Permit l ,` r _, CITY OF TIGAR® ELECTRICAL PERMIT
ii D -'.- COMMUNITY DEVELOPMENT Permit #: ELC2009 -00520
Date Issued: 10/07/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 639.4171 Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9595 SW WASHINGTON SQUARE DR B12
Subdivision: Lot: 0
Project: True Religion Blue Jeans
Project Description: Sign lighting for (2) interior wall signs
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #0
CARLSBAD, CA 92008 2 ea Sign or Outline Lighting 10/07/2009 $135 68
PHONE 1 ea 12% State Surcharge - 10/07/2009 $16.28
Electrical
Contractor:
SECURITY SIGNS INC
2424 SE HOLGATE BLVD
PORTLAND, OR 97202
PHONE. 503 - 546 -7114
FAX 503 - 230 -1861
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $151.96
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 ATT ON Orego law • • Tres • to follow the rules adopted by the Oregon Utility Notification Cent= Those rules _ •c
952 -001- 10th •ugh OAR 952 -' • -010' Y • ma obtain a copy of the rules or direct questions to OUNC by calling 503.246 6-9 1 800.3 . ' . r
M i lli / 14 il Iss ed By: Permittee Signature: �t
r
Sri
'� 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 an inspection that business day.
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 OFFICE USE ONLY
City of Tigard Received �0 ilM O /
Date/B Permit No /L �� _�S�
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone. 503 639.4171 Fax: 503.598.1960 Date/B Other Permit
TI G A R D Inspection Line 503 639.4175 Date Ready/By lur ® See Page 2 for
Internet www.tigard- or.gov Notified/Method. / /�j Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction Please check all that apply (submit 2 sets of plans w /items checked below).
® Addition/alteration/replacement
❑ 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 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: 100HP or more occupancy
1�. may' ❑ Six or more residential units ❑ Recreational vehicle parks
■ City/State/ZIP: /^ '. •
❑ -care facilities ❑ Supply voltage for more than
y � � C.*. f (� // ❑ Hazardous locations 600 volts nominal
Suite bldg. /apt. no.: Project name: 0 ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: i�)---P4f� Description I Qty. I Fee. 1 Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea add'l 500 sq ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft.) 75.00 2
` , fola11 �` " 1 se
Limited energy, multi -family 75.00 2
residential (with th above sq ft )
*mount only* Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106 85 2
Name: 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: Security Signs B. Fee for branch circuits
without service or feeder fee,
Contact name: Melissa Hayden 46 85 2
first branch circuit
Address: 2424 SE Holgate Blvd Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Portland, OR 97202 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 546 7114 Fax: : (503) 2301861 Reconnect only 66.85 2
E -mail: melissa @Securitysigns.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 2 , 55%0 2
Signal circuit(s) or limited -
Business name: Security Signs energy panel, alteration, or 47 gy
Address: extension Describe: Page 2 2
City /State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: 122809 Electrical Lic.: 26560c1s Suprv. Lic.: 383sig Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: / 3 C. lidg
Print name: Mark Linguist Date:
Plan review (25% of permit fee). -.9
State surcharge (12% of permit fee) [, • oA g
Authorized signature: TOTAL PERMIT FEE /51. 94.
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.
* Number of inspections allowed per permit
I•\ Budding \Permits \ELC- PermitAppdoc 05 /23/06 440-4615T( I I/05/COM/WEB