Permit (213) CITY OF TIGARD ELECTRICAL PERMIT
11111 u COMMUNITY DEVELOPMENT Permit#: ELC2018-00437
T f GAFF D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/17/2018
Parcel: 2S 113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 320
Project: Bridgeport Family Medicine Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Sign lighting.
Contractor: TUBE ART SIGNS&SPORTS DISPLAYS Owner: G&S FC LLC
4243-A SE INTERNATIONAL WAY 16083 SW UPPER BOONES FERRY RD,
MILWAUKIE, OR 97222 STE
TIGARD, OR 97224
PHONE: 503-653-1133 PHONE:
FAX: 503-659-9191
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 07/17/2018 $67.84
Specifics:
1 ea 12%State Surcharge- 07/17/2018 $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 fo • -- -s adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. Y• ..- •• -in- =•. of the rule direct questions to OUNC by calling •0 .232.1987 or 1.80 332.234
Issued By: :�_�� - Permittee re: "'!� • IJ� J2
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 Applicatig. y-1" Y
FOR OFFICE USE ONLY
CityofTigard Re eivea fi� Permit#: -
g I ,t.. $' .r 1 -
P ,
■ 13125 SW Hall Blvd.,Tigard,OR 97223"1 d IJ i J'
g Dan Review Related Permit / '
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: C%1 G �/
Inspection Line: 503.639.4175 , Ready Date/By: Juris: H See Page 2 for
I l C,A R D Internet: www.tigard-or.gov ` '- . .. . _. _ -_ t) Notified/Method: Supplemental Information
-`_ amu..-.., . . . ... .. TYPEe0Fy ORK_. ._ . ._: t , ,_ L_ .. .� LA VIEW r,
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
.. ;i 13,7
CATEGORY OFA s.C.`,ONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
Multi-familyMaster builderamps for all other installations. buildings.
❑ 00 Other: 0 Fire pump. 0 Installation of 150 KVA or
,,- JOB SITE INFORMATION AND=LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: 133229/1 Job site address: 16083 SW Upper Boones Ferry Rd 1001-IP or more. ❑"A">"E","1-2","1-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
Y g
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#:320 Project name:Bridgeport Family Medicin ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW Durham Rd FEE SCHEDULE `
Description I Qty. I Each I Total 1
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#:R513153 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
Manufacture and install one(1)sinle faced illuminated sign (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
®=PROPERTY OWNER .. 0 TENANT , ` Services or feeders installation,alteration,and/or relocation
Name:G&S FC,LLC C/O Colliers International 200 amps or less 100.70 2
Address:851 SW Sixth Ave.Suite 1200 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Portland,OR 97204 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
-. ,r., Branch circuits—new,alteration,or extension,per panel
® APPLICANT „ .❑ CONTACT„PERSON PERSON
- e. A.Fee for branch circuits with
Business name:Tube Art Group above service or feeder fee, 7 42 2
each branch circuit
Contact name:Haley Arnell B.Fee for branch circuits without
Address:4243-A SE International Way service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Milwaukie,OR 97222 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)653-1133 Fax: :(503)659-9191 Each manufactured or modular 67.84 2
Email:harnell@tubeart.com dwelling,service and/or feeder
Reconnect only 67.84 2
>,CONTRACTOR , Pump or irrigation circle 67.84 2
Business name:Tube Art Group Sign or outline lighting 1 67.84 2
Address:4243-A SE International WaySignal circuit(s)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Milwaukie,OR 97222 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(503)653-1133 Fax:(503)659-9191 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:harnell@tubeart.com 378-yy p cS 7/i/AD Inspections for which no fee is
CCB Lic.: 70956 Electric.1 Lic.: 7.64-SItG !Suprv.Lic.6„0/ specifically listed(V2 hr min) 90.00/hr
S - ELECTRICAL PERMIT FEES
/
Suprv.Electrician signature,requires. �--` 10 / l-0 Subtotal:
Print name: Jesse Yankee Date: 6/21/2018 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:4u,,, ,, / / TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Haley Arnell Date: 6/21/2018 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 440-4615T(l 1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDE T TIAL O ONLY: FEE SCFIEDULE
Fee for all residential systems combined: $75.00 Description I Qty. I Each I TotalI
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
with OAR 918-309-0040) 552.26 2
❑ 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
COMMERCIAL WORK ONLY:
„ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* 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
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16083 SW UPPER BOONES FERRY RD 320,
TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Electrical ELC2018-00437
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor