Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00070
Date Issued: 09/30/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S110AA02000
Jurisdiction: Tigard
Site address: 14255 SW PACIFIC HWY
Project: JR Furniture Subdivision: Lot: 0
Project Description: Sign lighting.
Contractor: INTEGRITY SIGNS OREGON Owner: WEC97H- OREGON -2 INVESTMENT TRUST
PO BOX 88 BY COMMACK LAND DEVELOPMENT
HUBBARD, OR 97032 7 PENN PLAZA, STE 618
NEW YORK, NY 10001
PHONE: 503 - 981 -3743 PHONE.
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 01/28/2011 $67 84
Specifics: 1 ea 12% State Surcharge - 01/28/2011 $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 a • all other ap• icable law All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuanc- o if work is s <.pended for more the 180
days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification ►eater Those r. es are ' -t forth in OAR
952 - 001 -0010 through OAR • 2- 001 -0090 You may obt- • - • • • • - .les or direct questions to OUNC by calling 503 • 1987 or 1 •
PP
Issued Rw / / � Permittee Signa re: y. t /An 9 , _
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 \1 FOR OFFICE USE ONLY
City of Tigard ` Dateiv i� Permit No
Er
13125 SW Hall Blvd., Tigard. OR 97 1\ Plan Review / _
Phone • 503.718.2439 Fax 503 598 1960 G` 3 0 Date /B Other Permit SCON f may) I g-- T 1 CARD Inspection Line 503.639 4175 S Date Ready /By ® See Page 2 for
Internet www.tigard - gov .�\GN r Notified /Method Supplemental Information
''TYPE of wont \. ���gG U1� PLAN REViEw
❑ New construction ® Addition /alteration�r placement Please check au that apply (snbirui 2 sets of plans wntems 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 ,dNFORMATION AND'LOCATION' , ' ❑Emergency system larger separately derived system.
_ , - ❑ Addition of new motor load of ❑ "A "E" "1 -2 ",' I -3 ".
Job no. Job site address: 14255 SW Pacific Hwy IOOHP or more occupancy
❑ Six of mote iesidennal units ❑ Recreational vehicle parks
City /State /ZIP: Tigard, OR 97224 ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite /bldg /apt no. • Project name: JR Furniture ❑ Service or feeder 600 amps or more
]FEeSGHEDULE ,`
Cross street /directions to job site J Dest,ripuon I Qty. I Fee. l Total
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'I 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.)
Limited energy, multi - family 75 00 2
Installed new raceway signs (2) residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 100 70 2
-: ` . ❑ PROPERTY =OWNER . ' - ' - 0 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: Ovei 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP- relocation
Phone: ( ) 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date A Fee for branch circuits with
- '0' APPLICANT - ' . ' - - . " ❑ CONTA PERSON above service or feeder fee.
each branch circuit 7.42 2
Business /6 J`71 y - 9N ,c B Fee for branch circuits without
service or feeder fee, first 56 18 2
Contact name: branch circuit
Each add'l branch circuit 7 42 2
Address: `p t9 Eii X -+ Cp Miscellaneous (service or feeder not included)
0 Each manufactured or modular
City /State /ZIP:
U b ,b h r �,(L $ �P 9f '2 / dwelling, service and/or feeder
67 84 2 °
Phone:d` 3) Qi Ty 3 Fax: : ( )
Reconnect only 67 84 2
7 Pump or irrigation click 67 84 2
E -mail:
Sign or outline lighting 67 84 2
.� CONTRACTOR Signal circuti(s) or limited- energy
Business name. rkryi, . Xi i /L A , / a � • panel alteration, or extension. Page 2 2
�1 jr Each additional inspection over allowable in any of the above
Address' Additional inspection (I hr nun) 66 25/ hr
Investigation (1 hr nun) 66.25/ hr
City /State /ZiP: Industnal plant (1 hr min) 78 18/ hr
Phone ( ) Fax ( ) Inspections for which no fee is
' I t / specifically listed ('/ hr nun) 90.00/ hr
CCB Lie.: /gig ii5. Electrical Lic ' .r� • Suprv. L 1 , d " • ELECTRICAL PERMIT FEES,
Supry Electrician signature, required > � 0 I iv Subtotal
J�- Plan review (25% of permit fee)
Print name: � '� i ��� Date: State surcharge (12% % of permit fee).
�L�i TOTAL PERMIT FEE
Authorized signature
K „Mgr � A. This permit application expires if a permit is not obtained within 180
Print ham ll Dat days after it has been accepted as complete.
* Number of inspections allowed per permit
I \BuddingAPeimis \ttLC- i'ermitApp doe 07/01/10 4411 1615T( I I /05 /COM/WEB
Pp C
Electrical Permit A lication RE � � K � � . . FOR OFFICE USE oNLv
lig City of Tigard Received Date /B : ) / i1i Peimit No • • za II —LT-5 .
° 13125 SW Hall Blvd., Tigard, OR 97223 ' J 2 7 2 011 Plan Review I
' Phone: 503.639.4171 Fax 503 598 1960 `
Date/B . Other Permit t — / _ I
Inspection Line 503 639 4175 Date Read /B ® See Pa e 2 for
l "I GARD Internet. www.tigard -or CITY OF TIGARD y y PP g
Notified/Method Su lemental Information
.niair-r•rmxit..
TYPE OF WORK' ' ' �
711.ddition/alteration/replacement •' PLAN REVIEW
1=l New construction 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 Other: where the available fault current ❑ Mannas 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 system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: IOOHP or more occupancy
rr 5/ ,
S L � �cfC'Jt iC / ✓ ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: t J ❑ Health-care facilities ❑ Supply voltage for more than
�) J G r [ J q ✓ ❑Hazardous locations 600 volts nominal
Service feeder 600 amps or more
Suite /bldg. /apt. no : � Proje t name � ���.��� �� ��� ID e rvice or er FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
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 1
Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft ) _
Limited energy, multi- family 75 00 2
c;.5 1\/ ( 91 - r3 ,& �, lJ 1 J' residential (with above sq. ft )
1 1111 `� Services or feeders installation, alteration, and /or relocation
200 amps or less 100 70 2
❑ 'PROPERTY OWNER " ❑ TENANT 201 amps to 400 amps 133 56 2
401 amps to 600 amps 200.34 2
Name: a "` - p t s ' fii r",- 'f' C4, roc, r 601 amps to 1,000 amps 301 04 2
(
Address: , _ ( � `!` '7 7Pe, ii }y !! II�� et z, C� Over 1,000 amps or volts 552 26 2
0� i ` 1 ' Temporary services or feeders installation, alteration, and /or
City/State /ZIP: N t`' (10 L l 000 1-00/c relocation
Phone: (. a 3-351_4,? q Fax 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT ' ❑' CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name:
1- B Fee for branch circuits without
r f t r i �t f� service or feeder fee, first
Contact name: 1...,1„ �'' rr branch circuit 56 18 2
O �" ` 1 Each add'I branch circuit 7 42 2
ib o Address: ° / 6 / Miscellaneous (service or feeder not included)
�+ / ( ! rp /r V Eac manufactured or modular
City /State /ZIP: �` Y I /� l /'/1/ 7��� dwelling, service and/or feeder 67 84 2
C
i !J�' c Reconnect only 67 84 2
Phone: ( ? Fax: ( sue ) r —� ( )
E - mail y', �' Pump or irrigation circle 67 84 2
q 01,k Sign or outline lighting 67 84 6'7, W' 2 41
. CONTRACTOR A A ` � �; Signal circuit(s) or limited- energy
1 Business name: 1 panel, alteration, or extension Page 2 2
4/6- ,. / , e — / Each additional inspection over allowable in any of the above
M
Address. t i 11 7 ¶' w ( // I) ei 11 4: Additional inspection (1 hr min) 66 25/ hr
' l y , YYY Investigation (I hr mm) 66 25/ hr
City /State /ZIP: � . C 7�7 S'(� /
re �/1 ! ' industrial plant (1 hr mm) 78 18/ hr
Phone: ( ,5b3) `7/.2 _/ 3 6,3 I Fax. ( ) Inspections for which no fee is 90 00/ hr
1 h `� specifically listed (% hr min)
CCB Lie.: El- - ►'lam Suprv. Lic : / t � Si EIECTRICAL_PERMIT FEES
/ / Subtotal: 6 7 , V'1
Suprv. Ele uric "alt�ign . ure aired: j Plan review (25% of permit fee)
Print name: L C` I i 5 - a ate: i c. 7 il State surcharge (12% of permit fee).
TOTAL PERMIT FEE: '7 D • /L1
Authorized signat e:
ye.) L ./ This permit appli cation expires if a permit is not obtained within y80
days after it has been accepted as complete.
Print name. / - 6 - �( / cam Date: / // * Number of inspections allowed per permit p
I lBuildmg)Permits�ELC PermitApp doc 07/01/10 440 -461 11 /05 /COM/WEB v / 25e / Q
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Bwldmg \Permrts\ELC- PermiApp doc 07/01/10