Permit (36) .11 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016 00657
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/20/2016
T ttxTtT g Parcel: 2S112DD00300
Jurisdiction: Tigard
Site address: 15900 SW 72ND AVE
Project: 76 Gas Station Subdivision: None Lot: None
Project Description: Sign lighting for(5)signs.
Contractor: RAMSAY SIGNS INC Owner: PACIFIC REALTY ASSOCIATES LP
9160 SE 74TH AVE BY APRO LLC
PORTLAND, OR 97206 17311 S MAIN ST
GARDENA, CA 90248
PHONE: 503-777-4555 PHONE:
FAX: 503-777-0220
FEES
Quantity Description Date Amount
5 ea Sign or Outline Lighting 09/19/2016 $339.20
Specifics: 1 ea 12%State Surcharge- 09/19/2016 $40.70
Electrical
Type of Use: COM
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $379.90
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.'-0Youmayobtain a copy of the rules or direct questions to OUNC by calling 50 .232.1987or 1.800.332.2344.
Issued By,// )4 917 4 °F��--.—_- Permittee Signature: Q 9 �-'�
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.
RECEIVE:".
Electrical Permit Application f oiz Ol F l( L l sI:11y1.1
City of Tigard MAY 0 9 2016 Received 140 Penn"'U 13125 SW Hall Blvd.,Tigard,OR 97223 ^ p an vie�lif� "�
II
111Phone: 503.718.2439 Fax: 503.598.19611`+ITY OF TIGAR I Date/B : Related Permit#: 1bi� OIC' •_il__i
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISI,. ,7-.dyDaYe/BY: INENEI H SeePage2for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: S[ -1O Cr`t`iil,,..1 c( i j l r- where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1 .ground,or
❑ 1-and 2-family dwelling RI Commercial/industrial 0 Accessory exceeds 14,000 0 Commercial-use agricultural
,., ,. ...,,'for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION AUG 2 4 a el: mergency system. larger separately derived
■Addition of new motor load of system.
Job#: Job site address:15'10D -4-) --74,. .,4,44,x. _rni . 0 6,r or more.
I s' ❑"A" "E""1-2""1-3"
City/State/ZIP: ``r�(y n V p yg t y pr-T1-"• ore residential units. occupancy.
`, f C C)C' �l 225 /� ILD 4NG 01 I[+ 4, facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: pi111/fps 6't o z /,,,,$, ,,„,E Seryic ous locations. ❑Supply voltage for more than
7�I Service or feeder 600 amps or more. volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each 1 Total I *
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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
NJ S i 5 ct ST-1 N 6 c i 0-5' Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) 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
Branch circuits-new,alteration,or extension,per panel
g APPLICANT 0 CONTACT PERSON
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:
Reconnect only 67.84 2
[CONTRACTOR Pump or irrigation circle 67.84 2
Business name: `RA.M 5/` 5j 1( .4 S Sign or outline lighting 5 67.84 339 4,2
Address: GI t c() 9 i E, --Ii-f-4-1 Atj f Signalnl,circuit(s)or limited-energyxen . 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: �'� Each additional inspection over allowable in any of the above
i Additional inspection(1 hr min) 66.25/hr
Phone:(5i.:,..5) "3~7 65-..%b i'7_, Fax:( 5 )/71 -0:2:2_0 Investigation(1 hr min) 90.00/hr
Email: /..-1,54_9 C _SC. rn; — S t Gr(5 , Ccs Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.:6 `-f 2_2_, Electrical Lic.:24'.,.-j 06 0...53Suprv.Lic.: 67"315!G specifically listed(%I hr min) 90.00/hr
Suprv.Electrician signature,required: _ l0/1/j 7 ELECTRICAL PERMIT FEES
Subtotal: 3 sl , iv
Print name:'j7-s Kl INI NI Er...--_. Date: 5-Li—I0 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): kid, /0
Authorized signature: TOTAL PERMIT FEE: 371,5a
�/ This permit application expires if a permit is not twined within 180
Print name:
�(r 155 Date:5_41_4 6, days after it has been accepted as complete.
• Number of inspections allowed per permit.
L\Building\Permits\ELC PermitApp_ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 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:
1=1BUT Burglar Alarm 25.01 to 50 kva 301.04 2
(� 50.01 to 100 kva 552.26 2
I I Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ 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 00/hr
specifically listed(V2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
[❑ Audio and Stereo Systems
❑ Boiler Controls
El 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: S t (off
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PetmitApp ELR_ERE.doc Rev 06/17/2015