Permit CITY OF TIGARD ELECTRICAL PERMIT
11 COMMUNITY DEVELOPMENT Permit#: ELC2013-00501
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2013
Parcel: 2S 102AC00700
Jurisdiction: Tigard
Site address: 12540 SW MAIN ST 120
Project: Fishfield Subdivision: BURNHAM TRACT Lot: 1
Project Description: Sign lighting for(1)wall sign.
Contractor: D&B SPECIALTIES LLC Owner: DOLAN&CO LLC
4475 SE POWELL VALLEY RD BY FLORENCE T DOLAN
GRESHAM,OR 97080 4523 NE DAVIS ST
PORTLAND, OR 97213
PHONE: 503-320-3888 PHONE:
FAX: 503-912-1363
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 08/28/2013 $67.84
Specifics:,
1 ea 12%State Surcharge- 08/28/2013 $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 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 ruls adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a co•y of th lit1irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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 -0). FOR OFFICE USE ONLY
City of Tigard O' Received permit No.: r��
v 1 �•.,. r, DateB : :'I J� LC�C�;— C1 _
13125 SW Hall Blvd.,Tigard,0' 3 q� Plan Review
C , M Other Permit:
Phone: 503.718.2439 Fax: 503.'98.19(Q(� G���� Date/By: 6E4 p�13 -�c,at o
.1.1 c \K a Inspection Line: 503.639.4175 V'\3— �`� 1S Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Q,C10 Notified/Method: Supplemental Information
�TYPEAFWO � PLAN REVIEW
El
construction El Addition/alterati 'eplacement 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
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB'SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Sr 100HP or more. occupancy.
Job no.: Job site address: 1.z..-5-K) („W, `!IA. r
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: l tJ op.-. 1 Z 2 3 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: MO Project name: t(S 4 c EGO ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: C( ,?CL , / 's( Description I Qty. I F_ee. li Total r"
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 75.00 2
. , DESCRIPTION;OF WORK (with above sq.ft.)
v b 1 1 Limited energy,multi-family
sq. 75.00 2
f � �� N �'� residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
' ROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
' � I`c 201 amps to 400 amps 133.56 2
Name: l F'�vS CA-2/L64. l (� 401 amps to 600 amps 200.34 2
Address: t et I I 0 le�- _ , 601 amps to 1,000 amps 301.04 2
V po�u � l �� et 1261 Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( 5V,;:„4) "LZ\ .— 100'1 Fax:( ) relocation
200 amps or less 59.36 I
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
:,APPLICANT ' ,I . ❑'CONTACT PERSON A.Fee for branch circuits with
�l ,,p above service or feeder fee,
7.42 2
Business name: V (S7( JQT 9- t i G-(6 v.3,,1 Y each branch circuit
C"�r�� N& B.Fee for branch feeder fee, without
' Contact name: service or feeder fee,first ( 56.18 2
; ! branch circuit
Address: C 5 0 Z V fee/L. 0 cvo l\I d'�y Each add'I branch circuit 7.42 2
City/State/ZIP: ' p �2 Miscellaneous(service or feeder not included)
ty CIS W6.60 0 Q`-' 't -7 03\ Each manufactured or modular
Phone:(k,'U�) 69 i ` cDS,(� Fax: :( )
dwelling,service and/or feeder 67.84 2
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I Reconnect only 67.84 2
E-mail: ko& C e ,(S't V✓ - Pump or irrigation circle 67.84 2
CONTRACT Sign or outline lighting 67.84 2•
Business name: p 4 13 e eCA^c,/�lC, /C— I a Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
.
Address: / 73 s p� c.,// vc, /1 Each additional inspection over allowable in any of the above
City/State/ZIP: / �t /� a 70d'd Additional inspection(1 hr min) 66.25/hr
lam,r`Lam, Q/'I Cie [ / Investigation(1 hr min) 66.25/hr
Phone:( 03) �C) 3 D gs /
_R2 Fax:(9,2) g 1 --- 1 3 Industrial plant(1 hr min) 78.18/hr
I Inspections for which no fee is 90.00/hr
CCB Lic.:J(76,(�v O Electrical,Lic.: . Ls Suprv.Lic.:7z 5,l 61 specifically listed(%hr min)
// J/// ` ELECTRICAL,PERMIT FEES
Suprv.Electrician signature,required: , iO t `1 Subtotal:
Print name' L 1# 0 Date:3i/4, >3 Plan review(25%of permit fee):
• �t. J ` State surcharge(12%of permit fee):
Authorized signature" .1/ $' 4' TOTAL PERMIT FEE: -75-.-°I 4;"-
This permit application expires if a permit is not obtained within 180
Print name: f!.:,.:_ �� �, 4....-Bate:, MY days after it has been accepted as complete.
/ * Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK'ONLY: - • .1
'FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I "
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating,Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
❑ Each additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
_ specifically listed(V2 hr min)
COMMERCIAL WORK ONLY: , ! ELECTRICAL;PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC -
❑ Instrumentation •
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❑ Intercom and Paging Systems - -
❑ Landscape Irrigation Control* .
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❑ Medical
❑ Nurse Calls •
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling
❑ Other •
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Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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1\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013