Permit (61) CITY OF TIGARD ELECTRICAL PERMIT
'' COMMUNITY DEVELOPMENT Permit#: ELC2018-00766
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/26/2018
T[4' Dg Parcel: 1 S135BC00100
Jurisdiction: Tigard
Site address: 10775 SW GREENBURG RD
Project: Union 76 Subdivision: None Lot: None
Project Description: (3)sign lighting to replace service station canopy signs and two street signs with LED lighting.
Contractor: JIM CARTER ELECTRIC LLC Owner: RAJ PETROLEUM
4996 FORSYTHIA DR ATTN: RAY BATRA
SPRINGFIELD, OR 97478 10775 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503-514-6812 PHONE:
FAX:
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 11/26/2018 $203.52
Specifics:
1 ea 12%State Surcharge- 11/26/2018 $24.42
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $227.94
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
2- -0090
may
questions to OUNC by
952-001-0010 Issued By:through OA 95Your/e-�--n a copy of the rules or direct Permittee Signaturecalling503.232.1987
/.�2.1 ���%C L7
2.2344.
�"�
OWNER INSTALLATION ONLY �C
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 1 SE:OM.)
Received
- City of Tigard . , Date/B : // Z • .s t :eimit#: ELC,�dOi CSP cif 4,
13125 S W Hall Blvd.,Tigard,OR 972.3 .' 1 x� Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: tuns: H See Page 2 for
T I G A RP Internet: www.tigard-or.gov }1 1,1\i 1 1":'' 21118
r,11 i Norified/Method: Supplemental Information
7'11 DF:WORK _ d
0 New construction ®Addition/alteration/replacement I,. Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
, where the available fault current 0 Marinas and boatyards.
Ci. Y:Or C f 1G O1 r , exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-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
JO StrE,; TION''Atiti."j 0 Emergency system. larger separately derived
Job#: Job site address: 10775 G ❑Addition of new motor load of system.
�+,,,�� 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard OR 97223 (2e,t4 �124S ❑Six or more residential traits. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Union 76 ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
FEE;BCHIptax.. . ,
Description I Qty. ] Each I Total
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'l 500 sq.ft.or portion 33.92 1
OFWOR" Limited energy,residential 75.00 2
Replace service station canopy signs and two street signs with LED lighting (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPER ,;-'clrvt?NER • . 0 �Y` 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
A Branch circuits—new,alteration,or extension, r Panel
�'` 1� � [���f�I'il'I'AGI`1��ON : Per
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP: Each add'I branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
( ) Fax::( ) Each manufactured or modular
67.84 2
Email:
dwelling,service and/or feeder
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name:Jim Carter Electric LLC Sign or outline lighting 3 67.84 2
Address:4996 Forsythia Drive
Signal a circuit(s)
er ti n or limited-energy
0 See Page 2 2
3't panel,alteration,or extension.
City/State/ZIP:Springfield OR 97478 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(541)514-6812 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:skydivesarge@gmail.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 202430 Electrical Lic.: C1017 Suprv.Lemic.: 5139S specifically listed(V2 hr min)
P q "'\/4n oo�'✓V/i vTi.,/ a// lit *LOOT".t S
Suprv.Electrician signature,re wire / Subtotal: 203.52
Print name: James M Carter Date: 11/11/2018 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 24.42
Authorized signature: TOTAL PERMIT FEE: 227.94
This permit application expires if a permit is not obtained within 180
Print name: Date: 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(11/05/COM/WEB