Permit CITY OF TIGARD ELECTRICAL PERMIT
f COMMUNITY DEVELOPMENT Permit#: ELC2019-00813
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/14/2019
Parcel: 1 S134BC00300
Jurisdiction: Tigard
Site address: 12264 SW SCHOLLS FERRY RD
Project: Restore Cryotherapy Subdivision: None Lot: None
Project Description: Sign lighting for(1)sign.
Contractor: INTEGRITY SIGNS OREGON Owner: FW OR-GREENWAY TOWN CENTER LLC
PO BOX 88 PO BOX 790830
HUBBARD, OR 97032 SAN ANTONIO, TX 78279
PHONE: 503-981-3743 PHONE:
FAX: 503-982-8153
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 11/14/2019 $67.84
Specifics:
1 ea 12%State Surcharge- 11/14/2019 $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 i suspe d for ore the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. o u are set rth in OAR
952-001-0010 through OAR 952-001-0090. You ma obtain a copy direct questions to OUNC by calling 503.232.19 or . .3 344.
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 ON I.)
City of Tigard Received
PermitNo.: /Y._,
■ 13125 SW Hall Blvd.,Tigard,OR 97223 plan R ` -
Phone: 503.718.2439 Fax: 503.598.1Et\itu ill
DateB .evtew Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Suns: EdSee Page 2 for
Internet: www.tigard-or.gov n 1 4 Z( 9 Notified/Method: /NOV
1 ,..- Supplemental Information
TYPE OF WORK l‘-Y OF TiGARD 1 PLAN REVIEW
0 New construction 0 Addition/aft atio -t : r 1{VISION Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition jgr Other: f .' where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
0 1-and 2-family dwelling Q. Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E,"1-2","1-3",
�J / c 100HP or more. occupancy.
Job no.: Job site address: /G�lf/9 ✓r' �V /G ��Jr ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 77C.,gth Q� 0 q'7 Z2') El Health-carefacilities. ❑Supply voltage for more than
�a 4 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt,no.: Project name: Esc "C El Service or feeder 600 amps or more.
"�r�t� FEE SCHEDULE
Cross street/directions to job site: 5.C..In s phe lt /l r, ,t/_'?Lo Description I Qty. I Fee. I Total
/LL.1�err LL7l� New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'!500 sq.ft.or portion 33.92 1
Tax map/parcel no.:
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
/v T/ e� A Limited energy,multi-family
sq.
V residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Aer PROPERTY OWNER 0 TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: ` 4, Ise,„,
c7„ ,45 401 amps to 600 amps 200.34 2
Address: 5 3 3'S 5 //E„1 ws /2? Sy7 2 5 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:14' d 9703.5 Temporary services or feeders installation,alteration,and/or
Phone:( 3 )493 3 Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
st APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name: xivi.S< each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name: . Mkt /a/,27/t1 service or feeder fee,first 56.18 2
3 54., /787/kt,/I branch circuitAddress: lJ,��Os► Each add'1 branch circuit 7.42 2
City/State/ZIP: �t► ���®� Miscellaneous(service or feeder not included)
/ l�� Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone:) 72, ?Q, Fax::( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting / 67.84 Ir%7, y 2
e—gR. Le// 5 row Signal circuit(s)or limited-energySee t
Business name: /'c ./r f�'CJ� `wv, �
panel,alteration,or extension. Page 2 2
Address: I.O. 00, C/y5 Each additional inspection over allowable in any of the above
City/State/ZIP: 6� 4 o f �20 37 Additional inspection hr min) 66.25/hr
�i Investigation(1 hr min) 66.25/hr
Phone:(„51,7 ) /O/---37&3 Fax:( ) Industrial plant(1 hr min) 78.18/hr
��1G� Inspections for which no fee is 90.00/hr
CCB Lic.:/93/i 5-5- Electrical Lic.:Cis—2G) Suprv.Lic.:, 56-- specifically listed(%hr min)
Suprv.Electrician signature,required r � ELECTRICAL PERMIT FEES
? JPy Subtotal: ( ? 3Print name: , ,5/ &IDate: / Zt� Plan review(25%of permit fee): il
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: `°_X
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC PermitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(11/05/COM/WEB