Permit (124) CITY OF TIGARD ELECTRICAL PERMIT
r COMMUNITY DEVELOPMENT Permit#: ELC2017-00155
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/07/2017
Parcel: 25101 AA00101
Jurisdiction: Tigard
Site address: 12000 SW 66TH AVE
Project: Landmark Ford Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Sign lighting for new LED board.
Contractor: TUBE ART SIGNS&SPORTS DISPLAYS Owner: CORLISS, JAMES L&CORA K
4243-A SE INTERNATIONAL WAY LEASE TO: FORD LEASING
MILWAUKIE, OR 97222 DEVELOPMENT COMPANY
PO BOX 23970
TIGARD, OR 97281
PHONE: 503-653-1133 PHONE:
FAX: 503-659-9191
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 03/07/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 03/07/2017 $8.14
Type of Use: COM Electrical
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 co f4He ules or direct questions to OUNC by callin+ $ •32.1987 or 1.800.332.2344.
Issued By: `i%3 > -- Permittee Signature: 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' 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 FOR OFFICE USE ONLY
City of Tigard114,,* C 1^q, Received _ 6
aDate/By: 3/7//7 Permit#: c-/.-f- 1 i 7�.c0L L�"
13125 SW Hall Blvd.,Tigard,OR 972 ., Plan Review t •/
': I Phone: 503.718.2439 Fax: 503.598.1 ,!' Date/By: Related Permit#:
Inspection Line: 503.639.4175 ( �ti 1 Ready Date/By: Juris: Id See Page 2 for
1 I(,\RI) 1 �. �—
Internet: www.tigard-or.gov Notified/Method: 7�i } Supplemental Information
TYPE OF WORK 4I v .5..1.. PLAN REVIEW
❑New construction El Addition/alteration/rept'f d 1T edit `^t • Please check all that apply(submit 2 sets of plans w/items checked):
❑ 0 Demolition �-'z ` cVI4 't > 0 Service or feeder 400 amps or more 0 Building over three stories.
Other: ,V, '.I a-� '
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONST' * e1 exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
ID Addition of new motor load of system.
Job#:
118336/2 I Job site address: 12000 SW 66th Ave. 10011P or more. ❑"A',°e',°1 -r',°1-3
City/State/zIP: Tigard,OR 97223-8574 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
0 Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: Project name: Landmark Ford600 volts nominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site: SW Franklin Street FEE SCHEDULE
Description I....Qty. I Each Total I *
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot#: g g
r1 1,000 sq.ft.or less 168.54 4
Tax map/parcel#: 12 S 10 A!0010 I IZ. 4 i(.;`n i C(I fes" Ea.add'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK i Limited energy,residential 75.00 2
Connect one new LED board to existing circuit (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
0 Renewable Energy 0 See Page 2
PROPERTY OWNER
I ll TENANT' Services or feeders installation,alteration,and/or relocation
Name: Landmark Ford 200 amps or less 100.70 2
Address: 12000 SW 66th Avenue 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard,OR 97223 601 amps to 1,000 amps 301.04 2
' Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
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
0-1
APPLICANT J l CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Tube Art Group above service or feeder fee,
7.42 2
each branch circuit
Contact name: Deborah Tol ke B.Fee for branch circuits without
2'i3- ay branch circuit
City/State/ZIP: Milwaukie,OR 97222 Each add/I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503)653-1133 Fax: :( 503) 659-9191 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: dtolke@tubeart.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Tube Art Group Sign or outline lighting 1 67.84 67.84 2
Address: 4243-A SE International WaySignalanel,alteration,
circuit(s)ioor extension.
0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Milwaukie,OR 97222 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)653-1133 Fax:( 503)659-9191 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: dtolke@tubeart.com Inspections for which no fee is
specifically listed 14 hr min 90.00/hr
CCB Lic.: 70956 Electr' al L s : 37554 CLS �prv.Lic.: 601 SIG p Y ( >
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,requir-.: . Subtotal: 67.84
Print name: David Jaque ate: 3/ 17 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 8.14
Authorized signature: ;i � TOTAL PERMIT FEE: 75.98
This permit application expires if a permit is not obtained within 180
Print name: Deborah Tol ke Date: 3/6/17 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