �t y 40AW#)r1 Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition '� t
Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-family �(''OmmerCial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ dwelling 7 0Accessory building amps for all other installations. buildings.
0 Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: 500 cLd ' Q Lj oS e f 100HP or more. ❑"A","E","1-z","1-3",
City/State/ZIP: "r aAd (�J Gj `! ❑Six or more residential units. occupancy.
v ` 7 2 z_7 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: i ❑Hazardous locations. 0 Supply voltage for more than
7`�
0 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
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
DESCRIPTION OF WORK Limited energy,residential
( ) .S °1 1-,` ,(
, ^ (with above sq.ft.) 75.00 2
' � d Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 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
0
APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit "1 56.18 $ / 2
City/State/ZIP: Each add'I branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder
Email: 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ?Ck_cOLA.,(ASK.,,A.A..._.4-- �J�ce !r'e C0.0 Sign or outline lighting 67.84 2
q '� Signal circuit(s)or limited-energy
Address: C a S�� C� S c i4 t ArN 2 panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: (76_61.0,144 � ' -el/
Each additional al ninspection
inspection1hri over allowable in2 any of the above
t � CJ 3 Additional inspection(1 hr min) 66.25/hr
Phone:(S ) (Q 2;2 ( ' 0-'5------ Fax:( ) Investigation(1 hr min) 90.00/hr
Email: ("F F.,- �) �/j Industrial plant(1 hr min) 78.18/hr
f e-fi --e_'- ^ C- -- Inspections for which no fee is
fq k 1� yas specifically listed 'h hr min) 90.00/hr
CCB Lic.: I l5- i '> Electrical Li .: �` U j Suprv.Lic.:z,O 20� pe y (
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 6,/g
Print name: (AL( -ft -e.. re,%j,_-..__ Date: (_ ' ?"-- 0 Plan Review Required(25%of permit fee): -----
State surcharge(12%of permit fee): (Q.71/
Authorized signature: TOTAL PERMIT FEE: `�.4`�-
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Vs hr min)
COMMERCIAL WORK ONO: ELECTRICAL PERMIT FEES
SubtotalEnteron Page 1):
Fee for each commercial system: $75.00
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 06/17/2015