Permit (5) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019-00704
Date Issued: 10/28/2019
T I G A R L3 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 136D D05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE#100
Project: The Partners Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Sign lighting for(2)mount wall signs.
Contractor: SECURITY SIGNS INC Owner: PNWP LLC#2
2424 SE HOLGATE BLVD PNWP LLC
PORTLAND, OR 97202 6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 503-546-7114 PHONE.
FAX: 503-230-1861
FEES
Quantity Description Date Amount
2 ea Signal circuit or Limited 10/28/2019 $150.00
Specifics: Energy Panel
1 ea 12%State Surcharge- 10/28/2019 $18.00
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $168.00
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: Or=.o law requires you to follow - rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through O A R• 2-001-r••0. You !, obtain7••py of the rules or direct questions to OUNC by calling 503.23 /$87 or 1.800.332.23-
Issued By: '
Permittee Signature: ,///. AL.,/.LAL.,/.-JO
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 FOR OFFICE USE ONLY
FrCit O Tl and R , Received3rfgDateB : C� alWAgrr.41 . , /i} `I AY 13125 SW Hall Blvd.,Tigard,OR 97223 /'Phone: 503.718.2439 Fax: 503.598.1960 OCT 1 6 2019 DateB : 1. 4W_ , MIE
Inspection Line: 503.639.4175 Ready Date/By: Juris: El Se7-'age 2 fo
Internet: www.riard-or. ov
TIGARD g g CITY OF TIGARD Notified/Method: Supplemental Information
a
: rtb r `I lk 4 ill, ';'-::•6.-°.,'-t, Ie i' C1171-73- ,..
15 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.
O Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTIONexceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
O 1-and 2-family dwelling ((Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
of
JOB SITE'INFORMATION AND LOCATION 0 Emergency system. larger separately enve
/I �/� ❑Addition of new motor load of system.
Job#: 112 L 3/'f') Job site address: 1/050 5w &634-4_ 4t/ 100HP or more. 0"A","E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: '77 44,22 )/ 172,2_3 ❑Health raze facilities. ❑Recreational vehicle parks.
I j D(y,��r ex-s L/-w/e ❑Hazardous locations. ❑Supply voltage for more than
Suite/bldg./apt.#: Project
ro ect name: r'I/` 'V`,�- �7/�Lv 600 volts nominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site: ;i ' E y
Description Qty. I Each I Total
C/L-���o'� New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: 5 1-3610 05 •• Ea.add'1500 sq.ft.or portion 33.92 1
. ,3 •r. , � Vie,
I ESCRIPTION 0 ' ' Limited energy,residential 75.00 2
y� ,t' (with above sq.ft.)
r �/� (2') ��L L S`�7/v Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
,' ROPERTY OWNER I ! 0 TE `' ". Services or feeders installation,alteration,and/or relocation
Name: PWI/)P , PA/ide -- 200 amps or less 100.70 2
v" �� 201 amps to 400 amps 133.56 2
Address: �� ! 401 amps to 600 amps 200.34 2
City/State/ZIP: 'rf /eab/L/ DA 9-7000 601 amps to 1,000 amps 301.04 2
Phone:( ) I 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,rept,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature- MI at Date: 401 amps to 599 amps 168.54 2
N°a CONTACT PERS/ Branch circuits new,alteration,or extension,per panel
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
service or feeder fee,first 56.18 2
Address:2424 SE HOLGATE BLVD branch circuit
City/State/ZIP:PORTLAND,OR 97202 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)546-7102 I 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
f Pump or irrigation circle 67.84 2
Business name:SECURITY SIGNS,INC Sign or outline lighting 2„ 67.84 2
Signal circuit(s)or limited-energy El See Page 2 2
Address:2424 SE HOLGATE BLVD panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:PORTLAND,OR 97202 Additional inspection(1 hr min) 66.25/hr
Phone:(503)546-7102 Fax:(503)230-1861 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:permits@securitysigns.com Inspections for which no fee is
90 00/hr
CCB Lic.: 122809 Electrical Lic.: 2CL Suprv.Lic.: 383-SIG
s.ecificall listed('/z hr min)
00" CTRICAL PERMIT; IXES
Suprv.Electrician signature,required: O Subtotal:
Print name: MARC LINDQUIST I Date:4/`gyp/ /�G} ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
%.7n?. :) 574. , TOTAL PERMIT FEE:
Authorized signature.
D � //F� ?/ This permit application expires if a permit is not obtained within 180
Print name: CYNDI STOC S / days after i lhas 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
Electrical'Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: EEE-$CJ DULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 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:
I I Burglar Alarm 25.01 to 50 kva
301.04 2
Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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('/z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal
on Page 1):
* Number of inspections allowed perr perm permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
I I Boiler Controls
I I Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
I I Intercom and Paging Systems
Landscape Irrigation Control*
❑ Medical
I Nurse Calls
Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permas\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015