Permit CITY OF TIGARD ELECTRICAL PERMIT
'�'! COMMUNITY DEVELOPMENT Permit#: ELC2015 00714
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/02/2015
Parcel: 1 S133AD16200
Jurisdiction: Tigard
Site address: 12700 SW NORTH DAKOTA ST 180
Project: Straight Up Chiropratic Subdivision: 1995-073 PARTITION PLAT Lot: 3
Project Description: Create(1)new treatment room. Change of use from restaurant to chiropractic clinic. Fully ADA compliant.
Contractor: MEYER SIGN CO OF OREGON Owner: PACIFIC CREST PARTNERS SCHOLLS L
15205 SW 74TH AVE 7000 SW HAMPTON ST,STE 130
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503-620-8200 PHONE:
FAX: 503-620-7074
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 09/02/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 09/02/2015 $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 is -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 . ion C, nter. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You a co of the rules or direct questions to OUNC by callin. 03.. 2 987 or 1. 0.332.2344.
Issued By: Permittee Signature: /% v X
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
City of Tigard Received Permit S:
13125 S Hall Blvd.,Tigard.OR 97223
Dale/BY:' q/�/L S air- s'QU�1"1
III g Plan Review
Phone: 503.718.2439 Fax: 503.598. Date/By: Related Permit#: eCA/_
Inspection Line: 503.639.4175 CJ E.I V E D Ready Date/By: has: el See 1� 5^ 4
e Page 2 for
l I` Internet: www.tigard-or.gov Notified/Method: -rrG Supplemental Information
TYPE OF WORK5 Lill PLAN REVIEW
❑ New construction ®Addition/alterat' I•cement,-, Please check all that apply(submit j sets of plans w/items checked):
(ARD ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: , s • k where the available fault current ❑Marinas and boatyards.
TEGORY OF CI• exceeds 10.000 amps at t50 volts or ❑Floating buildings.
❑ I-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
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
❑Addition of new motor load of system.
Job#: I Job site address:12700 SW North Dakota St. 100HP or more. ❑"A",,.E". '1-2 "1-3".
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:Straight up Chiropractic ❑Hazardous locations. ❑Supply voltage for more than
l ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directiotis to job site: FEE SCHEDULE
Description I Qts. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75'00
Connect 1 set of internally illuminated channel letters to existing electrical. Limited energy,multi-family
residential(with above sq.ft.) 75.00
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:Pacific Crest Partners Scholls 200 amps or less 100.70 2
Address:7000 SW Hampton St.#130 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2
Phone:( ) i Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that i own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 1 25.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Ili_ 0 APPLICANT " I ' ® CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Meyer Sign Co.of Oregon above service or feeder fee.
7.42 2
each branch circuit
Contact name:Tony McCormick B.Fee for branch circuits without
service or feeder fee,first
Address: 15205 SW 74th Ave. branch circuit 56.18 2
City/State/ZIP:Tigard,OR 97224 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)620-8200 I Fax: :(503)620-7074 Each manufactured or modular
67.84 2
dwelling,service and/or feeder )
Email:permits @meyersignco.com Reconnect only 67.84 2
,, CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Meyer Sign Co.of Oregon Sign or outline lighting I 67.84 2_
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: 15205 SW 74th Ave. panel,alteration,or extension.
City/State/ZIP:Tigard,OR 97224 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)620-8200 I Fax:(503)620-7074 Investigation(I hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:permits@meyersignco.com Inspections for which no fee is
CCB Lie.: 64014 Electrical Lic.: 20-190CL Suprv.Lic.: 569 SIG
airily listed(lh hr mint 90.00/hr,
�� A / ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ,,,;
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
12700 SW NORTH DAKOTA ST 180, TIGARD,
OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00714
Jeff Grove
Violation Summary:
Inspector Contractor
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
14285 SW 114TH AVE, TIGARD, OR, 97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2012-00714
Jeff Grove
Violation Summary:
Inspector Contractor