Permit (131) }
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017 00578
T j AR- 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/02/2017
Parcel: 1 S 135 BA00102
Jurisdiction: Tigard
Site address: 10104 SW WASHINGTON SQUARE RD
Project: Vision Works Subdivision: OAKBURG Lot: 9
Project Description: (1)sign circuit.
Contractor: RAMSAY SIGNS INC Owner: PPR SQUARE TOO LLC
9160 SE 74TH AVE PO BOX 847
PORTLAND, OR 97206 CARLSBAD, CA 92018
PHONE: 503-777-4555 PHONE:
FAX: 503-777-0220
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 08/02/2017 $67.84
Specifics:
1 ea 12%State Surcharge- 08/02/2017 $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.
Those9ffrules are set forth in OAR
952-001-0010 through19 ,
OAR 952-001-0090. You may o• .copy o he rules or direct questions to OUNC by calling 503.232. .or-4 0.332.2344.
Issued By: rZilir�._.C.� e!� r,1 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
E!ie!
,allLt?// 7 f Permit#:liq 131SHall BlvdTigard,OR 97 P
Phone: 503.718.2439 Fax: 503.598. c\\1 Date/By: Related Permit#:
Inspection Line: 503.639.4175 ,) Ready Date/By: Juris: RI See Page 2 for
T I GA R D Internet: www.tigard-or.gov ��11 + ' Notified/Method:
d, Supplemental Information
TYPE OF WORK 1C� ‘ 1? PLAN REVIEW
C*New construction ❑Addition/alteration Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: V
0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 14]Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: to toy z.1,4,w 004. pe,. SLA 100HP or more. ❑"A","E","1-2","1-3",
Ci /State/ZIP:'� �D ❑Six or more residential units. occupancy.
ty I 1 Q Q� d Or 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: V‘Jvati,3 Loa Q 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I 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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK' Limited energy,residential
(with above sq.ft.) 75.00 2
S% vs) CAlagA. .cr Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER ❑ 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
❑ APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7'42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I 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: RAYA.Q^J %is to e..0 Sign or outline lighting i 67.84 LAI H`) 2
Signal circuit(s)or limited-energy
Address: 1 ❑ See Page 2 2
Q i %.a. -NI* W V G panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
0 QT4^�1 0_' Q Rto10 Additional inspection(1 hr min) 66.25/hr
Phone:O't 77.y ss"Ste" Fax:( ) Investigation(1 hr min) 90.00/hr
Email. Li�Q�® Q ��1 1 Cv�Q/��Ito� Industrial plant(1 hr min) 78.18/hr
A WS J Inspections for which no fee is 90.00/hr
CCB Lic.:(03422... Electrical Lic.:u.lObCtS Suprv.Lic.: W43gE9 specifically listed(V5 hr min)ELECTRICAL PERMIT FEES ppa�
Suprv.Electrician signature,required:/ Subtotal: Gm A.m..
Print name`)ht(i. 1--rd
l Q 1 d 1st eq____ Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): Z1 LIe
Authorized signature: TOTAL PERMIT FEE: -Ls- �-•
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Budding\Permits1ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10104 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2017-00578
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10104 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2017-00578
Inspection Type: Inspector:
140 Sign installation Jeff Grove
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor