Permit r, CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019-00805
NI
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2019
Parcel: 2S 110DCO2200
Jurisdiction: Tigard
Site address: 15660 SW PACIFIC HWY A-5
Project: Willoughby Hearing Center Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Sign lighting for(1)wall sign.
Contractor: RAMSAY SIGNS INC Owner: ROIC OREGON LLC
9160 SE 74TH AVE ATTN: SCHOEBEL, RICHARD
PORTLAND, OR 97206 8905 TOWN CENTRE DR, STE 108
SAN DIEGO, CA 92122
PHONE: 503-777-4555 PHONE:
FAX: 503-777-0220
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 11/12/2019 $67.84
Specifics:
1 ea 12%State Surcharge- 11/12/2019 $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 Notifi ion Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may o ee the rules or direct questions to OUNC by calling 03. '2.198ZQr 1.8 . .2344.
Issued By: _�;— 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 FOR OFFICE USE ONLY
I 'ceived J �y� /may
City of Tigard . to/By: f I, f�/l�/ c{r,-- Permit#: i'--JCe ii iY—'CijdV S—
IIII - 11 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review tom'/ L�-r/�
Phone: 503.718.2439 Fax: 503.598.1960 V 2 Date/By: Related Permit#:
FICA R 11 Inspection Line: 503.639.4175 NO2 019 Ready Date/By: inns- ElSee Page 2 for
Internet: www.tigard-or.gov Notified/Method: -y Supplemental Information
_
TYPE OF WO t- i4 n PLAN REVIE." ;.. r 3 a.ai- :
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire
pump. ❑Installation of 150 KVA or
JOB SITE INFORMAT.ON AND LOCATION ❑Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address 6 W Pacific Hwy 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: Tigard OR 97224 ❑Six or more resident al units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt#: Project name:Willoughby Hearing Center ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. 1 Each 1 Total I '
New residential single-or multi-family dwelling unit.
Subdivision:, Lot#: Includes attached garage.
Tax map/parcel#
1,000 sq.ft.or less 168.54 4
l I5� ir," -: i 3c: y I�z
Es.add'l 500 sq.ft.or portion 33.92 1
� 1=�" �. -��. -. '� -` '�-.' Limited energy,residential 75.00 2
Install(1)sign circuit (with above sq.fL)
Limited energy,multi-family 75.00 2
residential(with above sq.ft)
Renewable Energy 0 See Page 2
1,S, 1 ,' t = I l - }i. let - '1.: .. " Services or feeders installation,alteration,and/or relocation
Name:Willoughby Hearing Center 200 amps or less 100.70 2
Address: 15660 SW Pacific Hwy 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard OR 97224 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
El APPLICANT ® CONTAG .PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Ramsay Signs above service or feeder fee, 7.42 2
each branch circuit
Contact name: Chris Brown B.Fee for branch circuits without
service or feeder fee,first Address: 9160 SE 74th Ave branch circuit 56.18 2
City/State/ZIP:Portland OR 97206 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)777-4555 Fax: : (503)777-0220 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: CBrown@ramsaysigns.com Reconnect only 67.84 2
- !,' t. , I"'.44 - . r.- .. ... ti= ... ' Pump or irrigation circle 67.84 2
i {
Business name:Ramsay Signs Sign or outline lighting 1 67.84 N 7r/ 2
Address: 9160 SE 74th Ave Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Portland OR 97206 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)777-4555 Fax: (503)777-0220 Investigation(1 lir min) 90.00/hr
Email: Cbrown@ramsaysigns.com
Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 63422 Electrical ' .: 26-106CL Suprv.Lie.: 493SIG specifically listed(1/z hr min)
C f .ELECTRICAL PERMIT FEES_,,,,'. ,
Suprv.Electrician signature,required: ; Subtotal (,� �11
Print name: Phill Steiger / Date: ❑Plan Review Required(25%of permit fee): ---
State surcharge(12%of permit fee): �',(il
Authorized signature: DAAro TOTAL PERMIT FEE: '- ---r ci g
�J
This permit application expires if a permit is not obtaine within 180
Print name: Chris Brown Date: days after it has been accepted as complete.
* Number of inspections allowed per permit
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