Permit (17) CITY OF TIGARD ELECTRICAL PERMIT
411
14 "` COMMUNITY DEVELOPMENT Permit#: ELC2016-00649
TIIGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/24/2016
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9624 SW WASHINGTON SQUARE RD G07
Project: Amazon Books Subdivision: None Lot: None
Project Description: (1)sign lighting
Contractor: TUBE ART SIGNS&SPORTS DISPLAYS Owner: PPR WASHINGTON SQUARE LLC
4243-A SE INTERNATIONAL WAY PO BOX 847
MILWAUKIE, OR 97222 CARLSBAD,CA 92018
PHONE: 503-653-1133 PHONE:
FAX: 503-659-9191
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 08/24/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 08/24/2016 $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. 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. A ' •1: • -.n law requires you to follow the rules adopted by the Oregon Utility Notification enter. Those rules are set forth in OAR
952-0r -0010 through OAR 95 •: -•,90. You may obtain a copy of the rules or direct questions to OUNC by calling 5•-. 32.1987 or 1.800.332.2 44.
Is-. ed By: / !��"�. A Permittee Signature: 4
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 OFFICE USE ONLY
City of Tigard EIVEp� Received r6®�� C, - ^ _/664/
1 } Receiv ,e / Permit#: c L.(�(�
13125 SW Hall Blvd.,Tigard,OR 970planRevie
■ Phone: 503.718.2439 Fax: 503.598. 9
Date/B : Related Permit#:
Inspection Line: 503.639.4175 C Ready Date/By: Eris: ® See Page 2 for
4 1-' RI) Internet: www.tigard-or.gov I,U G 2j 2 _n oI U Notified/Method:
Supplemental Information
TYPE OF WO G OF BOARD ( FLAN REVIEW
El Nconstruction 0 Addition/alter;ly�l�1 7�/IS0®,`� Please check all that apply(submit 2 sets of plans w/items checked):
❑New
emohtio 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
I=11-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: ['Fire pump. Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
129223 4 .9& 6SWWashin tonRd ❑l00H000foewmotorloadof system.
Job#: Job site address: ❑°n�,°E°,°1 -i^,°1-s°,
Washington Sq 100HP or more.
0 Six or more residential units. occupancy.
City/State/ZIP: Portland,OR 97223
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: G-08 I Project name: Amazon Books 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SW Green burg Rd FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1 S1260000300 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Connect one illuminated wall sign inside the mall, (with above sq.ft.) 75.00 2
Limited energy,multi-family
at the entrance to the store (space G-08),to existing circuit residential(with above sq.ft.) 75.00 2
0 PROPERTY OWNERI Renewable Energy 0 See Page 2
IRI Services or feeders installation,alteration,and/or relocation
Name: Amazon 200 amps or less 100.70 2
Address: 410 Terry Avenue North 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Seattle,WA 98109 601 amps to 1,000 amps 301.04 2
Phone:( ) I 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
ER APPLICANT`' I El CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Tube Art Group above service or feeder fee,
- each branch circuit 7.42 2
Contact name: Deborah Tolke B.Fee for branch circuits without
serAddress: 4243-A SE International Waybranchce i feederstfee,first 56.18 2
branch circuit
City/State/ZIP: Milwaukie,OR 97222 Eachadd'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503)653-1133 Fax: :( 503) 659-9191 Each manufactured or modular
Email: dtolke@tubeart.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Tube Art Group Sign or outline lighting 1 67.84 67.84 2
Address: 4243-A SE International Way Signal circuit(s)or limited-energy
panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Milwaukie,OR 97222 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)653_1133 Fax:( 503)659-9191 Investigation(1 hr min) 90.00/hr
Email: dtolke@tubeart.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 70956 Electrical L. .: 37554 CLS Suprv.Lie.: 366 SIG specifically listed C=hr min) 90.00/hr
ELECTRICAL PERMIT FEES
2-----M___,-
Suprv.Electrician signature,required: Subtotal: 67.84
Print name: Ken Sc ltz ate: 8/16/2016 0 Plan Review Required(25%of penult fee):
I k.....- State surcharge of permit fee): 8.14
Authorized signature: /r TOTALTAA PERMIT FEE: 75.98
---711,..),4;----
This permit application expires if a permit is not obtained within 180
Print name: Deborah Tolke Date: 8/1 6/201 6 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitAppELR ERE doe Rev 06/17/2015 440-4615T(11/05/COM/WEB