Permit (32) CITY OF TIGARD ELECTRICAL PERMIT
Permit#: ELC2018-00397
2 COMMUNITY DEVELOPMENT
Date Issued: 06/13/2018
T[ t 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134BC00600
Jurisdiction: Tigard
Site address: 12390 SW SCHOLLS FERRY RD
Project: Kiss Car Wash Subdivision: 1993-057 PARTITION PLAT Lot: 2
Project Description: Sign lighting for(1)sign.
Contractor: CUSTOM SIGN CO INC Owner: THOMPSON, DENNIS C
9316 SW 12TH DRIVE 9295 SW ELECTRIC ST
PORTLAND, OR 97219 TIGARD, OR 97223
PHONE: 503-201-8469 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 06/13/2018 $67.84
Specifics:
1 ea 12%State Surcharge- 06/13/2018 $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 2-001-0090. Youy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B - --r..Signature:
dir
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: I SF OyL.
City of Tigard rj ', `, [4.--, ;i 'fi� ' ,
13125 SW Hall Blvd.,Tigard,OR 97223 RJ�;,lv ..4- an Review
Mill
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: la See Page 2 for
Internet: www.tigard-or.gov JUN 1 3 !'' 'Notified/Method: � . Supplemental Information
TYPE OF WORKeiy �y p PLAN REVIEW
❑ t�`� ,�. Ii P`) Please check all that applysubmit 2 sets ofplans w/items
New construction �Additionlalteration/rep t g _}� q fit] ( checked):
❑Demolition 0 Other: BUT 1LO (l 1) Y A S101%,' ❑Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ i-and 2-family dwelling ,,,Commercial/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
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
�` 0 Addition of new motor load of system.
Job#: Job site address:12,-190 S SG L�FS v Jn, R(;� 100HP or more. ❑
occupancy.
Z ❑Six or more residential units.
City/State/ZIP: -�? . ZZJ0 Recreational vehicle parks.
y �' ��• � 0health-care facilities. 0 Supply voltage for mthan
Suite/bldg./apt.#: Project name: �` CA,f Woo;\A 0 Hazardous locations. pp Y g
�� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description 1 Qty. 1 Each 1 Total 1.
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'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Vie-3--V-3' a E C c `\ ,a 1 (with above sq.ft.) 75.00 2
� � G` ��I Limited energy,multi-family 75.00 2
7q.CC i'
'' K;55 'q._ \Al J\1 l t kv k7kk).,t residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT 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:( ) 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
0
APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: C V s-N 0 yvN S "i rj Co 'r�L, above service or feeder fee, 7.42 2
; _` y� each branch circuit
Contact name: C)t.l�C Y ? r' `k s B.Fee for branch circuits without
serAddress: 45/1D S 12.44" branchce it feederitfee,first 56.18 2
Z � branch circuit
City/State/ZIP: Pof. llA Of, 4-1 24 q Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(SVS) L4 �-%- C�4 b 9 Fax::( ) Each manufactured or modular 67.84 2
Email: t 0 1.�`� Q iAN �j dwelling,service and/or feeder
%C 4 0 J i/Sn.4�v` i, (std WI Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ' 1 "��(:- Sign or outline lighting 67.84 (�1 t 2
L�s `� �� � Signal circuit(s)or limited-energy
Address: ❑ See Page 2 2
Z��� SW 112-\."' 0,r panel,alteration,or extension.
City/State/ZIP: q 1.Z A q Each additional inspection over allowable in any of the above
(�l T�GSfI �l f Additional inspection(I hr min) 66.25/hr
Phone:(so-9 2_0 k irkitc.1 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 11-1 koy Electrical Lic.:Z1,--islic ,S Suprv.Lie.: i.17, specifically listed('/2 hr min)
+J ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: C7-1-1-1
Print name: y K Date: 0 Plan Review Required(25%of permit fee):
w ��t eState surcharge(12%of permit fee): 6'.. I I'(
Authorized signature:
TOTAL PERMIT FEE:� �
This permit application expires if a permit is not obtained within 180
Print name: "P(,.N k\6- Date: Co tl'"-(,`kc 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 440-4015T(1 t/05/t'AM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12390 SW SCHOLLS FERRY RD, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2018-00397
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor