Permit (103) CITY OF TIGARD14
ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2018 00359
13125 SW Hall Blvd.,Ti Date Issued: 06/04/2018
T[Ca 1W. and OR 97223 503.718.2439 9
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9712 SW WASHINGTON SQUARE RD F03
Project: Lucky Brand Subdivision: None Lot: None
Project Description: Sign lighting.
Contractor: INTEGRITY SIGNS OREGON Owner: PPR WASHINGTON SQUARE LLC
PO BOX 88 PO BOX 847
HUBBARD, OR 97032 CARLSBAD, CA 92018
PHONE: 503-981-3743 PHONE:
FAX: 503-982-8153
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 06/04/2018 $67.84
Specifics:
1 ea 12%State Surcharge- 06/04/2018 $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. ATTENTgon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010
ire
- 952-r..00•.. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: my Permittee Signature: ''/ �7/',L../(' elt-:7-70/\./
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 1.11.1
FOR OFFICE USE ONLY
City of Tigard REk,TIVE,.11beceiri,j,,x , x(�1 2�y?7 ' 13125 SW Hall Blvd.,Tigard,OR 97223 ate/ rl. j Permit# L��Yf/r � 5�
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
an Review/ (/
Inspection Line: 503.639.4175 MAY 2 010 Date D Related Permit#:
TIGARD Internet: Line:www.ttgard-or.gov I8 ReadyDate/By: J„�s
No fied/Method: Supplemental: El See Page 2 Information
r^r,'"rr hP�"rf rr rt�,'9 r r L " Information
�.:�.; 31�,�1,+r�r f"`r�;��/�l�jr?f/rr�lN,✓�.?.���"���;�����d�� ®7 r s � �f �
A i ��
/l.rr.rrbfrll/.,.rrlq �:P t`f, lr k ll°h ,p ,, it 2 s „, (plan /iteY;re%2` /,xck r. : K.+.1.'t,❑New construction ■❑Addltlori/altera ♦ va tPlease check all that apply(submit 2 sets of plans w/items checked).
f1r s i ���.I.l��
0 Demolition 0 Other: io/J ❑Service or feeder 400 am s or more
P ❑Building where the available fault current
❑Marinas and
ohattyyaarsdtsfigrealllr /1411:14(i:s d ) $ t - ✓: tatt fl �i exceeds o.r
10,000 amps at 150 volts or
0 1-and 2-family dwelling C: Commercial/industrialless to round,or exceeds 14,000 ❑Floating buildings.
❑ Multi family0Accessory building g ❑Commercial-use agricultural
0 Master builder 0 Other: amps for all other installations. buildings.
�f��� ��,f�r���i's15 "'�f-0,�14. ���l���i$tfd�g��� #I�rO� ri���rff�`�"rrf�'t''��' r'i�xH" ,f ❑Fire Pump. ❑Installation of 150KVAor
,., .r �;f ,x>; ifrr ii,�'r="fait . . ❑Emergency system.
�� larger separately derived
Job#: Job site address: 911 a St.)fit (�c/ , s S ❑Addition of ore motor load of "Atem.
100HP or more.
City/State/ZIP!—Friy, /w. ❑"A„ "E„ "1-2","1-3",
'" 11�. .2_2_3 ❑Six or more residential units. occupancy.
Suite/bldg./apt.#: F O3 ❑Health-care facilities. ❑Recreational vehicle pazks.
Project name: , /�. _ �� 0 Hazardous locations. ❑Supply voltage for more than
Cross street/directions to job site: 1 _ ` `-""'�
0 Service or feeder 600 amps or more. 600 volts nominal
V ako max, p
S�.�a.t..a. �.�.aL•-I+ ,,��",, � � %�' , It �r�>'°°'f' ,''�r,ow:r
lJ Description `�`� `" ot *
e Qty. Each Total
Subdivision: New residential single-or multi-family dwelling unit.
Lot#: Includes attached garage.
Tax m #:
1,000 sq.ft.or less
f i f fi fi map/parcel
ff r fr If 1 4 Ea.add'l 500 sq.ft.or o 168.543 4
/✓fs;„^l"„n$G'e,,5'"'.' s� ,/ re„ff�'i�t`,''/ri . s#�s y{ 9. fi;✓j ,�" ? %Iu lei fi/, rr 'try ?,,. portion 33.92 1
' 1f;}; Q ""` ✓' i r Limited energy,residential
tS Leet r1-Q.0 e:.1...�Y^ iet.44„) JvQ'Yl.ea (.<.Q.i (with above sq.ft.) 75.00 2
S` 1 As' Limited energy,multi-family
75.00
r residential(with above sq.ft.) 2
Il .'f�:i �„%,,.,,i,17,7111;at ffi q ff/fr refs ,�P 7 n
f f/r' ?r " rr rr a Renewable Energy 0 See Page 2
Name: Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
Address 201 amps to 400 amps
133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
Phone:( 601 amps to 1,000 amps 301.04 2
Fax:( ) Over 1,000 amps or volts
552.26 2
Email: Temporary services or feeders installation,alteration,and/or
Owner installation: This installation is being made on property that I own which is not 200 amps less
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125 25.08 2
.08 2
Owner signature
t Date: 401 amps to 599 amps
168.54
2
eRia „: „.‘,;.,,;*.1::444;11494131•1:4!,
#it ff t , Branch circuits—new,alteration,or extension,per panel y"r A.Fee for branch circuits with
Business name:—h i,Cgrij„ SbK S C").,0,&„..) '""
above service or feeder fee,
Contact name:, ` — each branch circuit 7.42 2
l�e t..Q.c t�.(�.,s
Address: B.Fee for branch circuits without
p.b • cg g service or feeder fee,first
branch circuit 56.18 2
City/State/Z11 ,10 cs,...%_of CSX... O3 Each add1 branch circuit
7.42 2
y
Miscellaneous
e(service
service oerdefeeder not included)Phone:(03) (_ 3- 1 3 J Fax: :( d ) Each manufactured or modular 67.8
4 2
Email 'b,, rcot
iisI t�S Q�L � � Reconnect only 67.84 2trfj FrDi rr r r h
ump or irrigation circle
67.84 2
Business name. P
�i • 1-tS Stgn or outline lighting 67.84
Address: O $ g r! (0�7,8�,2
panel,alteration,
or limited-energy
alteration,or extension. ❑ See Page 2 2
City/State/ZIP:1 '.. 1 „.4 O3 Each additional inspection over allowable in any of the above
Phone:(rp3)q i_3-T�� I Fax:( 0 — Additional inspection(1 hr min) 66.25/hr
u Investigation(1 hr min) 90.00/lir
Email: 1 e n� f'ell-eivi -11/4.sr:5)-ts 6 I1 . c — Industrial plant(1 hr min) 78.18/hr
�
CCB Lic.: Electrical _ Inspectrons for whrch no fee is
�t�G�(� Electcal L1C.:��rj 20 Suprv.Lic.: _sic. specifically listed(%z hr min) 90.00/hr
Suprv.Electrician signature,req
Print na •-. � — Subtotal t„..-2g�( ;"
,i[ —.47/ _ L �� Date: 5'/Z,1 /I 8 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): $. 1.,1"
Authorized signature:
TOTAL PERMIT FEE: 15.al
Print name: j Date: I This permit application expires if a permit isnot obtained within 180
days after it has been accepted as complete.
1:\Building\PennitslELC ppELRERE.doc Rev
PeanitA06/17/2015 * Number of inspections allowed per permit.
440-4615T(11/05/COM/WEB
Electrical Permit Application–City of Tigard
Page 2–Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
iasibES`lk IA n : FEE Sell, EMIL,
Description I Qty. I Each Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved: 5.01 to 15 kva 133.56 2
❑ 15.01 to 25 kva 200.34 2
Audio and Stereo Systems*
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm - 25,01 to.50 kva 301.04 2
50.01 to 100 kva . 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
>100 kva—no additional charge 0.0 3
CI Vacuum Systems* Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
[I Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/lir
specifically listed(1/2hr min)
�� y .477
C
E}MI2 ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Cl Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls •
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: —
*No licenses are required. Licenses are required for all
other installations
I Building'Permits\ELCPermitApp_ELR_ERE.doc Rev 0611',/2015