Permit (162) CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2019-00218
T I(I All.I7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/11/2019
Parcel: 2S102AA05500
Jurisdiction: Tigard
Site address: 12215 SW MAIN ST
Project: Beer and Wine Outlet Subdivision: KINGSTON Lot: 19
Project Description: Sign lighting.
Contractor: JERRY M YOUNGER Owner: CHOI,WOO Y&MAN JA
840 NE VILLAGE SQUIRE AVE 2323 NE 165TH DR
GRESHAM, OR 97030 PORTLAND, OR 97230
PHONE: 503-380-4774
PHONE: 503-253-9406
FAX: 503-253-9407
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 04/11/2019 $67.84
Specifics:
1 ea 12%State Surcharge- 04/11/2019 $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 2-001-0090. Y .i may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,
� � �I g
i
Issued By: �/ //. �. Permittee Signature:
— L%��
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.
RP`" -(' r ' ) FOR OFFICE USE ONLY
Electrical Permit Applicationn
MAR R 9 V 2 011 Received
City of Tigard DateB : AI_ O 'ASM
14 4 13125 SW Hall Blvd. TigardOR 97223
Phone: 503.718.2439 Fax: 503.598.1960 'rp , , C.:::/ L ` •.
- Inspection Line: 503.639.4175 u + 3�';; ,,q�dy Date/By: J See Page 2 for
TIGARD '148tified/Method: Supplemental Information
Internet: www tigard or gov
a j ,4 r ,r, „ .,r3,I,,, EN. m ; 'u.. •��t4tVi is ,k2?€ a. `:..y ritit *-�z,.�. 4
Please check all that apply(submit a sets of plans w/items checked):
❑New construction 0 Addition/alteration/replacement ❑Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition ❑
Other: , where the available fault current 0 Marinas and boatyards.
� ?�" ,": exceeds 10,000 amps at 150 volts or ❑Floating buildings.
�°-* -�5--. x'' less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling b? Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
i .> ❑Emergency system. larger separately derived
..,,.: ,.. �,.• ,�, --- '" ' � - • ❑Addition of new motor load of Y
Job#: Job site address: l k cZ I 5-- G(,(44 K cfC I OOHP or more. 0"A" "E""1-2""1-3".
❑Six or more residential units.
occupancy.
City/State/ZIP: O l-- of it. .. ..3 0 Health-care facilities. 0 Recreational vehicle parks.
���yt r 0 Supply voltage for more than
l7 ` _'/.,.�- 0 Hazardous locations
Suite/bldg./apt.#: Project name: �� �(f f t _ Q l"1 0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: I j t) t - .� ��� ' <
�14 ) ma-Pi-CI' gii—e.tt.. Description Qty. Each I Total New residential single-or multi-family dwelling unit.
�v I Lot#: Includes attached garage.
`Subdivision: 1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'1500 sq.ft.or portion 33.92 1
•k-41-4101:040#1..., 3H r 3 t' Limited energy,residential
..._ 75.00 2
(with above sq.ft.)
‘Cr t, itQ P'Uea Limited energy,multi-family 75.00 2
l residential(with above sq.ft.)
le
See
ge 2
pIOF* p �i . �;;, , �,, ?`' Services bor feeders installation,alt ,
❑erationand/or relocation
Name: IM,o-kia tAAJLet Aitt.G 200 amps or less 100.70 2
_` 201 amps to 400 amps 133.56 2
Address: 2`L i c kgti`a '1 401 amps to 600 amps 200.34 2
City/State/ZIP: ` d , g v2 Z'S 2� 601 amps to 1,000 amps 301.04 2
r V• ' Fax:( )�/ L Over 1,000 amps or volts 552.26 2
Phone:(
50, OM — �. S C Temporary services or feeders installation,alteration,,and/or
Email: fV A relocation
Owner installation:This instal tion 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,accordln to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: NiDate: 401 amps to 599 amps 168.54 2
Branch circuits new,alteration,or extension,per panel
�, ; ��4 „, s,; ,;�,,,� „ ,,, ��, ,. - Miet A.Fee for branch circuits with
Business name: �(/� above service or feeder fee, 7.42 2
GO each bunch circuit
Contact name: 142.K vt,et L B.Fee for branch circuits without
Q � service or feeder fee,first 56.18 2
Address: f (,Z( ''�.j &..£. .. fa't�4 branch circuit
` Each add'l branch circuit 7.42 2 I
vvv���
City/State/ZIP: 61, , Q 4-7 L(O ro Miscellaneous(service or feeder not included)
Phone: co
( 4 .4 4 c O 6 �l
Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
r . —
. " ;;,k O ,. E e s ,, ,_ i_:; Pump or irrigation circle67.84 2
Business name: '3�Y.r 6f t^ Sign or outline lighting M 67.84 2
f Signal circuit(s)or limited-energy g
Address: ik 1 rp_
r� panel,alteration,or extension. 0 See Pa e 2 2
K p �JQ't's t O v'�L�t e_ _Each additional inspection over allowable in any of the above
City/State/ZIP: fs ` . p Gi 1...--0??Q Additional inspection(I hr min) 66.25/hr
Phone:( (0-4, . 0 Lir?ti... I Fax:( ) /4._ Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: /Q� Inspections for which no fee is 90 00/hr
C Electri al is: p • etficall listed('Ya hr min
CCB Lic.: SSu rv.Lic.: ( I .' � . .. A
Suprv.Electrician signature,required fC
SubtotalPrint name: Ik (Q 0 ; I(q 0 Plan Review Required(25%of permit fee):
v a State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature: i
1 This permit application expires if a permit is not obtained within 180
Date: Vet
`2—O daysafterit has beenaccepted as complete.
Print name: ��� AIv `) Numberofinspectionsallowed perpetI:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015 5T(1 05/COM/WEB