Permit CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit#: ELC2015-00415
• 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/28/2015
TIGARD Parcel: 1S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY X
Project: Donut Day Subdivision: 2006-016 PARTITION PLAT Lot: 3
Project Description: Sign lighting.
Contractor: SIGNCRAFT SIGNS LLC Owner: PACIFIC CROSSROADS PROPERTIES IN
8900 SW BURNHAM, E109 BY WYSE INVESTMENT SERVICES CO
TIGARD, OR 97223 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97205
PHONE: 503-639-4910
PHONE:
FAX: 503-639-4999
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/28/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 05/28/2015 $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 rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through AR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: E•. 'J
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 RECEIVE FOR OFFICE USE ONLY
Received �/ /—Lit q,,
City of Tigard
Date/By: _ / PemitNo.: e„2.0 S-0Oy/S
13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 8 2015 Plan Review ' �a:Vs 1)0069
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
11GARD t VyL f
Inspection Line: 503.639.4175 Date Ready/By Juris: 0 See Page 2 for
Internet: www.tigard-or.gov CITY MAI Notified/Method: Supplemental Information
TYPE OF WORK 7 DIN(!IVTSIO1' PLAN REVIEW
New construction ❑Addition/alteration/replacement 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 ,J2 Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMAT / D J.00ATION ❑Emergency system. larger separately derived system.
/ JC ❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: O _ 1-404--/ 1001 IP or more. occupancy.
�J(� i 4/ t ('l�- ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: T ❑Health-care facilities. ❑Supply voltage for more than
ty t S a�z Oi _ C a a3 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: X Project name: ,f 1-4-4- O q� ❑Service or feeder 600 amps or more.
/` FEE SCHEDULE
Cross street/directions to job site: 99 r 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
Ea.add'I 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.)
1 Limited energy,multi-family 75.00 2
HOC> St r �1CtSf• des i5 tic. residential(with above sq.ft.)
_ l S 5 Renewable Energy ❑ See Page 2
519\ Lt,r4_,,3(1- Services or feeders installation,alteration,and/or relocation
,E1 PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: (2,‘4..v ft. ��Dss c � Qf[5P l LL y - Zn 1/tS+uvt�+ 401 amps to 600 amps 200.34 2
Address: (SD l S W —1,,,L. (A r s - S T e ID z) 601 amps to 1,000 amps 301.04 2
` Over 1,000 amps or volts 552.26 2
City/State/ZIP: Po --t-k Q„0_ 06_ Cj)Doc Temporary services or feeders installation,alteration,and/or
Phone:( t ) 't`-1. OLiat, 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, •er panel
❑ APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: 005. 4 c. each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
���d branch circuit 56.18 2
Address: (t`7 o to ¶to NC.4%.4-4 t L N w $'� )( Each add'I branch circuit 7.42 2
1 Miscellaneous(service or feeder not included)
City/State/ZIP: Tl 5,,..,- GvL ")a 13 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:(�j ) ��.''�■(� Fax: :( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Signor outline lighting ` 67.84 /o 7_al 2
Business name: 31 n cr--�'� 5 t S �L Signal circuit(s)or limited-energy See
S' panel,alteration,or extension. _ Page 2 _ _ 2
Address: Pa sty ,)-,:c I,/�p Oleo S L-) 13 Lin�1a n. SFvD Each additional inspection over allowable in any of the above
7 Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: (S,ar ► QL c--,n a.a3 Investigation(1 hr min) 66.25/hr
Phone:(Sc' )3 1 s3.1,49 l Fax:(i J], /O/x/17 Industrial plant(1 hr min) 78.18/hr
p Z �� ` % Inspections for which no fee is 90.00/hr
CCB Lic.: (5�L�/I1 T�lectrlcal Li : 4_6(-74 Suprv.Lic.: 7;267376 specifically listed(/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: igij,8 y
Plan review(25%of permit fee):
Print name: Date: State surcharge(12/o of permit fee): g tl�
Authorized signature: O.% TOTAL PERMIT FEE: '1st9 a
)�� This permit application expires if a permit is not obtained within 180
Print name: ,i0 mtk Date: CS—
days after it has been accepted as complete.
' Number of inspections allowed per permit.
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£,Z of '/?-A 6 t—U S
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 Qtr'. 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(I hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed('/]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
❑ 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
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013