Permit (184) th CITY OF TIGARD ELECTRICAL PERMIT
R COMMUNITY DEVELOPMENT Permit#: ELC2018-00068
D 13125 SW Hat Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/24/2018
T f j� g Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15955 SW 72ND AVE
Project: Synergy One Lending Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Sign lighting for(1)sign.
Contractor: ADVANCED ELECTRIC SIGNS INC Owner: PACIFIC REALTY ASSOCIATES
1550 DOWN RIVER DR ATTN: N PIVEN
WOODLAND,WA 98674 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 360-225-6826 PHONE:
FAX: 360-225-8299
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 01/24/2018 $67.84
Specifics:
1 ea 12%State Surcharge- 01/24/2018 $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 0 52-001-0090. You m py of the ruleor direct questions to OUNC by calling 503.23/:7 or 1.800.332.23441
-41
Issued By: _ Permittee Signature: .iilf1 /./1 _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 Application FOR OFFICE USE ONLY
City of Tigardt.t vg,1 ,<. ;a d. 1 MI ._ r
IN
- w 13125 SW Hall Blvd.,Tigard,OR 97223 IM
�,i 11' .. Review
Phone: 503.718.2439 Date/B : Related Permit#: 4
‘,„Ahi- V7,uy::i'.
T I G A R D Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: 10 See Page 2 for
W
Inspection Line: 503.639.4175 Internet: www.tiggNr. `t) *otified/Method: IMIA Information
, TYPE OF WORK * ,q` Y4 PLAN REV
New constr'Uction icir e ,..x*,
r ' Rte`' Please check all that apply(submit 2 sets ofplans w/items
0 ❑Addition alteration/rep Y• pp y checked):
CI' '71..4 I( x,., ❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: ,t" ;' l a c ,,.l"
n Liv where the available fault current 0 Marinas and boatyards.
CATEGO .Y, iW CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
El 1-and 2-family dwelling ':1 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
CI Multi-family U aster builder 0 Other: amps for all other installations. buildings.
0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION:. 0 Emergency system. larger separately derived
Job#: Job site address: �^Q r
0 Addition of new motor load of system.
/. LJ:5- s 7 Z."a i> /44,e 100HP or more. ❑"A","E","1-2» "1-3",
.
City/State/ZIP:
occupancy."7-4,44 ..p
0 Six or more residential units. P y
Z)� • 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: �/,ct/ �/, / ['Hazardous locations. 0 Supply voltage for more than
�/�T�4 4y DSL�^1'Q�:� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
,.=FESCHEDULE
Description I Qty. I Each I Total I *
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'I 500 sq.ft.or portion 33.92 1
q,: DESCRIPTION,OF,WORK ,,,,,N,,,; Limited energy,residential
/ -6.y-0) (with above sq.ft.) 75.00 2
S:9N lJ�H�t! Jrttt/1/, Limited energy,multi-family
✓ VV 75.00 2
residential(with above sq.ft.)
' 0 P.'.40—$: RTY OWNER i �U TET ANI r
Renewable Energy 0 See Page 2
•r- t x ' 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:( ) 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
PLICANT " Branch circuits-new,alteration,or extension,per panel
CONTACT...PERSON
A.Fee for branch circuits with
Business name: 6�C-dn,,te jerk) above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.p1r ,C„K_ B.Fee for branch circuits without
`-, 19‘,„2,4( service or feeder fee,first
Address: /sa , 19‘,„2,4(jt t,tx_... .(„. Q, branch circuit 56.18 2
Each add'l branch circuit 7.42 2
City/State/ZIP: C.c'� 4 0, W a. 917e . t9
Phone:� ,� < l Miscellaneous(service or feeder not included)
O ftz,(,v Each manufactured or modular
r,,s yl[yqa 6? sc I OGO ` dwelling,service and/or feeder 67.84 2
Email: :{,e '"T Reconnect only 67.84 2
.. CONTRACTOR
Pump or irrigation circle 67.84 2
Business name: rg f> ,14 Gz, 4,-- '/L , ,e4- Sign or outline lighting i 67.84 Cj y 2
�SSO 24J�, g• 4>C �� Signal circuit(s)or limited-energy
/
Address: VG r panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: 1 7tR�v �� Q �
Each additional al ninspection
inspection1hr over allowable in any of the above
`�V , Additional inspection(1 min) 66.25/hr
Phone:()) Z z "'fizz Investigation(1 hr min) 90.00/hr
Email:. ,grie., ,E4 f4ncir' , 4�6 N-r Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.:/0 S' - i Electrical Lic.:37 1 Suprv.Lic.: �5/i specifically listed(%hr min)
., ...
•' it 64' -,, ELECTRICA :'PERMIT IEEE ,
Suprv.Electricia1 sr ature,required: e /./L"* Subtotal: FLS
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 6. 1 i'
Authorized signature: TOTAL PERMIT FEE: 75,,r 3
This permit application expires if a permit is not o tained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitAppELRERE.doc Rev 10/26/2017 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: ,t= M FEE SCHEI 5LE
Description I Qty. t Each I Total I *
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
❑ 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 i
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/i hr min)
COMMERCI:!WORK Ql! Y: ; = ELECTRICAL itur FEES F=
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * 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_PermitApp_ELR_ERE.doc Rev 10/26/2017
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15955 SW 72ND AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2018-00068
Inspection Type: Inspector:
140 Sign installation Jeff Grove
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor