Permit 4
CITY OF TIGARD ELECTRICAL PERMIT
a . COMMUNITY DEVELOPMENT Permit #: ELC2013 -00088
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/13/2013
Parcel: 2S110DC00500
Jurisdiction: TIGARD
Site address: 11455 SW SUMMERFIELD DR
Project: Kona Kids - Schwindt Dental Subdivision: WILLOW- BROOK -FARM Lot: 17
Project Description: Sign lighting for (5) signs, (1) freestanding and (4) wall signs.
Contractor: E S & A SIGN & AWNING Owner: CDBK PROPERTIES LLC
89975 PRAIRIE RD 11565 SW DURHAM RD BLDG F 100
EUGENE, OR 97402 TIGARD, OR 97224
PHONE: 541 -485 -5546 PHONE:
FAX: 541 - 485 -5813 •
FEES
Quantity Description Date Amount
5 ea Sign or Outline Lighting 02/13/2013 $339.20 •
Specifics:
1 ea 12% State Surcharge - 02/13/2013 $40.70
Electrical
Type of Use: COM
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $379.90
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 9 001 -0 90. You m obbtainn a of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: ( 4 Permittee Signature: //�1 Pfoo C 1 I 1�L
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
. ° r City of Tigard C i R eceived /! �p
EVED D ateB CO Permit No.: � LC � oi3 � �db0 II 13125 SW Hall Blvd., Tigard, OR 9 Pl an Rev
Phone: 503.718.2439 Fax: 503.59 . I Date/B : Other Permit:
TI GARD Ins Line: 503.639 FEB 4 2013 Date Ready /By: lur 1 , /' 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: t Supplemental Information
TYPE OF WWI OFTIGARD PLAN REVIEW
['New construction ❑ Addition/altailiiirnagOVISION 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 W
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. O
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. O
❑ Addition of new motor load of ❑ "A "E ", "I -2 ", "I -3 ",
Job no.: 14595 Job site address: 1 r45 5 5 ivtf S,,t,na1 Jt e Id_ I r. IOO or more residential Recreational ` V
❑ Six or more residential units. ❑Rr vehicle parks.
City /State /ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than \
❑ Hazardous locations. 600 volts nominal. •
Suite /bldg. /apt. no.: Project name: Kona Kids / /- /) J JQ 0 Service or feeder 600 amps or more. .iNi.
FEE SCHEDULE ■ZNp
Cross street/directions to job site: Corner SW Durham Rd. /SW Summerfield Dr. Description I Qty. I Fee. I Total 1 • ` -
New residential single- or multi - family dwelling unit. 'mil
Includes attached garage. I N
Subdivision: Lot no.:
1,000 sq. ft. or less 168.54 4 k
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
q � - Limited energy, multi - family
J45t (/) Lk m Zi%s S residential (with above sq. ft 75.00
.) \
� i / u.� Services or feeders installation, alteration, and /or relocation
�� J"
�5f (`Y /' / la�� - �z S S 200 amps or less 100.70 2
„PROPERTY OWNER cgl TENANT 201 amps to 400 amps 133.56 2
/� T / l A L 401 amps to 600 amps 200.34 2
Name: �. J
601 amps to 1,000 amps 301.04 2
Address: / / 54,c J /,L 7J 17o,7, o_-C� igki cske i Over 1,000 amps or volts 552.26 2
City /State /ZIP: jj �� GJ Temporary services or feeders installation, alteration, and /or
i 62 % 7 Z ! relocation
/� 3) 3 3 z , v ctSD ( 6/ 6/7.-_, 300 7_ 200 amps or less 59.36 1
Phone: !!// !/7J(J Fax: X
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
a APPLICANT CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: e 3 A /`<T ...Y7zv ea - B. Fee for branch circuits without
service or feeder fee, first
Contact name: 9e0.e%. n ,5 r -) branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: aq° ' 76 fit koL Miscellaneous (service or feeder not included)
City /State /ZIP: L rv i f� 2 � dwelling, service and/or feeder / /14 Each manufactured modular 67.84 2
r 7 v /) /
Phone: 6,.../4 ) 40 - 5 3-"'7"V X 33 Fax :: (54/ ) ik j S- 5e �3 Reconnect only 67.84 2
/' oh �/SO[) Pump or irrigation circle 67.84 2
E - mail: k. esa_s, 5 , r
J � �� y x Sign or outline lighting 5 67.84 339 • ZO 2
CONTRACTOR" Signal circuit(s) or limited- energy
Business name: E S & A Sign and Awning, Co. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 89975 Prairie Road Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City /State /ZIP: Eugene, OR 97402
Industrial plant (I hr min) 78.18 / hr
Phone: (541) 485 -5546 Fax: (541) 485 - 5813 Inspections for which no fee is 90.00/ hr
specifically listed (%Z hr min)
CCB Lic.: 163470 Electrical Lic.: 20543CLS Suprv. Lic.: 514SIG ELECTRICAL PERMIT FEES
Q : -33 2.° a
Suprv. Electrician signature, required: ///JJJ
Plan review (25% of permit Subtotal fee):
Print name: Gordy Roseboro Date: 1/22/2013 State surcharge (12% of permit fee): /-40 D
Authorized signature ���� TOTAL PERMIT FEE: 4- - r. .
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete 4
Print name: Kelp Johnson Date: 1/22/2013 • Number of inspections allowed per permit. 379 D
.
1:\Building\Permits'ELC- PermitApp.doc 07/01/10 440- 4615T(I I /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
11455 SW SUMMERFIELD DR, TIGARD, OR,
97224
Commercial - Electrical
199 Electrical final
04/15/2013 00:00
ELC2013-00088
PASS - No C of O
Violation Summary:
Inspector Contractor