Permit „ CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00679
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2012
Parcel: 25101 DA00105
Jurisdiction: Tigard
Site address: 13009 SW 68TH PKWY C
Project: Extended Stay America Subdivision: VARNS ACRES Lot: 9
Project Description: Install (1) sign lighting.
Contractor: RAMSAY SIGNS INC Owner: BRE /HV PROPERTIES LLC
9160 SE 74TH AVE TAX DEPTARTMENT
PORTLAND, OR 97206 EXTENDED STAY HOTELS
100 DUNBAR ST
SPARTANBURG, SC 29306
PHONE: 503 - 777 -4555 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 12/03/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 12/03/2012 $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 i ccordance • approved • • ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A ENTION: Oregon :w r-•• ire :u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 0010 throu•h OAR 952 -00 ..090. '.0 ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
• /j
Issue By: ' Permittee Signature:
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 OFFICE USE ONLY
City of Tigard
Received q
IN - Phone: 503.718.2439 Fax: 503.5' ;:. I ! • Plan Review 7, 3 /� Permit No.: [ ,O1; "0 69
• 13125 SW Hall Blvd., Tigard, OR • •" . �± � U Plan Re
Date/B : Other Permit: 64, /F, op i'V Z..
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov DEC 0 3 2012 Notified/Method: Supplemental Information
TYPE OF W a ' • PLAN REVIEW
71GARD Please check all that apply (submit 2 sets of plans w /items checked below):
® New construction ❑ Addition /alt � ; pP Itil
UPI FIVV frw El 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 ", "l -3 ",
th 100HP or more. occupancy.
Job no.: Job site address: 13009 SW 68 Pkwy
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Extended Stay America ❑ Service or feeder 600 amps or more.
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
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
75.00 2
Instal 1 circuit residential (with above sq. ft.)
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
Name: See Attached 401 amps to 600 amps 200.34 2
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
1 7 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 ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: Ramsay Signs Inc B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Garrett Gibson branch circuit
Each add'I branch circuit 7.42 2
Address: 9160 SE 74 Ave Miscellaneous (service or feeder not included)
City/State/ZIP: Portland, OR 97206 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 777 -4555 Fax: : (503) 777 -0220 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: GarrettG @RamsaySigns.com
Sign or outline lighting 1 67.84 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Ramsay Signs Inc panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 9160 SE 74th Ave Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Portland, OR 97206
Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 777 -4555 Fax: (503) 777 -0220 Inspections for which no fee is 90.00/ hr
specifically listed (% hr min)
CCB Lic.: 63422 Electrical Lic.: 26106CLS Suprv. Lic.: 493Sig ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Wi/t (25% Subtotal: 67.84
Plan review (25 /o of permit fee):
Print name: Phil Steiger Date: 11/28/12 State surcharge (12% of permit fee): 8.14
e ----7 TOTAL PERMIT FEE: 75.98
Authorized signatur
�� This permit application expires if a permit is not obtained within 180
Print days after it has been accepted as complete.
rint name: Garrett Gibson Date: 11/28/12
• Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 07/01/10 440- 46t5T(11 /05 /COM/WEB