Permit (88) CITY OF TIGARD ELECTRICAL PERMIT
` Permit#: ELC2017-00498
> COMMUNITY DEVELOPMENT
Date Issued: 07/13/2017
f GAJ D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S102BD01200
Jurisdiction: Tigard
Site address: 12825 SW PACIFIC HWY
Project: Mobil Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 8
Project Description: (1)sign lighting for freestanding sign
Contractor: TUBE ART SIGNS&SPORTS DISPLAYS Owner: CSD TIGARD STATION LLC
4243-A SE INTERNATIONAL WAY 2300 NE BRAZEE ST
MILWAUKIE, OR 97222 PORTLAND, OR 97212
PHONE: 503-653-1133 PHONE:
FAX: 503-659-9191
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 07/13/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 07/13/2017 $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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00 throug AR 9090. You may obtain a copy of the rules or direct questions to OUNC by calling 50'.1987 or 1.800.332.23
Issued B Permittee Signature: .1,i lam.A.!
a
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 RECEIVED
Date/By:Receiv7/Jr /7 Permit#: E p6/ �06�Q __
13125 SW Hall Blvd.,Tigard, !�J Y Plan Review
II Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:?„44u p�,,y, q
Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for !L
lIG•vR1) JUL 2017
Internet: www.tigard-or.gov T,1Tri.c.,Meth : / // Supplemental Information
TYPE[ �� �t6`1ptl'iJ- THIU�/ARDhf j� PLAN REVIEW
0 New construction ®Additt7lLULII1�PGl1JA►V O'R" 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:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Multi-familyMaster builderamps for all other installations. buildings.
❑ 0 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: 131833/1 Job site address: 12825 SW Pacific Highway ❑ll00HPrmore motor load of system.
City/State/ZIP: Ti ard,OR 97223 o Six or more residential units. occupancy.
Tigard, 0 Health-care facilities. 0 Recreational vehicle parks.
0 Supply voltage for more than
Suite/bldg./apt.#: Project name: Mobil Gas Pole Sign 0 Hazardous locations. 600 volts nominal.
0 Service or feeder 600 amps or more.
Cross street/directions to job site: SW Walnut Street FEE SCHEDULE
Description I Qty. l Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: 1 Lot#: Includes attached garage.
Tax map/parcel#: R464385 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
(with above sq.ft.) 75.00 2
Connect one new illuminated pole sign to existing circuit Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
I PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: D&C Fowlkes 200 amps or less 100.70 2
Address: 2300 NE Brazee St. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Portland,OR 97212 601 amps to 1,000 amps 301.04 2
Phone:(503)381-7482 I 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
EB APPLICANT ( 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,
7.42 2
each branch circuit
Contact name: Deborah Tol ke B.Fee for branch circuits without
service or feeder fee,first
Address: 4243-A SE International Way branch circuit 56.18 2
City/State/ZIP: Milwaukie,OR 97222 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503)653-1133 Fax: :( 503) 659-9191 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: dtolke@tubeart.com 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
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: 4243-A SE International Way panel,alteration,or extension.
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 90.00/hr
CCB Lic.: 70956 Electri 1 Lic.: 37.554 CL Suprv.Lic.: 601 SIG specifically listed(A hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 67.84 _
Print name: David J.que Date: 6/29/17 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 8.14
Authorized signature: �,i,� off 7 �� TOTAL PERMIT FEE: 75.98
This permit application expires if a permit is not obtained within 180
Print name: Deborah ToI ke Date: 6/29/17 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB