Permit (151) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00159
T(G.ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/08/2017
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9714 SW WASHINGTON SQUARE RD F04
Project: Braganza Tea Subdivision: None Lot: None
Project Description: Sign lighting for(1)sign.
Contractor: VANCOUVER SIGN COMPANY INC Owner: PPR WASHINGTON SQUARE LLC
2600 NE ANDRESEN RD#50 PO BOX 847
VANCOUVER,WA 98661 CARLSBAD, CA 92018
PHONE: 360-693-4773 PHONE:
FAX: 360-693-2747
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 03/08/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 03/08/2017 $8.14
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You rn.obtain a cop les or direct questions to OUNC by calling 503 2. 987 or 1.800. 2344,
ti
Issued By: �`" Permittee Signature: �f '�
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applicationcl'k\ FOR OFFICE ISE ONLY
City of Tigard " Received
fh v - DateB : _ / �' s
13125 SW Hall Blvd.,Tigard,OR 97
: .,, Plan Review Related Permit#: Aall •
Phone: 503.718.2439 Fax: 503.598. ) `F Date/B :
T I G A R p Inspection Line: 503.639.4175 % 1..V *Ready Date/By: ® See Page 2 for
ERIEInternet: www.tigard-or.gov bO , V" Notified/Method: Supplementallnformation
TYPE OF WORK 1 0.c'%.:-'4J'''./ '$ REVIEW
®New construction 0 Addition/alteration/r9pl t eiei ,:',,S.)1, Please check all that apply(submit 2 sets of plans w/items checked):
>o-v \�A ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: V,i.K. where the available fault current
0 Marinas and boatyards.
CAM 'CONST 1 g $N 1. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Comns rcial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder ❑Other: 0 Fire
pump. 0 Installation of 150 KVA or
• JOB SITE INFORl Ai�i AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:9585 SW Washington Square Road 100HP or more. ❑"A","E","I-2","1-s",
City/State/ZIP: 0 Gj: .' 7;5 ❑Six or more residential units. occupancy.
p D V
o Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#:FC04 I Project name:Braganza Tea ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: PEE S�
Description i Qty. 1 Each j Total 1 *
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#: Ea.add'!500 sq.ft.or portion 33.92 1
D CRIIYLION,Of O : Limited energy,residential
s ft.) 75.00 2
Install(1)sign circuit (with above q
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER , t4 T�l - - Services or feeders installation,alteration,and/or relocation
Name:Braganza Tea 200 amps or less 100.70 2
Address:9585 SW Washington Square Road FC04 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Portland OR 97223 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,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
'� Branch circuits–new,alteration,or extension,per panel
Lai'CONi''CT,P'F }1�1 A.Fee for branch circuits with
Business name:Vancouver Sign Co above service or feeder fee, 7.42 2
each branch circuit
Contact name: Chris Brown B.Fee for branch circuits without
Add)t x.$600 NE Anent acn Rd 51 L 50 — servic sr,fn er , � N11/5 z Y
branch circuit
City/State/ZIP:Vancouver,WA 98661 Each add'1 branch circuit 7.42 2
Phone: (360)787-8099 I Fax: : 360 693-2747 Miscellaneous(service or feeder not included)
( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:CBrown@vansignco.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Vancouver Sign Co Sign or outline lighting 1 67.84 C7,s9 / 2
Address:2600 NE Andresen Rd STE 50 Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Vancouver,WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(360)693-4773 I Fax:(360)693-2747 Investigation(1 hr min) 90.00/hr
Email:CBrown@vansignco.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 63951 Electrical ' .: 37-46CLS I Suprv.Lic.: 648SIG specifically listed(ih hr min)
CAL,PES Vis
Suprv.Electrician signature,required:
Subtotal: ,J41d21*-r„-':�d.�
Print name: Adam Wallis Date: ( ' b- 1 - ❑Plan Review Required(25%of permit fee): `f
State surcharge(12%of permit fee): .‘,...7-..-78--$.74')
Authorized signature: / JJ f TOTAL
PERMIT FEE: ...../2.62d 75717
;� This permit application expires if a permit is not obtained within 180
Print name: '�',ia r' (-zj V7rot.„)/\ Date: (- b- i days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\B�ilding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615x(11/05/COM/WEB