Permit (145) CITY OF TIGARD ELECTRICAL PERMIT
I: ' COMMUNITY DEVELOPMENT Permit#: ELC2019-00282
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2019
T[trlR.0 g
Parcel: 2S 102AA00906
Jurisdiction: Tigard
Site address: 12084 SW MAIN ST
Project: Kimberly Bergis Rebel Fitness Club Subdivision: Lot: 4
Project Description: Sign lighting.
Contractor: SECURITY SIGNS INC Owner: BSM REALTY LLC
2424 SE HOLGATE BLVD BY RITE AID
PORTLAND, OR 97202 PO BOX 3165
HARRISBURG, PA 17105
PHONE: 503-546-7114 PHONE: 503-407-1334
FAX: 503-230-1861
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/02/2019 $67.84
Specifics:
1 ea 12%State Surcharge- 05/02/2019 $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 .- - -•opted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma o. -'.:-o y of the rules o direct questions to OUNC by calling 503.232.19 7 or 1.800.332.234
Issued By: —410 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.
Electrical Permit Application_
RECEIVED FOR OFFICE USE ONLY
II
City of Tigard Dme/B : 11 �— _—',
.� i
� 13125 SW Hall Blvd.,Tigard,OR 9722 R Plan Review
- � /
Phone: 503.718.2439 Fax: 503.598.14 1 R 2 9 2019 DateB _ f
: ` ��
Inspection Line: 503.639.4175 Ready Date/By: Jure H See Page 2 for
TIGARD_ CITY OF rIGARDInternet www.tigard-or.gov Notified/Method: Supplemental
iI _._ _ N4i ,' ". "a„C?'hb i W 7 1 1 lt; iii17-7 T a3'b7�7in1, 2-,1: '� e1 ' t '� '`� hip .
New construction ❑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 ❑Marinas and boatyards.
li,o ” i' ...........Il ,fy A vi r . d, w ii — j exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling .14 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. ❑Installation of 150 KVA or
ns. l t „i roi&i 1 i ion i, 1 =f Ali _ D Emergency system. larger separately derived
�� � /� ❑Addition of new motor load of system.
Job#: Il Job site address: ! 100100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: / �/f q ❑Six or more residential units. occupancy.
0
T`G➢!'I /�[! I Z� J� ❑Health-care facilities. Recreational vehicle parks.
Suite/bldg./apt.#: Project name:`4� G� fee ✓ 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 1'�� firive55 e1D°IWh ,_ it4
9,c) p� I A1� 4e4Description Qty. Each Total I *
Z7 New residential single-or multi-family dwelling unit.
Subdivision: 1 Lot#: Includes attached garage.
Tax map/parcel#: C 1,000 sq.ft.or less 168.54 4
Al,1 it , pl h(I•r o "yS too yam,_._ ,o t r.
0(47 Ea.add'l 500 sq.ft.or portion 33.92 1
�l o 1. Limited energy,residential
75.00 2
iovAi !GU)/
U) �A4/ii (with above sq.ft.)
�� ci
/ L+ Limited energy,multi-family residential(with above sq.ft.) 75.00 2
.: „,4,7,:5:„..,w7.:77Renewable Energy ❑ 2or relocation
m-� t.::_„,,:
�l!' 10 t,® _ Pii�uI��i� 51- "---- �i��'i�i;,i� is _ , �S�ervices or feeders installation,alteration,SeePage and/
Name: m�% G y o�4 s J a /7 eve's or less 100.70 2
Address: `2060 ///�/ i 57— v 220'1�ammps to 400 amps 133.56 2
��eS, f 7 -Z am
401 amps to 600 0 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( )3 9)'7 l"..3z./ Fax:(v` @ Over 1,000 amps or volts 552.26 1 2
aeee-J awry services or feeders installation,alteration,and/or
Email: awry
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
nt
Owner signature: !�'i11--- Date: 401 amps to 599 amps 168.54 2
. ..
Branch circuits-c new,alteration,or extension,per panel
�'6'li . . I�'i' 1, ►
AOT. ” ° � � e r
I9 �J ... A.Fee for branch circuits with
Business name:SECURITY SIGNS,INC above service or feeder fee,
7.42 2
each branch circuit
Contact name:CYNDI STOCKS B.Fee for branch circuits without
sAddress:2424 SE HOLGATE BLVDbranch circuit t feeder fee,first
56.18 2
City/State/ZIP:PORTLAND,OR 97202 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)546-7102 Fax::(503)230-1861 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:permits@securitysigns.com Reconnect only 67.84 2
yi"q> x r( yaiI NEa $, pig„ '111 ( a Is Pump or irrigation circle 67.84 2
Business name:SECURITY SIGNS,INC Sign or outline lighting / 67.84 2
Signal circuit(s)or limited-energy El See Page 2 2
Address:2424 SE HOLGATE BLVD panel,alteration,or extension.
City/State/ZIP:PORTLAND,OR 97202 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)546-7102 Fax:(503)230-1861 Investigation(1 hr min) 90.00/hr
Email:permits @ securitysigns.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 122809 Electrical Lic.: 26-560CL Suprv.Lic.: 383-SIG specifically listed(t/s hr min)
p ,2,9 il9��i4�.` ... 1 1a te,}7 p(dd i, �,o
Suprv.Electrician signature,required: Subtotal:
Print name: MARC LINDA IST I Date: V ti l*/`R 0 Plan Review Required(25%of permit fee):
ii / State surcharge(12%of permit fee):
Authorized signature: / TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: CYNDI STO /S Date: Z,6— 1 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permus\ELC_PemtitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12084 SW MAIN ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2019-00282
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor