Permit y CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELC2014-00247
T t G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/14/2014
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15660 SW PACIFIC HWY A-3
Project: Taekwondo Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Sign lighting for(1)sign.
Contractor: ELECTRIC AVENUE SIGN&LIGHTING Owner: TRC MM LLC
16005 NE 12TH ST 5973 AVENIDA ENCINAS STE 300
VANCOUVER,WA 98684 CARLSBAD, CA 92008
PHONE: 360-903-5447 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/14/2014 $67.84
Specifics:
1 ea 12%State Surcharge- 05/14/2014 $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 sus ,• -• •r mor- - 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Thos- • - are set forth ii OAR
952-001-0010 through OAR 952-001-0090. You may obtain a cop direct questions to OUNC by calling 503.232.198 or 80•
Issued By: - - Permittee Signature: ��.%%�A
C F 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 A t •lication I l/1,t (I I I I t I I 'I t 1.I 1
""""4"" 'pp77tnt-��eit • 1 s icat1p n— Ity o Tigard Received
n ..13125 t l Blvd.,Tigard, �� DateBy: syPt f k C 77 Permit No.: E Lc O Ill^UO ail
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.598 �� DaLe/B : Other Permit:* — `i
• .!iiL
Inspection Line: 503.639.4175 t)%4 Date Ready/By: larir 0 See Page 2 for
Internet: www.tigard-or.gov ���1, � Notified/Method: ('>s. Supplemental Information
TYPE OF WORI P ,11/41 PLAN REVIEW
❑New construction ❑Addition/alteration/repl:•; ii t Please check all that apply(submit 2 sets of plans w/items checked below):
O ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition rig Other: DE k..) '''')•i; where the available fault current ❑Marinas and boatyards,
CATEGORY OF CONSTR '�"k 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 pi Commercial/industri: ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE IIVFORMAT ION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A" "E `1-2°,"1-3
Job no.: Job site address: 15+ I00HP or more.
occupancy.
1 .a(� �Ud 1.(t..'�'�Cr ❑Six or more residential units. ❑Recreational vehicle parks.
City/StSte/Z1P: �''� � R ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 14.-. Project name:"'r'A Ei<vd.goilo ❑Service or feeder 600 amps or more.
Cross street/directions to job site: p FEE SCHEDULE
J writ C, 4 �, W/ ti' 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
Tax map/parcel no.: Ea.add'I 500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
e I tr./0 .f ook..-v P residential(with above sq.ft.) 75.00 2
t • Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER 1 ❑ TENANT 200 amps or less 100.70 2
/� `_- 201 amps to 400 amps 133.56 2
Name: To m t t L 1 a-5 401 amps to 600 amps 200.34 2
Address: 5973 /per/b A 41 300 601 amps to 1,000 amps 301.04 2
^ Over 1,000 amps or volts 552.26 2
City/State/ZIP 440 �� 92oc p Temporary services or feeders installation,alteration,and/or
Phone: ) owe"— 17900 Fax:( ) relocation
200 amps or less 59.36 1
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
p3 APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name: 23a Y41 )f i'o4/-CC. each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name: /J'E /4/ihAA., service or feeder fee,first 56.18 2
branch circuit
Address: 'A r9'9 .5f H // A ti�../ �
Each add'1 branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
tl ,,„ „,, ..•/e•'J7 ) `- OO5 Each manufactured or modular
dwelling service and/or feeder 67.84 2
6-72.4.
Phone:( �) � Fax::( )
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting I 67.84 G 7_� J 2
Business name: EC rme �y� Signal circuit(s)or limited-energy See
�� ./1.� panel,alteration,or extension. Page 2 2
Address: 147065 bt. `2'l'( _j Each additional inspection over allowable in any of the above
City/State/ZIP: t Additional inspection(I hr min) 66.25/hr
VAN �� f IA/Fax/4f( �S �Ui7� Investigation(1 hr min) 66.25/hr
Phone:( ) C�05__544 ) Industrial plant(1 hr min) 78.18/hr
4 Inspections for which no fee is
90.00/hr
CCB Lie.: l ev,mitto Electrical Lic.: Gj iv' ..c ( Suprv.Lic.:c49-2.b specifically listed(Y.hr min)
�/' i t ELECTRICAL PERMIT FEES
Suprv.Electriciarrst$$�r►►atu e,required: 1 �i ,NvI� I Subtotal: G7•$'y
Print name:/n/C// / c,4.6-jji�� Date: y ''� Plan review(25%of permit fee): --
State surcharge(12%of permit fee): it f ii
Authorized signature: I\ii y J TOTAL PERMIT FEE: •�fj ��
Print name:1 4' �l j Date:s /s- /y This permit application expires if a permit is not obained within 180
days after it has been accepted as complete.
L
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I oty. I Fee I Total 1 •
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
OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning
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
ElOther: 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(%z 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
El HVAC
❑ Instrumentation
[l Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15660 SW PACIFIC HWY A-3, TIGARD, OR,
97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00247
Jeff Grove
Violation Summary:
Inspector Contractor