Permit CITY OF TIGARD ELECTRICAL PERMIT
'1 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00216
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/17/2012
Parcel: 1S136DCO2504
Jurisdiction: TIG
Site address: 7275 SW DARTMOUTH ST 120
Project: Great Clips Subdivision: HUNTER POLLOCK N0.2 Lot: G
Project Description: Sign lighting for (1) wall sign
Contractor: SECURITY SIGNS INC Owner: AMERICAN INDUSTRIES INC
2424 SE HOLGATE BLVD 1750 NW FRONT AVE STE #106
PORTLAND, OR 97202 PORTLAND, OR 97209
PHONE: 503 - 546 -7114 PHONE:
FAX: 503 - 230 -1861
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 04 /17/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 04/17/2012 $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. ATTENT : on law requires you to follow the rules adopted by the Oregon Utility Notifi '' q Center. Those rules are set forth in OAR
952 - 001 -0010 rough OAR 52- - 090. You may obtain a copy of the rules or direct questions to OUNC by calling60 .1987 or 1.800.33 .2 23344 4. ..
Issued By: Permittee Signatur . C� O`-frt
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 permtt 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.
(, B `�T V 5GZN 20 Z - • Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard, AP R 11 201 Received ,. ffinrimil
y g Date/B : °I / Permit No.: 1u 1 ex i- 0 24 ,
ii Iii
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 'Fax: 503.598.1960 ,. Other Permit:
OF TIGA" .. -
T 1 G n R D Inspection Line: 503.639.4175 CI NG 1ENrIN ; 1 't t' y/By: runs: ® See Page 2 for
Internet: www.tigard- or.gov PL Notified /fvtethod: SupplementalInformation
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement 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 ❑ 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 . -
' ❑ I - 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 ", "I -2 ", "I -3 ",
Job no.: Job site address: C ((��I� I00HP or more. occupancy.
Z.J �7� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: '?'t.4 44.4., q 7 2 '' ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: /Z O I Project name: r? Co S ❑ Service or feeder 600 amps or more.
L� FEE SCHEDULE
Cross street/directions to job site: Description • I Qty. -I Fee. I Total I • -
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
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
Limited energy, multifamily, 67.84 2
Q `, ► 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
City / State/ZIP: Temporary services or feeders installation, alteration, and/or
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
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 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'I branch circuit 7.42 2
Address: 2424 SE Holgate Blvd Miscellaneous (service or feeder not included)
City /State/ZIP: Portland, OR 97202 Each manufactured or modular 67.84 2
dwell service and/or feeder
Phone: (503) 546.7114 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 67.84 4, iv 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
Investigation (1 hr min) 66.25/ hr
City /State/ZIP: Portland, OR 97202
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 546.7114 Fax: (503) 230.1861 Inspections for which no fee is 90.00 / hr
specifically listed (t/2 hr min)
CCB Lie.: 122809 Electrical Lie.: 26560CLS Suprv. Lie.: 383SIG ELECTRICAL PERMIT FEES
1 Subtotal: 10 7.
Suprv. Electrician signature, required:
' Plan review (25% of permit fee):
'Print name: Marc Linguist ' Date: State surcharge (12% of permit fee): g .
. TOTAL PERMIT FEE: 7a •9 g
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Melissa Hayden Date: • days after it has been accepted as complete:
y Number of inspections allowed per permit.
1: \ Building \Permits\E1.C- PermiiApp.doc 10/01/09 440- 4615T(11 /05 /COM/WBB