Permit rr CITY OF TIGARD ELECTRICAL PERMIT
''� I • COMMUNITY DEVELOPMENT Permit#: ELC2015-00752
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/17/2015
Parcel: 2S 112AD01100
Jurisdiction: Tigard
Site address: 6650 SW BONITA RD
Project: Sleep Train Subdivision: 2000-020 PARTITION PLAT Lot: 1
Project Description: (2)sign lighting
Contractor: RAMSAY SIGNS INC Owner: PACA PROPERTIES LLC
9160 SE 74TH AVE 6600 SW BONITA RD
PORTLAND, OR 97206 TIGARD, OR 97224
PHONE: 503-777-4555 PHONE:
FAX: 503-777-0220
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 09/17/2015 $135.68
Specifics:
1 ea 12%State Surcharge- 09/17/2015 $16.28
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $151.96
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 OA -r01-r r90. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
.41 Issued By: Permittee Signature:
4/fIr \-e--g-s. 'VL)Q-Q-9-Cb_-
i
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.
RECEIV i
Electrical Permit Application FOR OFFICE USE ONLY
Received /1 /7A.....{
City of Tigard SEP 17 2015 / Per"'`t k OD 7 Z.
11111 Date/By: c(�c..�/�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
1 Phone: 503.718.2439 Fax: 503.598.1960 r Related Permitjj/�/��/� /0/�
CITY O j jG` By:
I �R L) Inspection Line: 503.639.4175 .eady Date'By: ruris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DMJJ I ,ified Method: 776-- Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
n ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition 64 Other: / ' where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUiT'ION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 ❑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#: Job site address:66 .t+ 3 arlj TO 100HP or more. ❑"A","E","1-2".`i-3",
�',/� ❑Six or more residential units. occupancy.
City/State/ZIP:/State/ZIP: p2.4 ❑Health-care facilities. El Recreational vehicle parks.
Suite/bldg./apt.#: —1 Project name:,"`�--/'�/f��J -772A7 in ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. volts nominal.
Cross street/directions to job site: j�!/7)4 deo/ Z-S FEE SCHEDULE
Description I Qty. ) Each 1 Total I
New residential single-.or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 1 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
* t (with above sq.ft.) 75.00 2
, C
/\ . ( CEO! ` Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
WAROPERI OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: /Tt Yf fop 0 200 amps or less 100.70 2
Address: LC Qp s� -,i1-)q 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 77g94.4.0 ago 601 amps to 1,000 amps 301.04 2
Phone:( ) 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 ' 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT 1 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension, .er panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without '
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:BEM c(c' l S bl L Sign or outline lighting 2,, 67.84 (36t lie 2
Address: `�� �/ Signal circuit(s)or limited-energy ❑ See Page 2 2
CJ J G ' I A /'TV E panel,alteration,or extension.
d (f - ,
Each additional inspection over allowable in any of the above
City/State/ZIP: ar-/104.1
Additional inspection(1 hr min) 66.25/hr
Phone:t)j) 7 s-75-65" Fax:( ) Investigation(l hr min) 90.00/hr
Email: yc ` t i ain 5, �� Industrial plant(1 hr min) 78.18/hr
7 Inspections for which no fee is 90.00/hr
CCB Lic.:6, .2 El 'dal Lic.I.63 S/ Suprv.Lic 74)4, G'LS'specifically listed('%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electric' signature,required: Subtotal: X35, L C
Print name: /'j//J 1e Date:V/L//5 ■ ' ., : '
State surcharge(12%of permit fee): /G,Z r
TOTAL PERMIT FEE:
Authorized signature: /195, Cif
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit. /57/
1:,Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB