Permit q CITY OF TIGARD ELECTRICAL PERMIT
; 'I ° COMMUNITY DEVELOPMENT Permit #: ELC2012 -00611
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/25/2012
Parcel: 2S 101 DA00101
Jurisdiction: TIGARD
Site address: 13190 SW 68TH PKWY 110
Project: Stearns Lending Subdivision: VARNS ACRES Lot: 9
Project Description: (1) sign lighting for wall sign
Contractor: SECURITY SIGNS INC Owner: PACIFIC NW PROPERTIES LIMITED PA
2424 SE HOLGATE BLVD STERN FAMILY LIMITED PARTNERSHIP
PORTLAND, OR 97202 STERN, HELEN R REVOCABLE TRUST
6600 SW 105TH AVE #175
BEAVERTON, OR 97008
PHONE: 503 - 546 -7114 PHONE:
FAX: 503 - 230 -1861
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 10/25/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 10/25/2012 $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 rdance wi .pproved 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. ENTION: Oregon I- eq. es you to follow the rules adopted by the Oregon Utility No . — i• Center. Those rules are set forth in OAR
952 -0 -0010 thr•ugh OAR 952 .11-0091. may obtain a copy of the rules or direct questions to OUNC • •-' , • , a.•,:.-_ 1987 or 1.800.33 . 344.
Is ued By: `I �� I Permittee Sign. e: ` = %i % V�
r
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 FOR O FFICE U SE ONLY •
✓ • //
City of Tigard Date/B : Received 0 �/0,- • •• i Permit No.z j ? GIDdv/
III n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C �� /T
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: � �C ,
TI G A R D Inspection Line: 503.639.4175 Date Ready /By: lurk: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
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
100HP or more. occupancy.
Job Job site address: q �y
✓ � 7v �w . ....7iik.Lf/ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 27'4.3, QQ 7 2Z ❑ Health -care facilities. ❑ Supply voltage for more than
3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: NO Project name: es•7—G4 //K/ ` , "d j y ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: fi Ae 47„,) r , f 4‘;&,, 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 500 sq. ft. or portion 33.92
Tax map /parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
, Limited energy. multi - family 67.84 2
/_ , f /4� residential (with above sq. ft.)
!�� / Services or feeders installation, alteration, and/or relocation
*Mount Only* 200 amps or less 100.70 2
N PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
. 401 amps to 600 amps 200.34 2
Name: / '' ii li)loct / e I44e 601 amps to 1,000 amps 301.04 2
Address: e p o rr �/'�� o jO g , t Over 1,000 amps or volts 552.26 2
[� J �`� Temporary services or feeders installation, alteration, and/or
City /State /ZIP: ..eta.,G,„'T�r p z:;•40#-- relocation
Phone: / Fax: 200 amps or less 59.36 1
( �� b Z .4.(73,0 ( ) 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
R APPLICANT ❑ 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 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
dwelling, 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 & 7, A 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 (I hr min) 66.25/ hr
City/State /ZIP: Portland, OR 97202 Investigation (I hr min) 66.25/ hr
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 ('h hr min)
CCB Lie.: 122809 Electrical Lie.: 26560CLS Suprv. Lic.: 383S1G ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 7• g,
Plan review (25% of permit fee):
Print name: Marc Linguist Date: to z 5 -_ ' -. State surcharge (12% of permit fee): •/y
TOTAL PERMIT FEE: 75 e 9g
Authorized signature: � >tc� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Melissa Hayden Date: • Number of inspections allowed per permit.
I : \nuilding \Permits \ELC- I'crmitApp.doc 10/01/09 4.10- 4615T(I t /115 /COM/Wlin
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \ Permits \ELC- PermitApp.doc 10/01/09