Permit (2) rt CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2020-00089
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/13/2020
Parcel: 1 S 134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 600
Project: Rose Gold Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: Sign lighting for(1)sign.
Contractor: INTEGRITY SIGNS OREGON Owner: ROBINSON, JERRY CHRISTOPHER TRUS
PO BOX 88 DIETRICH, NANCY BISHOP
HUBBARD, OR 97032 9701 SE MCLOUGHLIN BLVD
MILWAUKIE, OR 97222
PHONE: 503-981-3743 PHONE:
FAX: 503-982-8153
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 02/13/2020 $67.84
Specifics: 1 ea 12%State Surcharge- 02/13/2020 $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 iss n , r if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificati n r. Those s are set forth in OAR
952-001-0010 through OAR 952-001-0090. You m btain a o of the ru r irect questions to OUNC by calling 5 . 9 or 1. . 2.2344.
Issued By: ittee 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 [SE ONI,1
City of Tigard BE GEIV i__ • t V .y�
;14. 4 13125 SW Hall Blvd.,Tigard,OR 97223 G Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 q O?I Date/B : Other Permit:
1 r, �tc n Inspection Line: 503.639.4175 FE.S 1 3 L L Date Ready/By: El See Page 2 for
Internet: www.tigard-or.gov OF_C1GA _otified/Method: y Supplemental Information
TYPE OF WORK �'11 Y IIdG DIVISION PLAN REVIEW
$l l41 U Please check all that apply(submit a sets of plans w/items checked below):
❑New construction 0 Addition/alteration/replacement
i, El Service or feeder 400 amps or more El Building over three stories.
El Demolition ®Other: N E vc/ S i(Z.) where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling gi Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ['Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A" "E" "1-2""1-3"
Job no.: Job site address: /Q//$ l' 1001-1P or more. occupancy.
5t4.,/ViM 11VKL 0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: --7 j j OQ q -7 273 o Health-care facilities. ❑Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: WO Project name: erscezZirN ❑Service or feeder 600 amps or more.
I_� _ FEE SCHEDULE
Cross street/directions to job site: Nj m i)0 . 4.54,016 Description I my. I Foe. I Total I
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: I,000 sq.R.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energ
y,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
'/eI r ) .L1r ''O PI n residential(with above sq.ft.)
�rL J I�{Lf Renewable Energy [7 See Page 2
Services or feeders installation,alteration,and/or relocation
.121 PROPERTY OWNER 0 TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: NA-LT E L L i Otri- -E.4F atA.?i 1.0 401 amps to 600 amps 200.34 2
Address: < )1 NF /'5 jG 7 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: A m4 04 Z 3>._ Temporary services or feeders installation,alteration,and/or
Phone: ) Fax:( ) relocation
3 2s/" 6,7q/ 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. qo l amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
fsi APPLICANT ® CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name: 5' j/ir7ool Jam' 'A(,. each branch circuit
'l B.Fee for branch circuits without
Contact name: fK ) //),,,7 service or feeder fee,first 56.18 2
branch circuit
_J
Address: r °? //j1p// ,94,/, Each add'l branch circuit 7.42 2
/ p Miscellaneous(service or feeder not included)
City/State/ZIP:
,5 Each manufactured or modular
q Fax: :( ) dwelling,service and/or feeder
Phone: 67.84 2
1 7z'-/ 37 Reconnect only 67.84 2
E-mail: aeVik rtlifr..•Cenle�l�j>,siji-4. eav-, Pump or irrigation circle 67.84 2
CONTRACTOR Signor outline lighting / 67.84 2
Business name: ',L)j "5 {JS ingt,Z e7 Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: P a Lax 88 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 6625/hr
City/State/ZIP: 46,46ftap 0.g 032 _ Investigation(I hr min) 6625/hr
Phone:(03 ) 9%-374,"'3 Fax:( ) Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.:/9/9755 Electrical Lic.:CL 5-2p Suprv.Lie.:3 "51( specifically listed('s hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:.4-Wji ap ry J Subtotal:
Print name: Air- V4/S���"'" Date: /-16-2U Plan review(25%ofpermit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:tnuildiaglPermas\ELC_PermnApp_ELR_ERE.doc Rev 0521/2013 440.4615T(11/OS/COM/WEE