Permit CITY OF TIGARD ELECTRICAL PERMIT
IIII
s • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00460
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/02/2012
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Chase Bank Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Sign lighting for remodeled sign - no sign permit required per planning.
Contractor: INTEGRITY SIGNS OREGON Owner: FRED MEYER INC
PO BOX 88 3800 SE 22ND AVE
HUBBARD, OR 97032 PORTLAND, OR 97202
PHONE: 503 - 981 -3743
PHONE: 503 - 232 -8844
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 08/02/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 08/02/2012 $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 i -•ance, or if wo s•ended for more the 180
days. ATTENTION: Oregon aw requires you to follow the rules adopted by the Oregon Utility Notif 'tion - , ter. « orth in OAR
952- 001 -0010 through OAR • 0' i ' ; . Yo may obtain a copy of the rules or direct questions to OUNC by calli ! 503 - 87 or 1.' ri :F
Issued By: Permittee Signature: i�2
/ /
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 Applica ' , p� 1 me FOR OFFICE USE ONLY
City of Tigard
tJdJ y DateBea /a. ari 'et No. �2 a 13125 SW Hall Blvd., Tigard, 0 Plan Review l n yA�
• ' . Phone: 503.718.2439 Fax: 503.598 06 0 2 2012 Date/By: Other Pernhii. ..— v� 7
TI G A 1: D Inspection Line: 503.639.4175 Date Ready /By: luris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method:
r ,• Notified/Method: / ! 6 — Supplemental Information
GI-TV, C AtIO PLAN REVIEW
❑ New construction El Addition /a eratioon /replacement
TYPE [ �� ` i t1VIPIIP.'
-f '; Please check all that apply (submit 2 sets of plans w /items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition f "Other: 51 b0 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 o of new motor load of ❑ "A ", "E ", "I - ", "I - ",
CC c 1 • I00HP or more. occupancy.
Job no.: Job site address:
r /J� `� W ). ill ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /Stale /ZIP. / El Health -care facilities. ❑ Supply voltage for more than
� ` 5 , _ / � ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: C pia - ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: /Lec Q �/ D escription I Qty. I Fee. I Total I •
Q 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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
I 75.00 2
_ _ .. • • •,' r - / / _ _' .• • / .4 _ ��_' _. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
46 n Ana ae 200 amps or less 100.70 2
D — PRRPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: �;• Dcz )21.1,.. l ��r� 601 amps to 1,000 amps 301.04 2
Address: o Over 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
APPLICANT I CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: (� - / e B. Fee for branch circuits without
t,� `F'. I '�hS' service or feeder fee, first
Contact name: 1 / branch circuit 56.18 2
Zy r w. Each add'I branch circuit 7.42 2
Address: (.0- A5 °x Sg Miscellaneous (service or feeder not included)
.,� � 61(.._. Each manufactured and/or dr r modular
City/State/ZIP: (�,� dwelling, service and/or feeder 67.84 2
p�.� � Reconnect only 67.84 2
Phone: ( .93 ) ,6/_�4,3 Fax: : (23 � p . gJ5.3
Pump or irrigation circle 67.84 2
E c Sigrt r outline lighting i 67.84 (.1. Vet 2
CONTRACTOR ignal circuit(s) or limited- energy
/
Business name: � ^ �L , s�� /�J panel, alteration, l or extension. Page a 2 ny 2
J / 41 T� / J r Each additi inspection over allowable in any of the above
Address: Q ay. p,g1 Additional inspection (1 hr min) 66.25/ hr
O Investigation (I hr min) 66.25/ hr
City /State/ IP: .1 /I 1 41 n ' 4�o3a Industrial plant (1 hr min) 78.18/ hr
Phone: (J 3 t 1 -3 �3 Fax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed (% hr min)
CCB Lic.: riq ISS , ), 0 Electrical Lic.: CLS e) Suprv. Lic.:' 44 S 1 6 ELECTRICAL PERMIT FEES
Subtotal: (A 84
Suprv. Electrician signature, re ytiied •
Plan review (25% of permit fee):
Print name �/E i S j , Date: -7 . 2 , State surcharge (12% of permit fee): B. W'
'������' TOTAL PERMIT FEE: r1 5 HI V
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
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