Permit (35) INCITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2018-00164
r G R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/07/2018
Parcel: 1 S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 201
Project: Renew Sleep Solutions Subdivision: None
Project Description: Sign lighting for(1)sign. Lot: None
Contractor: VANCOUVER SIGN COMPANY INC Owner: TIGARD MEDICAL MALL LLC
2600 NE ANDRESEN RD#50 PO BOX 98
VANCOUVER,WA 98661 POULSBO,WA 98370
PHONE: 360-693-4773 PHONE:
FAX: 360-693-2747
FEES
Quantity Description Date Amount
Specifics: 1 ea Sign or Outline Lighting 03/07/2018 $67.84
1 ea 12%State Surcharge- 03/07/2018 $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 th= 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 o..n a copy of the rules or direct questions to OUNC by calling 50 .232.1987 or 1.800.3 . 344.
Issued By: / Permittee Signature: 1 j ..
OWNER INSTALLATION • LY
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 Applicati 11 ILA FOR OFFICE;USE ONLY
14 City of Tigard Received •
- " 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : i WYE j
0. ,
Phone: 503.718.2439 Fax: 503.598.1eptkk t �. \ Plan Review
Deady Related Perini[#: /� )I i/_
Inspection Line: 503.639.4175 Yo
TIGAKDr �� ReadyDateBy: ® See Pa
Internet: www.tigard-or.gov W 1 (yii. 1 r-,.40 ,-,4 ,,\ Notified/Method: EMI ge 2 for
Supplemental Information
❑New construction ,
®Addition/a1F (htlileplacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition 0 Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
fs 3 1=., exceeds 10,000 am s at 150 volts or
❑ 1-and 2-familydwellingp ❑Floating buildings.
®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-familyamps for all other installations. buildings.
0 Master builder 0 Other:
0 Fire pump. 0 Installation of 150 KVA or
. '; t.t: ' : " ..- ' 'I t'_" ❑Emergency system, larger separately derived
Job#: Job site address:9735 SW Shady Ln ❑Addition of new motor load of system.
I00HP or more. ❑"A" "E" °`I-2" "1-3"
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#:201 I Project name:Renew Sleep `•i,�,iecvsig
`^ ❑Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site:
IgielealME❑Service or feeder 600 amps or more. 600 volts nominal.
Z :.,..
Description Qty. Each Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
7.7 = r" - t '
Limited energ residential
Install(1)sign circuit. (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
!t,°';" r Renewable Energy ❑ See Page 2
Services or feeders installation,alteration and/or relocation
Name:Renew Sleep 200 amps or less 100.70 2
Address:9735 SW Shady Ln 201 amps to 400 amps 133.56 2
City/State/ZIP:Tigard,OR 97223 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:(360)693-4773 I Fax:( ) Over 1,000 amps or volts 552.26 2
Email: 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
t,. ryz Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Vancouver Sign Group above service or feeder fee,
Contact name:Chris Brown
each branch circuit 7.42 2
B.Fee for branch circuits without
Address:2600 NE Andresen Rd Ste 50 service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP:Vancouver,WA 98661 Each add'l branch circuit 7.42 2
Phone:(360)693-4773Miscellaneous(service or feeder not included)
Fax: :(360)693-2747 Each manufactured or modular
Email: Cbrown@vansignco.com dwelling,service and/or feeder 67.84 2
f= f,,
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name:Vancouver Sign Group Sign or outline lighting 1 67.84 0_yi1 2
Address:2600 NE Andresen Rd Ste 50 Signal circuits)orlimited-energy
panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:Vancouver,WA 98661
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
CCB Lic.: 63951 I Electrical Lic. 37-46CLS i Suprv.Lic.: 648SIG 7ficall listed(���hr min) 90.00/hr
Suprv.Electrician signature,requir --
/ Subtotal:
/-
Print name: Adam Wallis I Date: 3 _ 0 Plan Review Required(25%of permit fee):
QAA
State surcharge(12%of permit fee):
/LI
Authorized signature: TOTAL PERMIT FEE: ,/75-,,,`i'
f I This permit application expires if a permit is not..tamed within 180
Print name: Chris Brown I Date: z3 I/ 7 days after it has been accepted as complete.
t:\Bailding\Pennits\ELC_PertnitA T' * Number of inspections allowed per permit.
pp_ELR_ERE.doc Rev 06/17/2015 440-4615T(II/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9735 SW SHADY LN 201 , TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2018-00164
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor