Permit (85) CITY OF TIGARD ELECTRICAL PERMIT
.s COMMUNITY DEVELOPMENT Permit#: ELC2019-00026
Date Issued: 02/07/2019
T G A I<.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 100
Project: King Lasik Subdivision: None Lot: None
Project Description: Sign lighting for(1)sign.
Contractor: HANNAH SIGN SYSTEMS INC Owner: TIGARD MEDICAL MALL LLC
1660 SW BERTHA BLVD PO BOX 98
PORTLAND, OR 97219 POULSBO,WA 98370
PHONE: 503-946-8373 PHONE:
FAX: 503-206-4900
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 01/28/2019 $67.84
Specifics:
1 ea 12%State Surcharge- 01/28/2019 $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 OAR 9 -001-0090. Yo ay obtain a cc.y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: o� Permittee Signature:
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.
I
Electrical Permit Avalication
City of Tigard
13125 SW Hall Blvd.,Tigard,OR 97223
gi
Phone: 503.718.2439 Fax: 50 U
Inspection Line: 503.639.4175 3.598,19:0h1 j A(N);t-71, )1 k: ::9"RIIIIIIIIMIIIIIIIIIIIIIII-Dt.wpi.:Ri,r;,../p 5-4 9 Orr- Bum", /-:?7tc)-z-)L 1-a z))(„
Ready Dateilly
Internet: www.tigard-or.gov (A-Ty of, 11(7,:Ahg*tifiedimethol
Related Permit ri:
Suns -, See Page-2 far
772:e Supplemental ltiformstlea
ii.L,.....„z ,.,LI,,L,,.*--,:,,,,:v. 4,-:!3;, ,.-:,--,,., :-: : .iAl.., ,*7 ,- -
0 New construction 0 Addition/alteration/replacement Please cheek sit that apply(submit 2 sets of plans wiitetus checked):
0 Service or feeder 400 amps or more 0 Building Me three stories.
o Demolition Other:C %.5;...Ai rl where die enl1st:4e fault current 0 Marinas and boatyards.
r‘'',,,:i„:::',,i:J.-,..,',.:.. ..1,4"...-,:,„.1,-,-...,:,,,.'''..,":".,."' - ' s.;...,.,.4 • ..,1 .,4 , ,f--,,,,_4,:.., ...-, -.-i„.. . ,:,:,,,,,„:::-,$ execedsto 10,4000armep:at 1 15C1/4‘..:It:::ts or si,,,,, ii,...,,i.,:iidio....iwieuh.,0 1_and 2-amity dwelling areommercial/industrial 0 Accessory building IC"
amps for all other installations. buildings.
0 Multi-Parnil 0 Master builder 0 Other: , [I Firs pump 0 Intarillation of ISO KVA or
-..e.ri......-e•c•Nr '- . 4 .,. ,, .,,.. „r., ._,,--4,.....',c,,,,,s,, ,.. 0 Ernerpney spiky.
0 ''" ," -'i. i 2 '' Nla:isit'al - - 's....C..' larger separately derived
()Addition of new motor load of system.
Job 4: Job site addren:7735 .5r
,.. 54,,, i 1004P or mare. C'RoAcecc"ur,pe"aaEtni",y"
l-2e",i-1-3 ,
City/State/ZIP: 1: a / 97423 a 0conal vhcle pa
ka
Suite/bldg./apt,4: ,,ti Project name.: /f-'., , 4, ‘'.., 011atardous foliations. 0 Supply voltage for more than
,.
... 0 Service or feeder 600 amps or more. 600 volts n41111/nal.
Cross street/directions to job site: f: . ,4 a Ai, .
'.: ,.'''''e "E'- ,',. , ,,:. ,v, !P.44
....“.. : Ots.) ,... 1 ...... l'•,
/ New residential single-or maid-family dwelling unit.
Subdivision: Lot 4: Includes attached garage.
1,000 sq.It or less 168 54 14
Tax map/parcel 4: ,
Ea adcfl 500 sq.ft.or portion 33.92 1
4 '...• -'2'i.1* Limited enmity,residential 75.00 2
(with above so ft.)
.11 hr '..: A - e ' S **1 I w-... .4- LIMited energy,multi-family 75.00 2
if residential(with abos e sq ft.)
C.' ill'efe " ' sr . . . . Renewable Energy CI See Psge 2
47 ''"'"7'''''I7- 4S'.7' ''''r'T-r'm"'.'r; r'''''''1"--Mil Sersices or feeders InstallatIon,alteration,and/or relocation
Name: k,',v' La S i'k- 200 amps or less 100.70 2
1 201 amps to 400 anms 133.56 2
Address: , r - ' ,../„tz pr,„(7,-,4
__ 401 arnps to 600 amps 2(4)34 .1]
City/State/ZIP: 77 ar"cti el, - 9
7.4z3 601 amps to 1.000 amps 301.04 2
Phone:(S'03) —6 _J Fax:( ) Over 1.000 amps or volts 552 26 2
1 Temporary services or feeders installation,alteration,and/or
Email: /INC ie e./V2.;e it) i(rda laS,'1(-', ( 1/T1. relocation r _
Owner installation:This installation is big made on property that I own which is not 200 amps or less 5936 _i
it intended for sale,lease,rent.or exchange.se---41--4-( RS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168 54
...TT-. -...-7----'-': - --- ..- ,------ 7.,-H-7.....:ii, —Bran it circuits-new altered#a or e tension. . r .suet
., ' ' - -- A.Fee for branch circuits with
Business name: -Ea:it .124_...'A/45 -c7/a a t'ae above service or feeder fee. 742 2
each branch circuit
Contact name: L5-h e / e„// t R Fee fin branch circuits without
— service or feeler fee,first 56.18 2
Address: /ol/76, ea eideitif PIG6 branch circuit
' Fach add'I branch circuit 7.42
City/StateJZIP: 77, 0 R V'7... 3 Miscellaneous(service or feeder not included)
g . ,,,,,_
Phone:(5 )3 , - .4/-,,a-a-/ Fax::( ) Each manufactured or modular 67.84 2
— . dwelling.service and/or feeder
Email: 5/ // ,al ells , ts( A/1 C‘r/Y7 Reconnect only 67.84 /
: ,b • 74,4:71.11,:,,„,!..;:. ,..z,,1: pump or inigation orde 67,84 -,
-
Business name: 41014,4,4 Sii,74 tyr,p1Fryg- / jr,,e„ Sign or outline lighting 1 67.84 C 1-Pi 2
Signal circuit(s)or litnited-cner8Y 0 See Page 2 2
Address: ica(c,D 4• ) ge-12,164 et._,/L panel,alteration,or=tension,
Each additional inspection over allowable In aaf the above
City/Stale/ZIP. A6g, C'2- 97a./i"a]
Additional inspection(1 hr nun) 66.25/hr
Phone:( ) Fax:( ) LInvestigation(1 hr mm) 90001 hr
Industrial plant(1 hr min) 78.18/hr
Email: Inspections for which no fce is 90.00/hr
CCB Lie.: z.030,13 Electrical Lie.: c_g_s (.4 , Suprv.Lic.:9h(2.7(.0 ft sixt-1-1-callY-1- 4 )
..
Suprv.Electrician signature.required: 144 1 _ Subtotal: 67,pit
Print name: At^ I LS / .r, .7)./..- Date: i—&--/9 0 Plan Review Required15%( of permit fee)*
. .
/ ---
./ ...„..-- ,... State surcharge(12%of it leo): : T.r
Authorired signature: -
TOTAL PERMIT FEE: Ts—,(it
_ ... This permit applicadon empires if a permit is not obtained widths 180
Print name: (,..„21/r.S 1) .n..1 Date: /— cS. .----/cp 1 days atter it his been accepted as cempkte.
• Number of inspections allowed per pennit.
I IttliwingtPermitsailLC_PantitAppfil.R_ERE eoc Rev 06,111414 440.4615w iroSicOMMES
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9735 SW SHADY LN 100, TIGARD, OR, 97223 June 13, 2019 at 8:34:47 AM
Record Type: Record ID:
Commercial - Electrical ELC2019-00026
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor