Permit ;4- r,;-.
CITY OF TIGARD ELECTRICAL PERMIT
IN t _'n
r' �. COMMUNITY DEVELOPMENT Permit#: ELC2015-00849
TIGA D, 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/02/2015
a - Parcel: 2S113AB00500
Jurisdiction: TIGARD
Site address: 16083 SW UPPER BOONES FERRY RD 320
Project: Bridgeport Family Medicine Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: (1)sign lighting
Contractor: TUBE ART SIGNS&SPORTS DISPLAYS Owner: G&S FC LLC
4243-A SE INTERNATIONAL WAY 16083 SW UPPER BOONES FERRY RD,
MILWAUKIE, OR 97222 STE
TIGARD, OR 97224
PHONE: 503-653-1133 PHONE:
FAX: 503-659-9191
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 11/02/2015 $67.84
Specifics:
1 ea 12%State Surcharge- 11/02/2015 $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 issuance, or if work is suspended for more the 180
days. ATTE N: Oreg•' law r-.uires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-0 0 through OAR 952 P:1-009•. •• may obtain a copy of the rules or direct questions to OUNC by calling 5 32.1987 or 1.800.332.2344.
I /, ' / ' Q' Tiszti,_
Issued y: �� �4
— ......... i Perm ittee Signature:k
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 AppllixIV F FOR OFFICE USE ONLY
City of Tigard Received Permit No,:£'(„C. Qop q7
m 13125 SW Hall Blvd.,Tigard,6)07213 9 2015
Date/By: /019 /S
g Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit::,p o fs D 9 G I
I`I GA R D Inspection Line: 503.639.4 7 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.go �/1' �� ���� � Notified/Method: Supplemental Information
T' 1 liPIAVOR ��I�51°1% Authorized signature:
lE1 New construction ❑Addition/alteration/replacement Print name: Deborah Tolke 1
❑Demolition ❑ Other:
CATEGORY OF CONSTRUCTION PLAN REVIEW
❑ 1-and 2-family dwelling ® Commercial/industrial ❑Accessory building 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.
❑Multi-family ❑ Master builder ❑Other: where the available fault current ❑Marinas and boatyards.
JOB SITE INFORMATION AND LOCATION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
Job no.: 126919/1 Job site address:16083 SW Upper Boones Ferry Rd. amps for all other installations. buildings.
❑Fire pump. ❑Installation of 150 KVA or
City/State/ZIP: Tigard,OR 97224 ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Suite/bldg./apt.no.: 320 Project name: Bridgeport Family Medicine 100HPormore. occupancy.
Cross street/directions to job site: SW 72nd ❑Six or more residential units. ❑Recreational vehicle parks.
❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
❑Service or feeder 600 amps or more.
Subdivision: Lot no.: FEE SCHEDULE
Description I Qty. I Fee. I Total I *
Tax map/parcel no.: 2S113AB00500 New residential single-or multi-family dwelling unit.
DESCRIPTION OF WORK Includes attached garage.
1,000 sq.ft.or less 168.54 4
install one(1) illuminated wall sign to existing circuit Ea.add'I500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
(with above sq.ft.)
❑ PROPERTY OWNER ❑ TENANT Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Name: Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Address: 200 amps or less 100.70 2
City/State/ZIP: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Phone: Fax:( )
601 amps to 1,000 amps 301.04 2
Owner installation: This installation is being made on property that I own which is not Over 1,000 amps or volts 552.26 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. Temporary services or feeders installation,alteration,and/or
Owner signature: Date: relocation
® APPLICANT ❑ CONTACT PERSON 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Business name: Tube Art Group 401 amps to 599 amps 168.54 2
Contact name: Deborah Tolke Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Address: 4243-A SE International Way above service or feeder fee,
7.42 2
each branch circuit
City/State/ZIP: Milwaukie,OR 97222 B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Phone: 503-653-1133 Fax: : 503-659-9191 branch circuit
Each add'l branch circuit 7.42 2
E-mail: dtolke @tubeart.com Miscellaneous(service or feeder not included)
CONTRACTOR Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Business name: Tube Art Group Reconnect only 67.84 2
Address: 4243-A SE International Way Pump or irrigation circle 67.84 2
City/State/ZIP: Milwaukie,OR 97222 Sign or outline lighting 1 67.84 6'7_ ( 2
Signal circuit(s)or limited-energy See
Phone: 503-653-1133 Fax: 503-659-9191 panel,alteration,or extension Page 2 2
Each additional inspection over allowable in any of the above
CCB Lic.: 70956 Electrical Lic.: 37554 CLS Suprv.Lic.: 366 SIG Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Suprv.Electrician signature,required / Industrial plant(1 hr min) 78.18/hr
Print name: Kerl Schultz Date: !��/�/5 Inspections for which no fee is 90.00/hr
[[[ specifically listed(1/4 hr min)
ELECTRICAL PERMIT FEES
I\Building\Permits\ELC_PermitApp_ELR_ERE doc Rev 05/21/2013 440-4615T(11/05/COM/WEB ±47(
—x -.-'S
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
16083 SW UPPER BOONES FERRY RD 320,
TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00849
Jeff Grove
Violation Summary:
Inspector Contractor