Permit (6) _� CITY OF TIGARD ELECTRICAL PERMIT
.,. ... 1.: -.INCOMMUNITY DEVELOPMENT Permit#: ELC2019 00689
TlGAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2019
Parcel: 2S112DD00800
Jurisdiction: Tigard
Site address: 15670 SW UPPER BOONES FERRY RD
Project: Chevron Subdivision: None Lot: None
Project Description: Sign lighting for(1) pole sign.
Contractor: ELECTRIC AVENUE SIGN & LIGHTING Owner: ABS HOLDING LLC
16005 NE 12TH ST 15670 SW UPPER BOONES FERRY RD
VANCOUVER,WA 98684 LAKE OSWEGO, OR 97035
PHONE: 360-903-5447 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 10/10/2019 $67.84
Specifics:
1 ea 12%State Surcharge- 10/10/2019 $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 952-001-0090. You y obtain a copy• -ru z or direct questions to OUNC by calling 503.232.1987 or 1.:10 33 /
Issued By: �i�e.--. lG _ - ' :: Signature: �� .J
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 'RECEIVE coli orrlcl: I sr,oyl.v
City of Tigard Received
Permit#:
,%,►�
11 r OCT10 2 010 Date/B : /13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439Date/B Related Permit#:
Email: TigardBuildingPermits@Tigard-or.gov q !'t''',.' "..!`r::''' Ready Date/By: ® See Page 2 for
T I GA RD Inspection Line: 503.639.4175 Internet: wWWaigard-br.gov Notified/Method: Supplemental Information
TAPE OF WORK PLAN REVIEW
❑New construction ,rfrAAddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El1-and 2-family dwelling 'Commercial/industrial 0 Accessory buildingampless to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑Multi-family 0 Master builder 0 Other: Fire form all other installations. butngs.
0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:
/$ 05u,app if ICI 100HP or more. ❑..A„ «E„ .1 2„ «1 3„
City/State/ZIP: � �y//� ��1�y},. �-�}} ,� ❑Six or more residential units. occupancy.
l�t1CL? 1.%l r 'C?1 (dl ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 'Troject name: G dr .^� 0 Hazardous locations. 0 600uSupply
yvolvoltage o more than
Cross Street/dlreCtiOns t0 Ob site: ' r ❑Service or feeder 600 amps or more.
J5 G� _SES :�,{� FEE SCHEDULE
Description I Qty. I 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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
K l (with above sq.ft.) 75.00 2
P�k_ _,51)..A �r �'1 �� 1 � 1l Limited energy,multi-family 75.00 2
J residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT 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:( ) 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
APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A - A.Fee for branch circuits with
Business name: J j s X4.0 / t y 1 . above service or feeder fee,
> �C'C1 ��' 'V V� �ICv1 L—t L{1RTZau 7.42 2
J each branch circuit
Contact name: J4 I �, i.Glt-[ aC 1 B.A B.Fee for branch circuits without
service or feeder fee,first
Address: / alb >244°5.1-- branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(3( ) '/)j J -L , Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: it., cI C'-Y�V� . :-4 ,-,,,44 ,
� L � Reconnect only 67.84 2
6.ONT TOR Pump or irrigation circle 67.84 2
Business name: +' �� I Sign or outline lighting / 67.84 2
ler - �� ��� L�l'�4 f � rctc� 74,9
Signal circuit(s)or limited-energy
Address: / ice` La .. ❑ See Page 2 2
�L!! panel,alteration,or extension.
1 Each additional inspection over allowable in any.of the above
City/State/ZIP:
CC i.4 E"t-ry( ,v 'f 41 gegl Additional inspection(1 hr min) 66.25/hr
Phone:(y60) ele7 ...- X Investigation(1 hr min) 90.00/hr _
( Industrial plant(1 hr min) 78.18/hr
Email: e CC;`jy 1 c_atie,S} , ,e l t f Inspections for which no fee is
CCB Lic.:63116 Electrical Lic.: j Suprv.Lic.: fi.5 i 6.
specifically listed(Yz hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician j
,Irequired: s %a {�
Subtotal: 2-P /
Print name: d f' l Date:!42 -49-206 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): ',I 1
0Authorized signature' i' �° TOTAL PERMIT FEE: + 5 g
This permit application expires if a permit is not obtained within 180
Print name: ' /t11�L`t_ � tc v .W� Date: )0 I a.2 6 days after it has been accepted as complete.
1111 * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitAppELRERE.doc Rev' 6/2017 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: FEE SCHEDULE
Description Qty. I Each I Total I *
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
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener*
g p >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
n 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:
n 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('/hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial s stem: $75.00 Subtotal Dnrage I):
y * Number of inspections allowed perrpermpermit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
Fl Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:ABuitding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017