Permit CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit#: ELC2015-00883
r F t -
Date Issued: 11/02/2015
13125 SW Hall Blvd Tigard OR 97223 503 718 2439
71GttRI? Parcel: 2S102AA04100
Jurisdiction. Tigard
Site address. 12230 SW MAIN ST 120
Project: Paddle Palace Subdivision: TIGARD HIGHWAY TRACTS Lot: 2
Project Description: Sign lighting for(3)walls signs
Contractor: RUDNICK ELECTRIC SIGNS LLC Owner HOBO PROPERTIES LLC
1625 WASHINGTON ST PO BOX 8087
OREGON CITY, OR 97045 PORTLAND, OR 97280
PHONE 503-655-2610 PHONE
FAX 503-980-7919
FEES
Quantity Description Date Amount
3 ea Sign or Outline Lighting 11/02/2015 $203 52
Specifics:
1 ea 12%State Surchafge- 11/02/2015 $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 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 OAR 952-001-0090 You may obtain a •py of the ru- direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By t — •er ittee Signature:
do
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.
I 56NJ o 15 -DO Q b
Electrical Permit Application , —1-- : -FOROFFICE USE ONLY --- -
Ci}�' of Tigard Received /
`J g 1� Date/B / j'— Permit No t f;
:11/-f-: - ° 13125 SW Hall Blvd,Tigard,OR � Plan Review
Other Permit
Phone: 503 639 4171 Fax 503 Date/13 A a .!
TPGARD inspection Line 503 639.4175 \' �01�J Date Ready/By MI ® See Page 2 for
Internet. www tigard-Or gov NO V Notified/Method Supplemental Information
-- ' TYPE OF WO\V ��
'IMO) PLAN REVIEW
QsJV ew construction ❑Addition/alte>b����� RC Please check all that apply(submit 2 sets of plans w/nems checked below)
/ ` ❑Service or feeder 400 amps or more ❑Building over three stories
❑ Demolition ❑ Other: 6 where the available fault current ❑Mannas 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 Commercial/industrial ❑Accessory building amps for all other installations buildings
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump ❑Installation of 75 KVA or
❑Emergency system larger separately derived system
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E","1-2",`I-3",
P� /, 00_,A%\._0 Six or or more R c reatioy
Job no.: Job site address: ►Ot) �f�� '1
❑Six or more residential units occupancy vehicle packs
City/Stale/ZIP: /�.� �y 2 ❑Health-care facilities ❑Supply voltage for more than
. B C lJ� r 1 a J ❑Hazardous locations 600 volts nominal
Suite/bldg./apt. no.: Project name: Rkb10 1 Liktt ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I QD'. I Fee. l Total I *
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')500 sq ft or portion 33 92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq ft) 75 00 2
6 40-\\ LE't A\ e Limited energy,multi-family
sq 75 00 2
residential(with above sq fi)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100 70 2
❑ PROPERTY O `� XTENANT 201 amps to 400 amps 133 56 2
4 � � ,_ 601 amps to 600 amps 301 34 2
Name: k,c� q � 601 amps to 1,000 amps 301 04 2
Over 1,000 amps or volts 552 26 2
Address: 1 r2 � �� P
���� l ��dVe} Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:(503) .711 , 2�/_ i I Fax:( ) 200 amps or less 59 36 1
`0 201 amps to 400 amps 125 08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168 54 2
intended for sale, lease, rent,or exchange,according to ORS 447,449,670,and 701.
Branch circuits-new,alteration,or extension,per panel
Owner sianat*......_ Date: A Fee for branch circuits with
above PERSON above service or feeder fee. 7 42 2
each branch circuit
Business name , ^� &' S B Fee for branch circuits without
�i A t�!I l C Q`C\ � service or feeder fee,first
Contact name: �OYA branch circuit 56 18 2
�1 Each add'I branch circuit 7 42 2
Address: W.0 t, „(\ Miscellaneous(service or feeder not included)
i ,�^ /t ���� Each manufactured service and/or d/ r modular
City/State/ZIP: �` Cpl`[, dwelling,service and/or feeder 67 84 2
Phone: (z;(5 ) (tp;`_ g �►,l I ax: :(513 ) � j-- ��t Reconnect only 67 84 2
1 Pump or irrigation circle 67 84 2
E-mail: ,`,
Skc'l.�e �ta�nx r�e ��tQ C4.-A cr.S n CV:Ytt\ Sign or outline lighting .1 67 84 c9 6S6-7_ 2
/} CONTRACTOR Signal circuit(s)or limited-energy
Business name: r ") s C' e. \ ' S� panel,alteration,or extension Page 2 2
c / �A g `w' `�-� Each additional inspection over allowable in any of the above
Address: 1�4 txc- ( L.n 47�cj(\ Additional inspection(1 hr mm) 66 25/hr
l t�"U. / ^ � 0r� Investigation(I hr mm) 66 25/hr
City/State/ZIP: U\j� Il
Q Industrial plant(I hr min) 78 18/hr S
Phone: ) Loc-c I.AT: , a •(SZ-j) --34 h Inspections for which no fee is 90 00/hr
specifically listed('A hr min)
CCB Lie.: \C . U Electrical Lic.: C,LS4 l Suprv. Lic.: SI el ELECTRICAL,PERMIT FEES
Suprv. Electrician signature,required: . Subtotal Q(7?� Sa
\ j _1 Plan review(25%of permit fee):
Print name: 'j , \ ,� Date: State surcharge(12%of permit fee)
%AA TOTAL PERMIT FEE 9a-4 scyi
Authorized signature:
This permit application expires if a permit is not obtained within 180
` days after it has been accepted as complete.
Print name: �„�p P . ( \���rrr UUU Date: * Number of inspections allowed per peimit
\Permits\
I ABuilding ELC-PermiiApp doc 07/01/10 440-4615T(I I/05/COMM'EB
l
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
I-1 Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1\Buddmg\Permits\ELC-PermfApp doc 07/01/10
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
12230 SW MAIN ST 120, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00883
Jeff Grove
Violation Summary:
Inspector Contractor