Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00427
TEGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/28/2011
Parcel: 2S113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 150
Project: Lasik -Joffe Medical Subdivision: Lot:
Project Description: Sign lighting for (1) wall sign.
Contractor: INTEGRITY SIGNS OREGON Owner: OREGON STATE BAR, THE
PO BOX 88 16037 SW UPPER BOONES FERRY RD
HUBBARD, OR 97032 TIGARD, OR 97224
PHONE: 503 - 981 -3743 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 07/28/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 07/28/2011 $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 Notification Center. Those r les are set forth in OAR
952- 001 -0010 through- 2- 001 -0090. You may o• -'• - • • ., ...;s or direct questions to OUNC by calling 5 . 2.1987 or 1.800.] 3 44.
Issued By: - - ee.Signature: ti _ . ,u
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.
56 ii —c.) $
Electrical Permit Application OFFICE USE ONLY
City of Tigard Received _.7 �/ Permit No.: _
Date /By: / 70 /� s r �tc2.6) t/v� 7
a 13125 SW Hall Blvd., Tigard, OR 92 4 Plan Review
Phone: 503.718.2439 Fax: 503.5 9$ 60 $ `LC ,1 Date/By: O P
Inspection Line: 503.639.4175 `\\\� Date Ready /By: Jari -s ® See Page 2 for
TIGARD
Internet: www.tigard- or.gov Jv ® A N ot i fie d /Method: • 1,16/' Supplemental Information
I - I TYPE 'OF 'WORK \;5 Q ,'" ' X° ". ; PLAN, e _ .
❑ New construction ❑ Addition /alteration/replaaeto x
v' . v. Please check all that apply (submit 2 sets of plans w /items checked below):
m�nt
"• ❑ Service or feeder 400 amps or more El Building over three stories.
• ❑ Demolition [}OtheC: � 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
z _ , ,. , , , , _ . .• ❑ Emergency system. larger separately derived system.
' - - JOB SITE INFORMATIO °,AND `LOCATION , "" Addition of new motor load of ❑ ' A ", "E", ' 1 -2 ". '` I -3 ".
I00HP or more. occupancy.
Job no.: Job site address:
1‘031 c ,, �\\ 0 vehicle parks.
/ JW ❑ Six or more residential units. P
❑ Health -care facilities. ❑ Supply voltage for more than
City /State /ZIP: --r-c5,..6.1, ��
0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: t 5 6 Project name: \ � � _ /J ❑ Service or feeder 600 amps or more.
6 > V wlx , FEE ` SC H EDUL E ''"
Cross street/directions to job site: `
j I i Description 1 Qty. I Fee. 1 Total 1
�C 7�S ) ill New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 I
Limited energy. residential
D ESCRIPTION, OF, WORK ' (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
KOLti LyJ :Lt.( S C residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
._ 0 PROPERTY' OWNER. 1 . '' , ENANT %. 201 amps to 400 amps 133.56 2
1 l e 1��1 . I 401 amps to 600 amps 200.34 2
Name:
1a_ 5 fc — .a��— �,Pr bbb Q '/ L2..fL, 601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I
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.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. [E *11— ICANT i . i'•'CONTACT. PERSON''' above service or feeder fee
each branch circuit 7'42 2
Business name: O -Q fi x,' SitykS n B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
t‘ Q h O – Each add'I branch circuit 7.42 2
Address: p . Gri Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: O
y L J. lQ.il/. t C) Ci 7 c 3 , dwelling, service and/or feeder 67.84
Phone: (5b3) q8) 3143 i Fax:: (SZ3) .9 f _?1s3 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: J ,p, �� fa et jiy Si its h #e ey • • ( Sign o outline lighting ( 67.84 `'7 2
•%` € TRAcTO
N .'
naI circuits) or limited - energy
Business name: n panel. alteration, or extension. Page 2 2
oeX S / 114.173.*. J Each additional inspection over allowable in any of the above
Address: a b � 4 0] (,, „ — Q Additional inspection (I hr min) 66.25/ hr
p r's Investigation (1 hr min) 66.25/ hr
City /State /ZIP: `!
1 1�I� �,�LL / ' / S� / 4 e7... Industrial plant (1 hr rein) 78.18/ hr
Phone: (52 ,3) q F , / _ 3 7 Fax: ( ) Inspections for which no fee is 90.00/ hr
, •7 specifically listed ('/2 hr min)
CCB Lie.: J Electrical Lie.: C . 2 Suprv. Lic.: $' 379 ELECTRICAL.PERMIT FEES
Suprv. Electric y( �S' atu Subtotal: re, required: J c 84.
7.
Plan review (25% of permit fee): �(
Print name: �� . l Date: `-1 �1 - S surcharge (12% of permit fee): �T
f`` l[ / Q[ TOTAL PERMIT FEE: 1�+j • 98
Authorized signal --: IP A" 111
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:A Building \PermitsVELC -1'ermitApp.doe 1)7/01/1 I) 440- 4615T( I I /Ili /COM/WEB