Permit CITY OF TIGARD ELECTRICAL PERMIT
a - COMMUNITY DEVELOPMENT Permit#: ELC2013-00585
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2013
Parcel: 2S 115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY J1
Project: HomeStreet Bank Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: (4)sign lightings
Contractor: TUBE ART SIGNS&SPORTS DISPLAYS Owner: SN PROPERTIES PARTNERSHIP
4243-A SE INTERNATIONAL WAY 1121 SW SALMON ST
MILWAUKIE,OR 97222 PORTLAND,OR 97205
PHONE: 503-653-1133 PHONE:
FAX: 503-659-9191
FEES
Quantity Description Date Amount
4 ea Sign or Outline Lighting 10/02/2013 $271.36
Specifics:
1 ea 12%State Surcharge- 10/02/2013 $32.56
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $303.92
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 ce 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. ENTION: Ore n law requires you to follow the rules adopted by the Oregon Utility Notification C ter. Those rules are set forth in OAR
952- 1-0010 through OAR 9. 001-r� You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. 7�or�11..�8000.332,223344. J�,,
Iss d By: �A —- _ - Permittee Signature: .X 1 14O _ �"�✓�'1INL/
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.
-,,,,,,, ,--,Nr
Electrical Permit Applicatiol?i u, .\ `= FOR OFFICE USE ONLY
City of Tigard eceived / permit No.: e�
74 `� OCT 0CT ® 1 2013 Plan Review/D / /3 fi-CCA, 585
a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
0. Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: ICJ/ OO(/�
• Inspection Line: 503.639.4175 CITY OF TIGARD �e�R eady/By: runs: El See Page 2 for
TIGARD Internet: www.tigard-or.gov P������I��l]����� tifled/Metho (°/4,' Supplemental Information_rie..44:
TYPE OF WORK PLAN REVIEW
❑New construction E Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: 121963/3 Job site address: 16200 SW Pacific Hwy 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:HomeStreet Bank ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:Sw Durham Rd&Highway 99 Description I Qty. I Fee. I Total I
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.:R2002170 Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
Connect(4)new fascia signs residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
. Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) I Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
® APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:Tube Art Group each branch circuit
B.Fee for branch circuits without
Contact name:Jessica Kosmas service or feeder fee,first 56.18 2
branch circuit
Address:4243-A SE International Way Each add'l branch circuit 7.42 2
City/State/ZIP:Milwaukee,OR 97222 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)6531133 ex 1217 I Fax: :(503)659-9191 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:jkosmas @tubeart.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 4 67.84 027/.3(P 2
Business name:Tube Art Group Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:same as above Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:
Investigation(1 hr min) 66.25/hr
Phone:(503)6531133 Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 70956 Electrical Lic.: 37554 der.ry.Lie.: 366SIG specifically listed(/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: —' Subtotal: A2/. '(o
Print name: Ken Shultz � ltZ ��ate: 10/1/2013 Plan review(25%of permit fee): 5
State surcharge(12%of permit fee): Sot
Authorized signatur-• / . ,v ', I TOTAL PERMIT FEE: &Uj. q�.
' This permit application expires if a permit is not obtained within 180
Print name: Jessica osmas Date: 10/1/2013 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440.461ST(II/05/COM/WEB