Permit ; . ' q CITY OF TIGARD ELECTRICAL PERMIT
`' .° COMMUNITY DEVELOPMENT Permit #: ELC2009 -00660
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/15/2009
T CG A R L? Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY Q2
Subdivision: Lot: 0
Project: Baskin Robbins
Project Description: Sign /outline lighting for (1) sign.
Owner: FEES
SN PROPERTIES PARTNERSHIP Quantity Description Date Amount
1121 SW SALMON ST
PORTLAND, OR 97205 1 ea Sign or Outline Lighting 12/15/2009 $67.84
PHONE: 1 ea 12% State Surcharge - 12/15/2009 $8.14
Electrical
Contractor:
TUBE ART SIGNS & SPORTS DISPLAYS
4243 -A SE INTERNATIONAL WAY
MILWAUKIE, OR 97222
PHONE: 503 - 653 -1133
FAX: 503- 659 -9191
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 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 Notifica ' n Center. T - r s are set forth in OAR
952 - 001 -0010 through 0 • R 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 46. 699 or 1 :t 44.
`_
Issued By: L • fi r / e."--
_ f � I _, . - 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 an inspection that business day.
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.
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Metrical Permit Application F:014 0FI IC 1111 0,NI:I
'
City of Tigard RReetceed Permit No...
li Pq ' a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review I rr - ab i •
mr
'' . e Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit:
TI GAR 15 Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
. Internet: www.tigard - or.gov Notified/Method: Tt Supplemental Information
TYPE OF, WORK - PLAN .REVIEW
® New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ® Other: Sign Replacemnt where the available fault current ❑ Marinas and boatyards.
. " ' CATEGORY OF CONSTRUCTION - exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION 'AND LOCATION : ' ❑ Emergency system. larger separately derived system.
• ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: 113488/1 Job site address: 16200 SW Pacific Hwy 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Q -2 Project name: Baskin & Robbins ❑ Service or feeder 600 amps or more.
" FEE SCHEDULE
Cross street/directions to job site: SE Corner of Durham Rd & 99W. Description 1 Qty. 1 Fee. 1 Total 1 •
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential
67.84 2
DESCRIPTION OF WORK ' " (with above sq. ft.)
Limited energy, multi - family 67 84 2
Replace (1) sign on exterior facia. Connect to exsiting circuit residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
• ❑ PROPERTY OWNER . ❑ TENANT'. 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /ZIP: 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, 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
' . -1:g APPLICANT • 1 ® CONTACT PERSON , above service or feeder fee,
7.42 2
each branch circuit
Business name: TubeArt B. Fee for branch circuits
Contact name: Dan Osterman without service or feeder fee 56.18 2
first branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: dosterman @tubeart.com Pump or irrigation circle 67.84 2
CONTRACTOR . - Sign or outline lighting 1 67.84 2
Business name: TubeArt Signal circuit(s) or limited -
energy panel, alteration, or
Address: 4243 -A SE International Way extension. Describe: Page 2 2
City /State /ZIP: Milwaukie, OR 97222 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 653 -1133 Fax: (503) 659 -9191 Investigation per hour (1 hr min) 66.25
CCB Lic.: 70956 Electrical Lic.: 37554c1s Suprv. Lic.: 366sig Industrial plant per hour 78.18
/ ELECTRICAL .PERMIT FEES
Suprv. Electrician signature, required: so-Al Subtotal:
Print name: Ken Schultz.te: 12/7/9
Plan review (25% of permit fee):
� State surcharge (12% of permit fee):
Authorized signature: SWF, TOTAL PERMIT FEE: -75 , -L 8
S
This permit application expires if a permit is not obtained within 180
Print name: Dan Ost: Date: 12/7/9 days after it has been accepted as complete.