Permit (79) a'
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017-00665
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/11/2017
- 9 Parcel: 1 S 134BC00300
Jurisdiction: Tigard
Site address: 12286 SW SCHOLLS FERRY RD
Project: Cyclebar Subdivision: None Lot: None
Project Description: Sign lighting for(2)signs.
Contractor: RUDNICK ELECTRIC SIGNS LLC Owner: FW OR-GREENWAY TOWN CENTER LLC
1400 S TOWNSHIP RD PO BOX 790830
CANBY, OR 97013 SAN ANTONIO, TX 78279
PHONE: 503-263-3600 PHONE:
FAX: 503-263-4617
FEES
Quantity Description Date Amount
2 ea Sign or Outline Lighting 09/11/2017 $135.68
Specifics:
1 ea 12%State Surcharge- 09/11/2017 $16.28
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $151.96
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. You may..tain a co. s the rules or direct questions to OUNC by calling 5 Tor 1.800.332. .
Issued By• ,/,moi �;i Permittee Signature:
OWNER INSTALLATION ON L
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.
I
'El&trical Permit Application FOR OFFICE USE ONLY
City of Tigard Received .�
= n { Permit No.: - �
s c .Date/13 � sd/
13125 SW Hall Blvd.,Tigard,OR 972 is r��� Plan Review
Phone: 503.639.4171 Fax: 503.598.1".,'.?..1,1 �..* I F b Date/B : Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Supplemental Information
Internet: www.tigazd-or.gov _1 — Notified/Method: III � Y
'44111
New construction C Addition/alteratiety aa:•i e1�O.i r"` '-•`' Please check all that apply(submit 2 sets of plans w/items checked below).
xrr�'-
i ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑ Other: 1 :P:i;,, 'I r r/ t a where the available fault current 0 Marinas and boatyards.
�' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
0 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations buildings.
0 Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 75 KVA or
❑Emergency systemlarger separately derived system.
-3'11165 RiVitca 0 ! 0 Addition of new motor load of 0"A","E","1-2","1-3",
C 100HP or more. occupancy.
Job no.: Job site address: 12 2 84, si41 self,6 Yrs 7 J 0 Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: J ❑Health-care facilities. ❑Supply voltage for more than
n Tga r d t 0R ' 722'3 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Cyc)e baY ❑Service or feeder_;600 amps or more.
/ r4,-E.;-.0-0-
s gip:.
Cross street/directions to job site: �W' 217 pev 1-?J /- 1,)l( 210 Description QtyFee Tote1
New residential single-or multi-family dwelling unit.
(Sento IIs Ferry Wd) Includes attached garage.
Subdivision: Lot no.: 1,000 sqft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
, i i ` 3 : (with above sq.ft.)
X.-; ; I l> = , -1' .
Limited energy,multi-family
1 residential(with above sq.ft.) 75.00 2
a
51 J H nits tCe�'C�7/O Y7 j Services or feeders installation,alteration,and/or relocation
' .► .--- ih_4' 200 amps or less 100.70 2
3.Y ' on. tqq i t .. t° i ., 201 amps to 400 amps 133.56 2
y�J_p__ 401 amps to 600 amps 200.34 2
Name: s 1X-1 Y r� 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel
Owner signature Date: A.Fee for branch circuits with
,. ,k $.� I_ ,% -. ' 'i � l . above service or feeder fee, 7.42 2
h„ B.each branch circuit
Business name: i, win 1 Ck Eied_f—rl c .5-1-3 N 5, 4.i_G B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Contact name: 01?6L u r branch circuit
a ii Each add'l branch circuit 7.42 2
Address: /s./o 0 5, row,,,..1,,/r a Miscellaneous(service or feeder not included)
Ca
Each manufactured or modular 67.84 2
�..
City/State/ZIP: o111110y t 0 R ! 9 7013 dwelling,service and/or feeder
Reconnect only 67.84 2
Phone:(663)263'3600 Fax: :(603)263-H6/7
/ Pump or irrigation circle 67.84 2
E-mail: ',err .11 '_%, ru, ['G C f.!.,,, G0 )'i9 Sign or outline lighting rL 67.84 tcc r tk, 2
; Signal circuits)or limited-energy
L panel,alteration,or extension. Page 2 2
Business name: �U p'h i'C k E 1 eGTr')L 5 its, LLC Each additional inspection over allowable in any of the above
Address: f H o o S -/o w yis L i X Additional inspection(1 hr min) I 66.25/hr
Investigation(1 hr min) 66.25/hr
City/State/ZIP: C.aN b y/ OR 9701.3
Q Industrial plant(1 hr min) 78.18/hr
3 263 (o D Inspections for which no fee is
Phone:(;00 ) Fax:(S )24 3-4 6 / p
90.00/hr
specifically listed(9s hr min
CCB Lic.: �8'6518 Electrical Lic.: C Ls 7 Su rv.Lic.: -2(/2 ;`; ,, „_,, , . I
Subtotal: 134.,,t.,,
Suprv.Electrician signature,required �/��'_"" . Plan review(25%of permit fee):
Print name: sf Cj/Gh ,,1„.„;,,L, Date: F-1S-/-7 State surcharge(12%of permit fee): \fig..i_-(
r -- TOTAL PERMIT FEE: (' lip
Authorized signatur • --; Thispermit application expires if a permit is not obtained within 180
,, �..._' PP P
(3 ^� i ... days after it has been accepted as complete.
Print name: `.i' k,» t Date.: '' � '� {t-- t * Number of inspections allowed per permit.
I:\Building\Permits\ELC-PermitApp.doe 07/01/10 440-4615T(11/05/COM/WEB
APPLICANTS
NOTE: Person specified as'Applicant"shall be designated"Permittee"and shall provide financial assurance for work.
\\'hen the owner and the applicant are different people,the applicant must be the purchaser of record or a lessee in possession with written
authorization from the owner or an agent of the owner. The owner(.)must sign this application in the space provided on the back of this
form or submit a written authorization with this application.
THE APPLICANT(S) SHALL CERTIFY THAT:
• If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the
conditions and limitations of the approval.
• All of the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and
the applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found that any such
statements are false.
• The applicant has read the entire contents of the application,including the policies and criteria,and understands the
requirements for approving or denying the application.
I hereby acknowledge that I have read this application,that the information given is correct,that I am the owner
or authorized agent of the owner,and that plans submitted are in compliance with the City of Tigard,
SIGNATURES of each owner of the subject property required.
00 ScS ✓.e4 ItJ. ;ck
Applicant's signature Print name Date
Ryan Sexton g . 9 . 17
Ryan Sexton A' H moi" ".°..*--
Owner's signature Print name Date
Owner's signature Print name Date
SIGN PERMIT APPLICATION
City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • wwwtigard-or.gov • 503-718-2421 • Page 2 of 2