Permit p CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00085
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/04/2016
Parcel: 2S112CB00900
Jurisdiction: Tigard
Site address: 15000 SW HALL BLVD
Project: Bonaventure Sign Permit Subdivision: WILSON ACRES Lot: 8
Project Description: Sign lighting for monument sign.
Contractor: FORESS SIGN&MANUFACTURING Owner: MWSH TIGARD LLC
30255 HIGHWAY 34 3425 BOONE RD SE
ALBANY, OR 97321 SALEM, OR 97317
PHONE: 541-928-5858 PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 ea Signor Outline Lighting 02/04/2016 $67.84
1 ea 12%State Surcharge- 02/04/2016 $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. Specia Code 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 suan or if work is suspended more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifc ion nter. ose rules are et orth in OAR
952-001-0010 through OA 952-001-0090. You may obtain a copy oft ules or direct questions to OUNC by callin 3.232 987 or 1.
Issued By: Permsa Signat e:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Data:
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.
Elctrtal Permit Application
r
„ 1
City of Tigard V�yCAN
p� � Permit#:
13125 SW Hall Blvd.,Tigard,OR Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 job Date/By: Related Permit#: 16
Inspection Line: 503.639.4175rC8 Ready Date/By: luris: H See Page 2 for
Internet: www.tigard-or.gov `` > Notified/Method: y Supplemental Information
TYPE OF PLAIN REVIEW
®New construction ❑Addition/alter !� Please check all that apply(submit 2 sets of plans w/items checked):
l� ❑Service or feeder 400 amps or more ❑Building over three stories.
El Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
I-and 2-family dwellingCommercial/industrial [:1 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ®Other:Sign ❑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: 15000 SW Hall Blvd 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard'OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Bonaventure Senior Housin ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW Ross St./SW Sattler St. FEE SCHEDULE
Description t.. I 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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
with above s .ft.) 75.00 2
Installation of double sided illuminated sign Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Ener ❑ See Page 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:Brad Dineen 200 amps or less 100.70 2
Address:8325 SW Ross St. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97224 601 amps to 1,000 amps 301.04 2
Phone:(503)566-5715 Fax:(503)480-3131 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 ® CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Foress Sign&Mfg above service or feeder fee, 7.42 2
each branch circuit
Contact name:Hal Fletcher B.Fee for branch circuits without
Address:30255 Hwyservice or feeder fee,first
34 branch circuit 56.18 2
City/State/ZIP:Albany,OR 97321 Each add']branch circuit 7.42 2
Miscellaneous service or feeder not included
Phone:(541)928-5858 Fax: :(541)928-9068 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:hfletcher@foresssign.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Foress Sign&Mfg Sign or outline lighting 1 67.84 �_ 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:30255 Hwy 34 panel,alteration,or extension.
City/State/ZIP:Albany,OR 97321 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(541)928-5858 Fax:(541)928-9068 Investigation(1 hr min) 90.00/hr
Email:hfletcher@foresssign.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 144386 Electrical Lic.: -50CLS Suprv.Lic.: -SIG specifically listed %hr min
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,req ' ed: Subtotal:
Print name: Hal Fletcher Date: 2/1/16 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:
TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Hal Fletcher Date: 2/1/16 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 4404615T(11/05/COM/WEB
EleTtHcal Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description
Qty. Each Tont
)' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener*g p >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%:hr min)
COMMERCIAL WORK ONLY: ELICMICAL PERMIT FEES
Subtotal(Enteron Page 1):
Fee for each commercials stem: $75.00
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1ABui1ding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
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
15000 SW HALL BLVD, TIGARD, OR, 97224
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00085
Jeff Grove
Violation Summary:
Inspector Contractor