Permit n CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00726
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued: 01/10/2013
Parcel: 2S 112AC00100
Jurisdiction: Tigard
Site address: 14529 SW 72ND AVE
Project: Save on Tires Subdivision: BONITA INDUSTRIAL PARK Lot: 5
Project Description: New 3'x12' illuminated wall sign on east - facing wall.
Contractor: INTEGRITY SIGNS OREGON Owner: DONNELLY, THOMAS J
PO BOX 88 PO BOX 83192
HUBBARD, OR 97032 PORTLAND, OR 97283
PHONE. 503 - 981 -3743 PHONE.
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 01/09/2013 $67 84
Specifics:
1 ea 12% State Surcharge - 01/09/2013 $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 acco • - I 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 ATTEN ' ON. Oregon - . requires ou to follow the rules adopted by the Oregon Utility Notification C •ter Those rules - set forth in OAR
952- 001 -001' throug AR 952 -001 090 ou ma obtain a copy of the rules or direct questions to OUNC by calling 503 or 1 81 , .332 2334
Issued 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
lig City of Tigard Date/Bed ,.f�A� Permit No.: t �C.L /o2 — 407A.
.
° 13125 SW Hall Blvd., Tigar _ Plan Review
.
Phone. 503.718.2439 Fax: 503.598.1960 q Date/B Other Permit. 6R/Di _eV
TI G A It D Inspection Line: 503 639.4175 DEC 1 9 2 012 Date Ready /By Jura: M See Page 2 for
Internet www.tigard or.gov Notified/Method Supplemental Information
TY , bIli E t jIg
AKD PLAN REVIEW
❑ New construction ❑ AamiaL/LItdIHJd#A'fY itint Please check all that apply (submit 2 sets of plans whtems checked below)
Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Q u00 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 11 ommercial /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", ' 1 -2 ". "I -3 ".
Job no.: Job site address: / "lS q writ) tea_ 100HP or more occupancy
❑
0 Six or more residential units Recreational vehicle parks
City /State /ZIP: 60 J ❑Health-care facilities 0 Supply voltage for more than
° ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name:c SU / / Y ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross streeUdirections to job site: - , 62 pj 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 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
010 Ii_e_e_. 3 x 1.7 &4 J zf residential (with above sq. ft.)
� � Services or feeders installation, alteration, and/or relocation
A.,2 ct_ /VC., rr n Z5 ' ,2 (P 200 amps or less 100.70 2
ID PROPERTY OWNER I ErIfICANT 201 amps to 400 amps 133.56 2
Nam '52 n 0'y I I '��
401 amps to 600 amps 200.34 2
p I�'� 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
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
PLICANT I .. )2'C�NTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Qr e' L.t 2 �, ' C J B. Fee for branch circuits without
Ge o� `'/� / service or feeder fee, first 56.18 2
Contact name: /LDS R! branch circuit
Each add] branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: 603) el _ 3'77,3 Fax: : (sue 61 p _ aA.S- 3 Reconnect only 67.84 2
Pump or imgation circle 67.84 2
E - mail:
, ? -. Sigh oor outline lighting ( 67.84 ( Te`'f 2
CONTRACTOR t goal circuit(s) or limited- energy
Business name: �r 1 1�7 c. i pi D panel. alteration, or extension. Page 2 2
" JJ I Each additional inspection over allowable in any of the above
Address:) U so/ 8 Additional inspection (I hr min) 66.25/ hr
City /State/ZIP:J /� , L '7O3a Investigation (1 hr min) 66.25/ hr
n/ -6f- z / Industrial plant (1 hr min) 78.18/ hr
Phone: (A72) 98/ _ 3 79/, Fax: ( f _ y`5"� Inspections for which no fee is 90.00/ hr
/ specifically listed (' hr mm)
CCB Lic.: Ry /53 1 Electrical Lic.: CL5 c I Suprv. Lic.: '39f_5/ b ELECTRICAL PERMIT FEES
-- Subtotal: (,r7 "'(
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print nam — 4 ` 3 Date: State surcharge (12% of permit fee) / `f
Authorized signature:
TOTAL PERMIT FEE: r75: q8'
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. D
Print name: Date: • Number of inspections allowed per permit. GG'/'/�I
1:\ Budding \Pcrmns1ELC- PermnApp.doc 07/01 /111 440- 46157111/05/COM/WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14529 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
04/12/2013 00:00
ELC2012-00726
PASS - No C of O
Violation Summary:
Inspector Contractor