Permit (280) CITY OF TIGARD ELECTRICAL PERMIT
11111 a COMMUNITY DEVELOPMENT Permit#: ELC2015-00129
Date Issued: 03/17/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S115A601901
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY
Project: Haggen Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: Sign lighting for(1)internally illuminated wall sign.
Contractor: E S&A SIGN&AWNING Owner: ABS OR-O LLC
89975 PRAIRIE RD 250 PARKCENTER BLVD
EUGENE, OR 97402 BOISE, ID 83706
PHONE: 541-485-5546 PHONE:
FAX: 541-485-5813
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 03/17/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 03/17/2015 $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
952-001-0010th g 95 1- 90. You may obtain a copy of the rules or direct questions to OUNC by calling 50 2.1987 or 1.800.332.2244.
Issued By: Permittee Signature: � jat!��LL�/�"
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 ONL\
Received
City of Tigard Received
: Permit No.: "dt — • (,
III
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
= Phone: 503.718.2439 Fax: 503.59 Date/B : Other Permit: , 4 .0 f 5 jedo ,,
T I c n R D Inspection Line: 503.639.4175 'EC E I V E D Date Ready/By: Juris c -® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: C.� Supplemental Information
TYPE OF WORREB 2 5 2015 PLAN REVIEW
❑New construction ❑Addition/alter a Please check all that apply(submit 2 sets of plans witems checked below):
�` '�� `YAR D ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ®Other:SigtUI D{NG DIV ISI ON where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONS RUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ I-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
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E","1-2","I-3",
Job no.: Job site address: 16200 SW Pacific Hwy I or more. occupancy.
El Six x o or r more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,Oregon 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Haggen ❑Service 01 feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site:SW Durham road Description I Qty. I Fee. I Total
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 I
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
– Limited energy,multi-family 75.00 2
Install(1)internally illuminated wall sign residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ® TENANT 200 amps or less 100.70 2
– 201 amps to 400 amps 133.56 2
Name:Haggen Northwest Fresh 401 amps to 600 amps 200.34 2
Address: 16200 SW Pacific Hwy 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552,26 2
City/State/ZIP:Tigard,Oregon 97224 Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( )
relocation
200 amps or less 59.36 I
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, ter panel
® APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42
Business name: ES&A Signa and Awnings each branch circuit
B.Fee for branch circuits without
Contact name: Kaela Ouellette service or feeder fee,first
branch circuit 56.18
Address:89975 Prairie road Each add'I branch circuit 7.42 2
City/State/ZIP: Eugene,Oregon 97402 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(541)485-5546 Fax: :(541)485-5813 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: kouellette@esasigns.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 1 67.84 G 7 Pi 2
Business name: ES&A Signs and Awnings Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:89975 Prairie road Each additional inspection over allowable in any of the above
— Additional inspection(I hr min) 66.25/hr
City/State/ZIP:Eugene,Oregon 97402 Investigation(1 hr min) 66.25/hr
Phone:(541)485-5546 Fax:(541)485-5813 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 163470 Electrical Lie.: 21534CLS Supry Lie.: 514 SIG specifically listed(1/]hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _ 4 ` Gu AIN'��.r Subtotal: �.7, L
Print name: Gordy Roseboro Date: 2/6/2015 Plan review(25%of permit fee):
State surcharge(12%of permit fee): ji-II
Authorized signature '_ TOTAL PERMIT FEE: 75". i
This permit application expires if a permit is not obtained within Igo
Print name: Kaela Ouellette Date: 2/6/2015 days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(11/05/COIWWEB