Permit CITY OF TIGARD ELECTRICAL PERMIT
III I • COMMUNITY DEVELOPMENT Permit#: ELC2014-00622
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/06/2014
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9779 SW WASHINGTON SQUARE RD D11
Project: Champs Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: A new wall sign for Champs,approximately 57 squarefeet,located on the east facing wall.The sign is internally lit.
Contractor: RUDNICK ELECTRIC SIGNS LLC Owner: PPR WASHINGTON SQUARE LLC
1625 WASHINGTON ST PO BOX 847
OREGON CITY, OR 97045 CARLSBAD, CA 92018
PHONE: 503-655-2610 PHONE:
FAX: 503-980-7919
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 11/06/2014 $67.84
Specifics:,
1 ea 12%State Surcharge- 11/06/2014 $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 suspended for more the 180
days. ATTENTIO n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-001 rough OAR 9 -0 9 u may obtain a copy of the rules or direct questions to OUNC by calling 50 ':7 or 1.800.332.234
Issue By: Permittee Signature: x 1,
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 ikN I ll FOR OFFICE USE ONLY
Cl of Ti and Received / r�
City Tigard
Date/By: l o /tz[ f�j — F ennit No.: p! dOI/f`a (��
13125 SW Hall Blvd.,Tigard,OR 97223 Q Plan Review / a—(� Y,
1111
Phone: 503.639.4171 Fax: 503.598.1960 �01 Date/By: Other Permit: ;Lip AO 111—tx CI51-
T I G A R D Inspection Line: 503.639.4175 QC , t ►ate Ready/By: Juris: 61 See Page 2 for
IInternet: www.tigard-or.gov V.G� 4` ,tted/Method: , Supplemental Information
)
TYPE OF WORK PLAN REVIEW
..i. t �
\ Please check all that apply(submit 2 sets of plans w/items checked below):
New construction ❑Addition/alteration K4mye -nt
❑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 75 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATIQN ❑Addition of new motor load of ❑"A","E","1-2","1-3",
\ 100HP or more. occupancy.
Job no.: Job site address:
S ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: -- \ �.[� ❑Health-care facilities. ❑Supply voltage for more than
r c� (TC� (1,ZZ,� ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: �\\ I Project name: W5 _❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: + 0 t. .t Description I Qty. I Fee. I Total I •
u Ilq , New residential single-ara or multi-family dwelling unit.
v�� 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
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
1 I` Limited energy,multi-family 7500 2
ikcS _ (�� t\ ��1 �\ AcIA C `�,► ∎Rs residential(with above sq.ft.)jXl�xyl ) YA o Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Cit /State/ZIP: /� Temporary services or feeders installation,alteration,and/or
Y A...■ 1 ( \f:t " ` 20loaation
1 �Fa\\a 200 amps or less 59.36 I
Phone:( ) 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 I Vi.,CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: ■ B.Fee for branch circuits without
A�C P; oCl(k,,- service or feeder fee,first
Contact name: \ \ l _branch circuit 56.18 2
( _ nV` n�� Each add'I branch circuit 7.42 2
Address: �l.L�1,5 AT , ,-(c4v S-rt Miscellaneous(service or feeder not included)
City/State/ZIP: p°°°t������`iii Each manufactured or modular 67.84 2
tY e, � �� dwelling,service and/or feeder
Phone:(�'S) � Fax: :(�p3) ileo,- I1`C\ Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: S}��( �y Q�QC C.J Ste6(L`A.('C�V\ Sign or outline lighting ■ 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name: qit ,6 C k' S panel,alteration,or sptension. Page 2 2
ti;�e C Each additional inspection over allowable in any of the above
Address: 11 ZS r .1 J-�. l Additional inspection(1 hr min) 66.25/hr•
City/State/ZIP: /' ,�` /i\r (k q'Y I Investigation(1 hr min) 66.25/hr
l E l l V� Industrial plant(1 hr min) 78.18/hr
Phone: ) Ls-s —__. la Fax:(e.Z J) etS6."'"l a('q Inspections for which no fee is 90.00/hr
specifically listed('A hr min)
CCB Lic.:/g06-5w Electrical Lic.: 0(..„.c---7 Suprv.Lic.:7y42 S-a, ELECTRICAL PERMIT FEES
Subtotal:
Suprv.Electrician signature,required:
ta Pla n review(25%of permit fee):
Print name: SY�1/ N 6�G k I Date: 1a 1 t-x State surcharge(12%of permit fee):
1111 TOTAL PERMIT FEE:
Authorized signature: ��` This permit application expires if a permit is not obtained within 180
(fra ` days after it has been accepted as complete.
Print name: l �( Date: 1O �y * Number of inspections allowed per permit.
\ \E
I.\Building PermitsLC-PermitApp.doc 07/01/10 ww 440.46115T(1 l/055/COM/WEB
L_
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9779 SW WASHINGTON SQUARE RD D11,
TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2014-00622
Chip Barnett
Violation Summary:
Inspector Contractor