Permit (11) CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit#: ELC2015-01009
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13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/30/2015
Parcel: 1 S134BC00300
Jurisdiction: Tigard
Site address: 12282 SW SCHOLLS FERRY RD
Project: Bugerville Sign Permit Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Sign lighting for(2)wall signs.
Contractor: ADVANCED ELECTRIC SIGNS INC Owner: FW OR-GREENWAY TOWN CENTER LLC
1550 DOWN RIVER DR PO BOX 790830
WOODLAND, WA 98674 SAN ANTONIO,TX 78279
PHONE: 360-225-6826 PHONE:
FAX: 360-225-8299
FEES
Quantity Description Date Amount
Specifics: 2 ea Signor Outline Lighting 12/30/2015 $135.68
1 ea 12%State Surcharge- 12/30/2015 $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 OAR 952-001-0090. Youay obtain a copy oft tett questions to OUNC by calling 503.232.
Issued By: e.Signature.
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 OF FICE, USE'ON LY
Cl`J O Tigard Received l
f g Date/By: Icy' O I� Permit#:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19 %\s
Date/By: Related Permit#:
Inspection Line: 503.639.4175 Q® ady Date/By: Juris: EI See Page 2 for
Internet: www.ti and-or. ov C 1lvv tifed/Method:
g g C, � Supplemental Information
TYPE OF WORK t, �` v PLAN REVIEW
❑New construction ❑Addition/alteration/replace t Please check all that apply(submit 2 sets of plans w/items checked):
.�� ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ®Other:Sign where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCT exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ I-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: 12282 Scholls Ferry Rd 100HP or more. ❑"A","E","l-2-,"I-3'-,
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Burgerville ❑Hazardous locations. ❑Supply voltage for more than
El Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to,job site: FEE SCHEDULE
Description I Qty. Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
Install of(2)wall signs with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Ener [I See Page 2
El PROPERTY OWNER ® TENANT Services or feeders installation,alteration,and/or relocation
Name: Burgerville 200 amps or less 100.70 2
Address: 12282 Scholls Ferry Rd 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:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
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 ® CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Advanced Electric Sign above service or feeder fee, 7.42 2
each branch circuit
Contact name:Michael Boyd B.Fee for branch circuits iviihoat
service or feeder fee,first
Address: 1550 Down River Dr branch circuit 56.18 2
City/State/ZIP:Woodland,WA 98674 Each add']branch circuit 7.42 2
Miscellaneous service or feeder not included
Phone:(360)225-6826 Fax: :( ) Each manufactured or modular 67.84 2
Email: michael@advancedelectricsign.com dwelling,service and/or feederReconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Advanced Electric Sign Sign or outline lighting 2 67.84 135.68 2
Signal circuit(s)or limited-energy
Address: 1550 Down River Dr panel,alteration,or extension. El See Page 2 2
City/State/ZIP:Woodland,WA 98674 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(360)225-6826 Fax:( ) Investigation(I hr min) 90.00/hr
Email: michael@advancedelectricsign.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 105405 •� li I� Electrical Lic.: 37-841e15 Suprv. Lic.: 307sig specifically listed /:hrmin
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: 135.68
Print name: Steve Slack Date: 12/30/15 ❑Plan Review Required(25%of pen-nit fee):
State surcharge(12%of permit fee): 16.28
Authorized signature TOTAL PERMIT FEE: 151.96
This permit application expires if a permit is not obtained within 180
Print name: Michael Boyd Date: 12/30/15 days after it has been accepted as complete.
Number of inspections allowed per permit.
1.\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440.4615T(l1/05/COM/WEB