Permit (24) CITY OF TIGARDIN ELECTRICAL PERMIT
^. COMMUNITY DEVELOPMENT Permit#: ELC2017 00393
Date Issued: 05/30/2017
T f fA AR L 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9336 SW WASHINGTON SQUARE RD W13
Project: White House Black Market Subdivision: None Lot: None
Project Description: Sign lighting for(3)signs.
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
3 ea Sign or Outline Lighting 05/30/2017 $203.52
Specifics:
1 ea 12%State Surcharge- 05/30/2017 $24.42
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $227.94
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 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through O:• 952-001-0090. Yo •stain a c •y of the r -s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344..8
Issued By: �L.4..a., _ — Permittee Signature: ( [ -- +'[-+�-�
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 603.639.4175 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 �l Received
FOR OFFICE 115E ONLY
City of Tigard , �'"°�"
Date/B : , 6 i 7 *FAA
!NI M 13125 SW Hall Blvd„Tigard,OR 97 1 mi Plan Review
2 Phone: 503,718.2439 Fax: 503.598. 960 3I. DateBv: Related Permit#: 4. A. .
Inspection Line: 503.639.4175 �R� Ready Date/By: F4 ee Page 2 for
T I(,A 14 Il Internet: www.tigard-or,gov CO lt���e`,ified/Method: ��� Supplemental Information
E Qk WOR (4 ' 4` PLAN:RE W
❑New construction ®Addition/alteratil 1~ement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition El Other: where the available Fault current ❑Marinas and boatyards,
"CATEGORY OIC CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings,
;(t ❑ l-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 ❑Commercial-use agr cultural
amps for all other installations, buildings.
T ❑Multi family 171 Master builder ❑Other: 0 Fire pump, 0 Installation of 150 KVA or
r I ii i3Q INFQR L M p l (i (f O1 s' ❑Emergency system, larger separately derived
Washington SqRd ❑Addition of new motor load of system.
Job#: Job site address:9 g IOOHP or more, ❑"A","E","1-2","1-3".
rZli ❑Six or more residential units. occupancy.
N City/State/Z1P:Tigard,OR 97223 ❑Recreational vehicle parks;
❑Health-care facilities,
(i Suite/bldg./apt.#: Project name:White House Black Market ❑Hazardous locations, 0 Supply voltage for more than
❑Service or feeder 600 amps or more, 600 volts nominal
Cross street/directions to job site: ',u-T ice N�l��ul ( �aI E`SCHEDULE h h I'' j
Description onQty. 7 EachTod
�' p �Ui�.k i�,�� ... � ,!, J tat
_.7 New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
y Tax map/parcel#:
tEa.add'1500 ft or ort 33.92 I
� sq. portion
?ESCRIPTION."OF WORK -
Limited energy,residential 75.00 2
Install(3)sign circuits. (with above sq.ft.)
i Limited energy,multi-family 75.00 2
t residential(with above sq.ft.)
Renewable Energy [3 See Page 2
El PROPERTY OWNER =: ka TENANT Services or feeders installation,alteration,and/or_relocation
Name:White House Black Market 200 amps or less 100.70 2
Address:9318 SW Washington Sq Rd 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
1.1 Phone: ( ) 'Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email; relocation
j Owner installation:This installation is being made on property that i own which is not 200 amps or less 59.36 I
j intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 snips to 400 amps 125.08 2
si Owner signature: Date: 401 amps to 599 amps 168.54 2
', ri APPLICANT A CQN,IAc ,PERso ; ; 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 rvirhour
Address:2600 NE Andresen Rd Ste 50service or feeder fee,first 56.18 2
branch circuit
- City/State/ZIP:Vancouver,WA 98661 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: (360)693-4773 Fax: :(360)693-2747 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
cis
Email:Cbrown@vansignco.com Reconnect only 67.84 2
CONTRACTOR -i Pump or irrigation circle - 67.84 2
4 Business name:Vancouver Sign Group Sign or outline lighting 3 - 67.84 ,a 2
- -°" Signal circuit(s)or limited-energy
``V1 Address:2600 NE Andresen Rd Ste 50 panel,alteration,of extension. 0 See Page 2 2
I.•• City/State/ZIP:Vancouver,WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Q Phone:(360)693-4773 Fax:(360)693-2747 investigation(1 hr min) 90.00/hr
Email:Cbrown@vansignco.com Industrial plant(I hr min) 78.18/tic
inspections for which no fee is 90.00/hr
CCB Lic,: 63951 Electrical Lie.: 37-46CLS Suprv.Lie.: 648SIG specifically listed('h hr min)
ELECTRICAL'PERMIT,FEES
Suprv.Electrician signature,reqid:It d: Subtotal: '3,5,1„
Print name: Adam Wallis 447/7741/r/i` R ttt; ❑Plan Review Required(25%of permit fee):_
0,,,,, State surcharge(12%of permit fee): t 4,112
Authorized signature: - TOTAL PERMIT FEE: 2i7 CjLi
This permit application expires if a permit is not obtainedwithin 180
Print name: Chris Blown Date: days after it has been accepted as complete.
Nu mber of i nspections allowed per permit
I:AItniktingVPcrmiisltil,.C_I'crmiiApp_lil„fi_IiRti lee Rev 06/17/2015 440-4615T(II/05/COM/WLn
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9336 SW WASHINGTON SQUARE RD W13,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2017-00393
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor