Permit CITY OF TIGARD ELECTRICAL PERMIT
I IN
11 COMMUNITY DEVELOPMENT Permit #: ELC2013 -00223
Tigard OR 97223 503.718.2439
1 3125 SW Hall Blvd., Ti Date Issued: 04/16/2013
71�;AFt 9
Parcel: 1 S133AD16200
Jurisdiction: Tigard
Site address: 12700 SW NORTH DAKOTA ST 100
Project: Sesame Donuts Subdivision: 1995 -073 PARTITION PLAT Lot: 3
Project Description: Sign lighting for (2) wall signs
Contractor: SIGNCRAFT ELECTRICAL ADVERTISING LLC Owner: PACIFIC CREST PARTNERS SCHOLLS L
8900 SW BURNHAM, E109 7000 SW HAMPTON ST, STE 130
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 639 -4910 PHONE:
FAX: 503 - 639 -4999
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 04 /16/2013 $135.68
Specifics: 1 ea 12% State Surcharge - 04/16/2013 $16.28
Electrical
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 dance w : •proved 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. AT NTION: Oregon la re. - - s y• to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 010 thro gh OAR 952 - 0.090. Y. • . obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
■ 1
Issue y: iltfi. t_1 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' 1�, / `L� 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 Applicati ECEJ f ED FOIE 01. F. l SE: OS l.1
lI �l �,,J Received 1
City of Tigard Date/13y: '} 6 Permit No. e �p 3 -4:
. . " 13125 SW Hall Blvd., Tigard, OR 972A P R 16 2013 Plan Review Permit: P p G 7
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other ao / 3 - 7
I I t , I` I , Inspection Line: 503.639.4175 C�-�y OF TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov j (�� ��(� DIVISION D Notified/Method: Supplemental Information
TYPE OF J I G DIVISION PLAN REVIEW
[st New construction El Addition/alteration/replacement Please check all that apply (submit sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories. n (�
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. ^ t�J
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. y
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural L
❑ 1- and 2- family dwelling (Commercial /industrial ❑ Accessory building amps for all other installations. buildings. Q,
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or l(1
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A " "E " "1 -2 " "1 -3 " wt
1 ( 100HP or more. occupancy. V
Job no.: Job site address: �� 00 5, no ( T V� �A C J ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: — I — %C ` fl a �i ❑Health care facilities. 0 Supply voltage for more than
� f p � ❑ Hazardous locations 600 volts nominal A
Suite/bldg. /apt. no.: Project name:S 3 y Chi non 46 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I • w
New residential single- or multi - family dwelling unit.
Includes attached garage. ;
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4 " L
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 7500 2
'o k. U f a / , n e,A2 <19 n S - /o 11:3e).<71/45?. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
t G A C C - r y∎ A 200 amps or less 100.70 2
❑ P'kOPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
\J �+ 401 amps to 600 amps 200.34 2
Name: �ta C t, c: L l C P.61 Park n� SLi. n i k 601 amps to 1,000 amps 301.04 2
Address: '70O S , id /SA O , I > S-r�, / 30 Over 1,000 amps or volts _ 552.26 2
✓ n Temporary services or feeders installation, alteration, and /or
City/State /ZIP: ji I ei t � 01,70113 relocation e i,
Phone: (5 /J) 11 04 „ 3 r ` I 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
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
n each branch circuit
Business name: S(. , SA/41 £ /J 0 r) s B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: /4 4 h 4 ie branch circuit
fir/ Each add'l branch circuit 7.42 2
Address: / - 8 .49 / 4.'4 i `ot -0.4 Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State /ZIP: �J "'�� q a / � , Q it 9 7 09 dwelling, service and/or feeder 67.84 2
(503? Reconnect only 67.84 2
Phone:416, O � e / Fax:: ( )
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting A 67.84 . 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: / n a-� A-/ef r.i / H c4� I L> panel additional inspection over allowable in any of the above alteration, or extension. Paget 2
C+ 1 Each
Address: '. n\, h � �� ! o Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP:' 'i - L� _ 0 (? 7 3 Investigation pn ( I mm) 66.25/ hr
(;,� Industrial plant (1 hr min) 78.18/ hr
Phone: (^'(J 3) G 3 21 Ci' b I Fax: Aso 3 i3.,10 -- t)'s1 6 Inspections for which no fee is 90.00 / hr
specifically listed ('/z hr min)
CCB Lic.:/: y a oI Electrical Lic.:3� -1, 7 I Su rv. Lic.: 4, s) (, ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required. . � - ■ Subtotal: / s 5'e ' V
Plan review (25% of permit fee): —
Print name: �-�I �l a ( , 5 - Date: L( , I (.o .. 63 State surcharge (12% of permit fee): /(p • �. g
TOTAL PERMIT FEE: l (. �f �p
Authorized signature: - � a
r % . / This permit application expires if a permit is not obtained within 180
Print name: ��� S�(y it Date: _ ` �^ I� Number of days inspections after it has been accepted as complete.
" + V • allowed per permit.
1: \Building\Pemmits\ELC- PermitApp.doc 07/01/10 440.4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
E l Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits'ELC- PermitApp doc 07/01/10
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
12700 SW NORTH DAKOTA ST 100, TIGARD,
OR, 97223
Commercial - Electrical
140 Sign installation
05/10/2013 00:00
ELC2013-00223
PASS
Violation Summary:
Inspector Contractor