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Permit (128) CITY OF TIGARD ELECTRICAL PERMIT I. , COMMUNITY DEVELOPMENT Permit#: ELC2019-00579 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/05/2019 TIC;r1 R f.7 g Parcel: 1 S135BD01300 Jurisdiction: Tigard Site address: 10830 SW GREENBURG RD Project: Comfort Inn&Suites Subdivision: None Lot: None Project Description: Sign lighting for(1)wall sign. Contractor: RUDNICK ELECTRIC SIGNS LLC Owner: SCHAEFER, ROBERT M&SALLY J& 1400 S TOWNSHIP RD MILLER, GERALD V CANBY, OR 97013 BY SHILO INN-WASHINGTON SQUARE 11600 SW SHILO LN PORTLAND, OR 97225 PHONE: 503-263-3600 PHONE: FAX: 503-263-4617 FEES Quantity Description Date Amount 1 ea Sign or Outline Lighting 09/05/2019 $67.84 Specifics: 1 ea 12%State Surcharge- 09/05/2019 $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. T is permit will expire if ,ork is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Orelaw re;" es yo i to follow th rules -dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OA' 2-001 •fi You; .y obtain a c•- of t h ules or direct questions to OUNC by calling 503.23 .1987 or 1.800. 344. __ -..-.---,-- - _ Issued By: �� I� , 1 Permittee Signature: _ `� _ 4:='OWNE- INSTALLATION ONLY The installati•• s 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 RECEIVE . RecteeiB %�jYY ,L7//ved /) , � , - Da lig '4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review i Phone: 503.718.2439 Fax: 503.598.1960 AUG 2 8 2019 DateB Related Permit#: - _. , _ TIGARD Inspection Line: 503.639.4175 Ready bate/By. ® See Page 2 for Internet: www.tigard-or.gov - Notified/Method: lemental Information C�l r Pak RD s/� Su PP New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards. "'_ a° `' a _ ? exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ 1-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agr cultural amps for all other installations. buildings. 0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or : ; l l )' Jr'-'-''''''' -'> ❑Emergency system. larger separately derived ❑Addition of new motor load of system Job#: Job site address: ic) �c"�� ,,..-1 100HP or more. 0"A","E","1 2","1-3", City/State/ZIP: --"'`/ Ci Z ❑Six or more residential traits. occupancy. j'� (1 ` z2 J ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Lha Al1 ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: Description Qty. Each Total * New residential single-or multi-family dwelling unit. Subdivision: l Lot 4: Includes attached garage. 1,000 sq.ftor less 168.54 4 Tax map/parcel#: ,..� Ea.add l 500 sq.ft.or portion 33.92 I energy,residential 75.00 2 3 CC -Vs (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) ;. Renewable Energy 0 See Page 2 is I , V t i Services or feeders installation,alteration,and/or relocation Name: C,.x{y&C1s` UN'1f-\ (_.'"‘"k C'S 200 amps or less 100.70 2 Address: t C \ 201 amps to 400 amps 133.56 2 � v ���V � ��' 401 amps to 600 amps 200.34 2 City/State/ZIP: l`s Z2'? 601 amps to 1,000 amps 301.04 2 Phone:44S6�) Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or 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 i Branch circuits-new,alteration,or extension,per panel "'€ ..' "' A.Fee for branch circuits with Business name: 7--L) ,cK z.�ecA L SI above service or feeder fee, Contact name: ��S 7.42 2 each branch circuit `s1A<)*k��- ijKC,\ic-,,nkl____ B.Fee for branch circuits without service or feeder fee,first Address: I4c C"JE \ �,, �A branch circuit 56.18 2 City/State/ZIP: C „+L�6 Each add'l branch circuit 7.42 2 Phone: Miscellaneous(service or feeder not included) (�5L'�) Zc . -- 3�C Fax: :(°Z3) ?L,3_ L,1'4 Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: ''±-•.,17 '.;,.,,C 4_,, ', , {..T i a ,iatReconnect only 67.84 2 s 2 $uslnesS nalme: :3t'1�-C`� C r�c'Sr C�C�e, u___ " Sign or outlineTighting 67.84 2 \ Signal circuit(s)orlimited-energy Address: 14c JL ---\---6,,,,„-‘1.1S),,,, (�� panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: c'- �'�(� �.o l Y Each additional inspection over allowable in any of the above l r >"C.. 'T�= J Additional inspection(1 hr min) 66.25/hr Phone:Ws-6S) -- _:' „, T,, Fax:(e-•_..' 3) Z6) „ 1-N,CI Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email: S`ke0Q- 2s.AY:t C'\c___P\e(- c-,C` c (1`>, e yot\ �j � Inspections for which no fee is 90.00/hr CCB Lie.: C` c—' Electrical Lic.: u rv.Lic.: s•ecificall listed '/hr min Suprv.Electrician signature,required . ,E.,..-.1.7.z-11\ ySubtotal: 5�- - Print name: .e pf\ 0)•,Y i C� Date: %...-2t-I _(9 0 Plan Review Required(25%of permit fee): ...__�- e ``�I State surcharge(12%of permit fee): .'Z,;1.Z. `-:,-,_- TOTAL PERMIT FEE: -- Authorized signature: c---^"•�" ,__ -�'""`Y�� ,;, ----Th L._ _-y- t This permit application expires if a permit is not obtained within 180 Print name: •JR�I:�JC%+- ‘J O Date: '6-2`. , — \� days after it has been accepted as complete. t 1 * Number of inspections allowed per permit. IBuilding\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: witztracummuccmairmisi Fee for all residential systems combined: $75.00 Renewable electrical energy systems: IIICheck Type of Work Involved: 5 kva or less 100.70 _© 5.01 to 15 kva 133.56 _© ❑ Audio and Stereo Systems* 15.01 to 25 kva - 200.34 _© Wind eneration s stems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 _© 50.01 to 100 kva 552.26 _© ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) III 552.26 —© ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 _© ❑ Vacuum Systems* >100 kva—no additional charge 0.0 _© Each additional ins'ection over allowable in an of the above: ❑ Other: Each additional inspection is ) 111. 66.25/hr —© charted at an hourl 1 hr min Inspections for which no fee is ■ 90.00/hr —. s.ecificall listed(%z hr min) t.. . } Fee for each commercial system: $75.00 allowe Subtotal(Enter on Page 1): * Nnmber of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ 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\ELC_PennitApp ELR_ERE.doc Rev 06/17/2015