Permit (54) CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit#: ELC2016-00780
13125 SW Hall Blvd.,Ti Date Issued: 10/27/2016
T[tR. and OR 97223 503.718.2439 9
Parcel: 2S 101 AA09100
Jurisdiction: Tigard
Site address: 12447 SW 69TH AVE
Project: Consumer Cellular Subdivision: WEST PORTLAND HEIGHTS Lot: A
Project Description: (1)56 sq.ft.illuminated wall sign on west elevation.
Contractor: SECURITY SIGNS INC Owner: SDC TIGARD CORPORATE CENTER INC
2424 SE HOLGATE BLVD ATTN:ANDREW HARPER
PORTLAND, OR 97202 101 CALIFORNIA ST,26TH FLOOR
SAN FRANCISCO, CA 94111
PHONE: 503-546-7114 PHONE:
FAX: 503-230-1861
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 10/19/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 10/19/2016 $8.14
Type of Use: COM Electrical
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. 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 0'R 952-001-0090. Yo y o tam opy es or direct questions to OUNC by calling 503.232 1987 or 1.800.332.2 4 .
Issued By: Permittee 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 OFFICE USE ONLY
City of Tigard d y ?A...), ceived / PermitNo.: —
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �'�/��J� f�r fjl
�' Plan Review (( /� / G`�
Phone: 503.718.2439 Fax: 503.598.1960 ( }1l'�1 Date/By: Other Permit '6 td_6�]y
T I GA RD Inspection Line: 503.639.4175 0 L,I u Li' Date Ready/By: furls: � El See Page 2 for °' /U
Internet www.tigard-or.gov Notified/Method: /G�v Supplemental Information
affilROAMMAPAMIZUW OV WORK r t -7A7f -- , ;;,: , W v
Please check althat apply(submit 2 sets of plans w/items
checked argew construction 0 Addition/alterati 7t.
❑Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF COINSTRUCTION t _ exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling arommercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0Firepump. 0 Installation of 75 KVA or
` JOB BITE INFORMATION A1�TD LOCATION ❑Emergency system. larger separately derived system.
°` _ 4 9., ;S T _ i 0 Addition of new motor load of 0"A","E","1-2","13"
Job no.: I Job site address:12gtj 7 �J &Iit/6r 00HP or more. occupancy.
�}� l �!/`� f!v
0 Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: pne D Q 7 22:3 0 Health-care facilities. 0 Supply voltage for more than
` 4 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 1 Project name Je5e 2. e&-z.1.444/‹. 0 Service or feeder 600 amps or more.
matiggiatiaNOWTOPOCROCUVIMMM
Cross street/directions to job site: Description I Qty. I Fee. 1 Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
r +�� �.,. -F4 x.. DESCRIPTION OF `{VORK. tl ` (with above sq.ft.) 75.00 2
/ Limited energy,multi-family
1 N51-141,1- 6) I Z.I-i/ n t N111-822 f- diii'G c 5-/4 Af residential(with above sq.ft.) 75.00 2
vices or feeders installation,alteration,and/or relocation 5a n0�5a nC4LI�Lf_er0100.70
_
amps or less 100 70
Q 1iOPERTX' UWNEIt. `M 0 2
<�� �� �_, ��,,�.�- __, :�. ... � . t-.^*�._ *..� . ..� . .TE�� ��� , � 201 amps to 400 amps 133.56 2
Name: W NJvm ex n !�� / L b . 401 amps to 1,0 amps amps 200.3412
CY(sv��+/ /�s/`, 601 amps to 1,000 301.04 2
Address: /2z-P-17 Sh-) / `f/ _ !VC' Over 1,000 amps or volts 552.26 2
1;
City/State/ZIP: P 0 '�g_ /722,a Temporary services or feeders installation,alteration,and/or
relocation
Phone: ( ) Fax:( ) 200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rint,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
A Branch circuits—new,alteration,or extension,per panel
Owner signature: _NO--
Date A.Fee for branch circuits with
.„ . y0 lyeAPPLICANT` CONj 0 PEON r 3,
above
eachbserviranchcecircuit or feeder fee, 7.42 2
RS
Business name:SESCURITY SIGNS,INC B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Contact name:CYNDI I£4e1r J`7DClS branch circuit
Each add'l branch circuit 7.42 2
Address:2424 SE HOLGATE BLVD Miscellaneous(service or feeder not included)
City/State/ZIP:PORTLAND,OR 97202 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:(503)546-7102 Fax: : (503)230-1861 Reconnect only 67.84 2
E-mail permits@securitysigns com
Pump or irrigation circle 67.84 2
Sign or outline lighting ' 67.84 kit
2
i' a£,�. w: . ,.,� , VONTRAcTOR 0 ry 2 (p 7.11'
-s �. -. Signal circuit(s)or limited-energy
Business name:SECURITY SIGNS,INC panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address:2424 SE HOLGATE BLVD Additional inspection(I hr min) 66.25/hr
City/State/ZIP:PORTLAND,OR 97202 Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:(503)546-7102 Fax: (503)230-1861 Inspections for which no fee is
specifically listed(1/2hr min) 90.00/hr
CCB Lic.: 122809 Electrical L•• • .6,6I Suprv.Lic.: 383SIGr ELEcr1 ICtL PERMITt EEB 1
Suprv.Electrician signature,required: /�
�� Subtotal: G 7,Sly
Plan review(25%of permit fee):
Print name: MARC LIND.• IST Date: A, State surcharge(12%of permit fee): F', pi
..0
Authorized signature: Aro TOTAL PERMIT FEE: 75-, 1 Y
A / This permit application expires if a permit is not obtained wit to 180
Print name: CYNDI I D /`7/_/// days after it has been accepted as complete.
ate' ` / �'/6 * Number of inspections allowed per permit.
I:ABuildingVPermitsAELC-PermitApp.doc 07/01/1O 440-4615T(11/05/COM/WEB
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
12447 SW 69TH AVE, TIGARD, OR, 97223
Record Type:
Commercial - Electrical
Inspection Type:
199 Electrical final
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
ELC2016-00780
Inspector:
Jeff Grove
Contractor