Permit v, ;,,t4,,,,-;;,4;,4„; CITY OF TIGARD
ELECTRICAL PERMIT
I I '.°. 4. COMMUNITY DEVELOPMENT Permit #: ELC2010 -00272
>TIGARL$ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/08/2010
Parcel: 2S 102AA01100
Jurisdiction: Tigard
Site address: 12035 SW PACIFIC HWY A
Subdivision: Lot: 0
Project: Brake Team
Project Description: Sign lighting for relocated freestanding sign.
Owner: FEES
TIGARD AUTO STOP PARTNERS Quantity Description Date Amount
2829 RUCKER AVE STE #100
EVERETT, WA 98201 1 ea Sign or Outline Lighting 06/08/2010 $67.84
PHONE: 1 ea 12% State Surcharge - 06/08/2010 $8.14
Electrical
Contractor:
SECURITY SIGNS INC
2424 SE HOLGATE BLVD
PORTLAND, OR 97202
PHONE: 503 - 546 -7114
FAX: 503 - 230 -1861
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 don 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 - , uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 1 -0010 through OAR n 2_ Y• . may obtain a copy of the rules or direct questions to OUNC by calling 503.246.66• • 800.332.2344. •
i ,/ /
Issue Permittee Signature: . /A �
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 an inspection that business day.
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 I OR Omer: tisi; ONi
City of Tigard Received /p
Permit No. F /a-
Permit
13125 SW Hall Blvd., Tigard, OR 97223 RECE V g Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
T i G i� D Inspection Line: 503.639 nn Date Ready/By: lint: ® See Page 2 for
Internet: www.tigard - or.gov JUN V Notified/Method: Supplemental Information
TYPE OF WORK crry OF TW RD PLAN REVIEW
1 apply (submit sets of p
ID New construction ® 77rty Addition/alteratio 1 ��{{dJ OW istu Please check all that pp a ( plans g over checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: 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
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency sstem larger separately derived system.
A
❑ Addition of new motor load of ❑ "A ", "E ", "] - ", "1 - ",
Job no.: Job site address: ` _ 1 100HP or more. occupancy.
❑
( ❑ Six or more residential units. Recreational vehicle parks.
City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Q �^� - '
Suite/bldg. /apt. no.: Project name: , r ❑ Service or feeder 600 amps S°C
Cross street/directions to job site: �� ` ' Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
Limited energy, multi- family 67.84 2
,lo -) akrxf residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
*Mount Only* 200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
relocation
services or feeders installation, alteration, and/or
City / State/ZIP:
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
7 , Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit _
Business name: Security Signs B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Melissa Hayden branch circuit
Each add'l branch circuit 7.42 2
Address: 2424 SE Holgate Blvd Miscellaneous (service or feeder not included)
City/State/ZIP: Portland OR 97202 dwe manufactured e and/or or r modular 67.84 2
y Portland, dwelling, service and/or feeder
Phone: (503) 546.7114 I Fax: : (503) 230.1861 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Melissa @SecuritySigns.com Sign or outline lighting 1 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Security Signs panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 2424 SE Holgate Blvd Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Investigation (1 hr min) 66.25/ hr
ity /State/ZIP: Portland, OR 97202
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 546.7114 I Fax: (503) 230.1861 Inspections for which no fee is 90.00/ hr
specifically listed (th hr min)
CCB Lic.: 122809 I Electrical Lic.: 26560CLS I Suprv. Lic.: 383SIG ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Marc Linguist I Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Melissa Hay n Date: . Number of inspections allowed per permit.
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