Permit q CITY OF TIGARD ELECTRICAL PERMIT
1111 e COMMUNITY DEVELOPMENT Permit#: ELC2015 00619
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2015
Parcel: 1 S135BD01300
Jurisdiction: Tigard
Site address: 10830 SW GREENBURG RD
Project: La Quinta Subdivision: MEADOW VIEW Lot: 8
Project Description: Sign lighting for(3)signs.
Contractor: MEYER SIGN CO OF OREGON Owner: SCHAEFER, ROBERT M&SALLY J&
15205 SW 74TH AVE MILLER, GERALD V
TIGARD, OR 97224 BY SHILO INN-WASHINGTON SQUARE
11600 SW SHILO LN
PORTLAND, OR 97225
PHONE: 503-620-8200 PHONE:
FAX: 503-620-7074
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 08/05/2015 $203.52
Specifics:
1 ea 12%State Surcharge- 08/05/2015 $24.42
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $227.94
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Cod- nd 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 iss -nce or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi - '•n nter. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtai iwcLquestions to OUNC by callin. •03.2 .198 •r 1.80
Issued By: `' 1--•- —'r__c Perm ittee Signature: ��r
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 FOR OFFICE USE ONLY
Received �
City of Tigard Permit No.: ))f�
y Date/B : I mil in C-OcfIL �. •.. 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19 EC E IV E 1�Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: ludic RI See Page 2 for
Internet: www.tigard-Or,gov Notified/Method: ' Supplemental Information
E OF WORK PLAN REVIE
i r Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction ® A�Itlitiott/altcratiul�/(��rycetpt_t
DIVISION ❑Service or feeder 400 amps or mare ❑Building over three stories.
❑Demolit ❑Other: BUILDING where the available fault current ❑Marinas and boatyards.
111711r illia 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-fami l v ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or
❑Emergency system. larger separately derived system.
ATION ❑.Addition of new motor load of ❑"A" "E" "l-2" "I-3"
Job no.: Job site address: 10830 SW Greenburg Rd. or more. occupancy.
❑Six x o or r more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name:La Quinta ❑sen;ce or feeder 6tx1 amp.of more.
FEE SCIIEDUL ...
Cross street/directions to job site: uescriptirn, I Qt,. I Fee. Total •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I 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 2
DESCRIPTION OF WORK (with above sq.ft.) - 75'00
Limited energy,multi-family
75.00 2
Connect 1 internally illuminated wall sign to existing electrical.Also retrofit residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
the pylon sign and Directional sign with LED. 200 amps or less 100.70 2
: ® PROPERTY OWNER Iii, ® TENANT ,, 201 amps to 400 amps 133.56 2
Name:Robert M and Sally Schaefer and Gerald Miller 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 11600 SW Shilo Ln. Over 1.000 amps or volts 552.26 2
City/State/ZIP:Portland,OR 97225 Temporary services or feeders installation,alteration,and/or
Y relocation
Phone:( ) I Fax:( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not
intended for sale,lease,rent,or exchange,according to ORS 447.449,670,and 701. 401 amps to 599 amps 168.54
Branch circuits—new,alteration,or ex_tension,per panel
Owner signature: Date:_ A.Fee for branch circuits with
ir ® APPLICANT :i11.1161. ® CONTACT PERSOI, above service or feeder fee,
7.42
each branch circuit
Business name:Meyer Sign Co B.Fee for branch circuits without
service or feeder fee.first 56.18 2
Contact name:Tony McCormick branch circuit
Each add]branch circuit 7.42 2
Address:15205 SW 74th Ave Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP:Tigard,OR 97224 67.84 2
dwelling,service and/or feeder
Phone:(503)620-8200 I Fax: :(503)620-7074 Reconnect only . 67.84 . 2
Pump or irrigation circle 67.84 2
E-mail:permits @meyersignco.com
Sign or outline lighting 3 67.84 ?v3.50L 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:Meyer Sign Co panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 15205 SW 74th Additional inspection(1 hr min) 66.25/hr _
City/State/ZIP:Tigard,OR 97224 Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:(503)620-8200 I Fax:(503)620-7074 Inspections for which no fee is yn.no/hr
specifically listed(V2 hr nun)
CCB Lie.: 64014 I Electrical Lie.: 20-19OCL I Suprv.Lic.: 569 SIG RIC'XL PERMIT FEES_ , '
Suprv.Electrician signature.ra ed: Subtotal: I s—)-
t Plan review(25%of permit fee):
Print name: Todd Barcla 4r i • / Date: 8/5/15 State surcharge(12%of permit feel: (N.ko...,
M ip TOTAL PERMIT FEE: ' .?•ci'i
Authorized signature: i`'� C• This permit application expires if a permit is not obtained within 180
Print name: Tony McCormick Date: 8/5/15 days after it has been accepted as complete.
Y * Number of inspections allowed per permit. ,y 1 Gt
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