Permit (132) INCITY OF TIGARD ELECTRICAL PERMIT
v '> COMMUNITY DEVELOPMENT Permit#: ELC2017-00898
T!GAR 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/05/2017
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Sign lighting for(1)illuminated wall sign.
Contractor: RAMSAY SIGNS INC Owner: ROIC OREGON LLC
9160 SE 74TH AVE ATTN: SCHOEBEL, RICHARD
PORTLAND, OR 97206 8905 TOWN CENTRE DR, STE 108
SAN DIEGO, CA 92122
PHONE: 503-777-4555 PHONE:
FAX: 503-777-0220
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 12/05/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 12/05/2017 $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. 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 obtain- o. • he rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 44 2 5f1 t...- 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 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 Tigard a Date/BReceived
13125 SW Hall Blvd.,Tigard,OR nI i. f 1/I X10 I ,
Plan Review
III III Phone: 503.718.2439 Fax: 8 9 Date/B : Related Permit#: ' if-.' 7.. 1 p
TIGARDIMINI
Inspection Line: 503.639. • 0� Ready Date/By: r, ee Page 2 for
Internet: www ttgard or.go ( t- "°t Noufied/Method: Supplemental Information
0 New construction 0 Addition/a t 0171 . '' ent Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition
0�Tc 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Other: where the available fault current 0 Marinas and boatyards.
L..;. v:notvi %-,,,4- ' t , bsI `t't y9* !!, , � \ wtm ' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling L ommercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
\\ ` 6 't ' t l t "` 9 \\ltiV ���'. 0 Emergency system. larger separately derived
��// ❑Addition of new motor load of system.
Job#: Job site address:/5 5.7 0 ,,SW R ,' 1/Pz I 100HP or more. ❑"A","E","1-z",°°1-3",
0 Six or more residential units. occupancy.
City/State/ZIP: T}/�eI aq yZZ y 0 Recreationa
l vehicle parks.(Jl facilities.
Suite/bldg./apt.#:
Project name: 5��e.,,. 1 ❑Hazardous locations. 0 Supply voltage for more than
f
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: QAC IU 7 t I 4\,LA. 4��;
Description .Qty.I Each 1 Total
New residential single-or multi-family dwelling unit.
Subdivision: 1 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
WANV7717,11,7=i= Iralr, i, Ntei:\VN‘iNWAX Limited energy,residential
� J/ �/ //'
(with above sq.ft.) 75.00 2
owe__ stet�t z'(iGur.7/ 4; ilea/ /141/4'x/ 7�✓ 'Lib l/ ,'i7^- Limited energy,multi-family 75.00 2
J residential(with above sq.ft.)
vA\y vAvL vvv v y Renewable Energy 0 See Page 2
y y:.y _ i I ' \ \� ,: . A 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:( ) 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
v\ ywvv 1 7,41',,: �. f. \\ V vy \i'i s ky . 4,7W0%%,:
.. 0Branch circuits—new,alteration,or extension, 'er panel
%w A.Fee for branch circuits with
Business name: 5.e.-‘e_ `�l� above service or feeder fee,
7.42 2
rT each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: ( ) I Fax: : ( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:
Reconnect only 67.84 2
1vv. \ \\ ;\ i i \\v70- \0' \ ` `\iyaV „A4 ` `\ y.v. .-„ ,,t4 >t \ . u \ ` Z \,. Pumporirrigationcircle 67.84 2
iv
Business name:' i�S &y tJ S ttiS Sign or outline lighting /.67.84 C� $y
W 2
( -?,44_,A__
Signal circuit(s)or limited-energy 0 See Page 2 2
Address:
b sr �C{E 4e panel,alteration,or extension.
/ /
Each additional inspection over allowable in any of the above
City/State/ZIP: /?`ls�t rG'/ �/? 7'?72_0� � Additional inspection(1 hr min) 66.25/hr
Phone:(50 ) 7 7- -i/5-55 Fax:(5o3 )`7-11•027 Zd Investigation(1 hr min) 90.00/hr
Email:L'( ( � t�a�"` //9 L'Ort--
whichhr no 78.18/hr
L1!'/. 7� Inspections for no fee is
CCB Lic.: Electrical Lic.: oo Suprv.Lic.: • s.ecificall listed(t/2 hr min) 90.00/hr
52 tgk'';'N'''.7111:171:=127111117 ,Mg5tVA
Suprv.Electrician signature,required:����, ' Subtotal: 4.7, '—f
Print name: /7/ -- Date: r//:7/1 0 Plan Review Required(25%of permit fee):
��� State surcharge(12%of permit fee):
Authorized signature:7714' TOTAL PERMIT FEE: ---25
"..,—,?----
This✓ j�/ This permit application expires if a permit is not obtained within 180
Print name: / /r sr�_ Date:f/f f l I 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
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Description Qty. Each 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 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
111 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
s.ecificall te.(V s o .)
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
*
(SEE OAR 918-309-0000) Number of inspections allowed per permit.
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_PermitApp_ELR_ERE.doe Rev 06/17/2015