Permit CITY OF TIGARD ELECTRICAL PERMIT
E. ' COMMUNITY DEVELOPMENT Permit#: ELC2019-00865
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/17/2019
T[G.1 R.C7 g Parcel: 1S136CD01400
Jurisdiction: Tigard
Site address: 11654 SW PACIFIC HWY 6
Project: Paradise Deli&Grocery Subdivision: None Lot: None
Project Description: Sign lighting.
Contractor: CARRICK INC Owner: YASAVOLIAN, PIERROUZ
4875 NW KAHNEETA DR 9 SPINOSA
PORTLAND, OR 97229 LAKE OSWEGO, OR 97035
PHONE: 503-334-6005 PHONE.
FAX: 503-645-8273
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 12/17/2019 $67.84
Specifics:
1 ea 12%State Surcharge- 12/17/2019 $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 w requires yto follow the rules adopted by the Oregon Utility Notification Center. hose --ru are set forth in OAR
952-001-0010 through OAR 001- 090. You obtain a copy of the rules or direct questions to OUNC by calling 503.232. ' • 1.8 344.
Issued By: "/t 4� 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 EIIIIIIIIEISIIIIIZIIIIIIIIIIIr
City of Tigard C E I �I to/By: /it,� f ,.Permit#61._e" )/9 -9c),h
• 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy:ved / /1L/
g g Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503.593.1960 DEC 0 5 2019 Date/By:
Inspection Line: 503.639.4175 Ready Date/By: Duns H See Page 2 for
T I G.ARI) Internet: www.tigard-or.gov CITY OF TI GAF,D1otified/Metf3od:�L�`7/� �� Supplemental Information
TYPE OF WORK BU1LtM tU"O MS'° N<'� /L. /ivJ " ,�� '
PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
E)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.
0 1-and 2-family dwelling ''Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 Multi-family ❑Master builder ❑Other: ❑Fire
ep umall other installations. buildings.
pup. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATIONElEmergency system. larger separately derived
Job 4: Job site address: }� . J V� 1/,( 0 Addition of new motor load of system.
1F S9 S act �. / 100HP or more. ❑"A","E","1-2","1-3",
occupancy.
0 Six or more residential units. uP Y
City/State/ZIP:' CI facilities.
�� J ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 1)01/45-a cD1i S c Is)�' ( 0 Hazardous locations. 0 Suppl600 y voltage for
nominal.more than
❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I '
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot 4: g g
Tax map/parcel 4: 13 6. C D v i�f o° E .a sq.for less 168.54 4
S Ea. 500add'1sq ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: c)! fir► C-f-ou' A s' as/l4 N 200 amps or less 100.70 2
Address: I 16,5 2.1 Sly fize,l� L #,.7. , 201 amps to 400 amps 133.56 2
,� 401 amps to 600 amps 200.34 2
City/State/ZIP: '..-03a`zp) QYZ 601 amps to 1,000 amps 301.04 2
Phone:( ) 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,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 0'CONTACT PERSON Branch circuits—new,alteration,or extension, .er panel
A.Fee for branch circuits with
Business name: t� C C1 `4^+-L above service or feeder fee, 7 42 2
��_ `, each brannh circuit
Contact name: �)Y � .c-Tc B.Fee for branch circuits without
Address: Lie 7.s �V l-S �Vteed" LD{-, branservche or feederstfee,first
branch circuit 56.18 2
City/State/ZIP: ,,i r,/ Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ?jt—) ,1 4/, .-.-3O' Fax::( ) Each manufactured or modular 67.84 2
�/!��`�, dwelling,service and/or feeder
Email:
arn44 vIA caf-n 6.4/14c r<-67"1 Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: (ACC).d.--(..t. Sign or outline lighting ( 67.84 6 7j1' 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:
1.04 e_ as e Lj i�J i panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: /2 SS Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: ,� ! Electrical Lic.: Suprv.Lic.: specifically listed(%hr min)
11 i ��`��� p �� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: f."X'
Subtotal: 7.g Li
Print name: 0�� a,���c Date: j ViSii�'.' 0 Plan Review Required(25%of permit fee):
//�/�' State surcharge(12%of permit fee): ,P, /9.
cie
Authorized signature: 77:00,1°'
0d�/ TOTAL PERMIT FEE: S�,
,�� (..,:or This permit application expires if a permit is not obtained within 180
Print name: iih �1CG C ,� I G Date: i V I F✓ days after it has been accepted as complete.
* Number of inspections allowed per permit.
i.Building\Permits\ELC_PermitApp_ELRERE.dos Rev 06/17/2015 0-4615 (11/05/COM/WEB