Permit (11) CITY OF TIG111 .1ARD
I. ' COMMUNITY DEVELOPMENTELECTRICAL PERMIT
Permit ELC2019 00758
TIG A R.:D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/29/2019
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9595 SW WASHINGTON SQUARE RD B12
Project: Aldo Subdivision: None Lot: None
Project Description: Sign lighting.
Contractor: VANCOUVER SIGN COMPANY INC Owner: PPR WASHINGTON SQUARE LLC
2600 NE ANDRESEN RD#50 PO BOX 847
VANCOUVER,WA 98661 CARLSBAD, CA 92018
PHONE: 360-693-4773 PHONE:
FAX: 360-693-2747
FEES
Quantity Description Date Amount
Specifics: 2 ea Sign or Outline Lighting 10/29/2019 $135.68
1 ea 12%State Surcharge- 10/29/2019 $16.28
Type of Use: COM Electrical
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 .quires you to fallow the ales adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-i i $90. You.ay obEli_a cop,/the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i� ,l C
le 1 .�" Permittee Signature: / g }y ,��
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 ApplicationP. FOR OFFICE USE ONLY
City of Tigard Received ,
III RI OCT 2 9 2019 DateB : >< _ /9
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : ��'
T 1 G AR D Inspection Line: 503.639.4175 Ready Date/By: EMI0 See Page for
Internet www.tigard-OLgov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction �❑[Addition/alteration/replacement I lease check all that apply(suborn 2 acts of plan,whtems the ked):
❑Demolition E-]Other: I(y+ ❑Service of feeder 400 amps or more ❑Budding over thwc stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION 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 ❑Comme cial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder Other: e...-7 t t,y 4ti 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: -' 100HP or more.
!7 / ✓ Job site address: !J ....r7:
:J( ? (1()17,-�f 1 t�-J l� ❑..A>,..E„«1.2„.,1.3„
City/State/ZIP: oft, 9 713-1 )-- ❑Six or more residential units. occupancy.
_! 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 6-( Project name: ,L DD ❑Haza dous locations. ❑Supply voltage for more than
❑Service or feeder 6)0)amps or mac. 600 volts nominal.
Cross street/directions� � to job site: ry p7 FEE SCHEDULE
G f t✓1T I N(1TV l`)/ i)Pr 1'—e- �! rs`I Description I Qty. I Fath I rural «
✓ New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 'I 1. r"--‘,f`<j `,---<06) 1,000 sq.ft•or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,resident al
(with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
0 PROPERTY OWNER TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name:
(„r.)0 200 amps or less 100.70 2
Address: r 201 amps to 400 amps 133.56 2
J a)&51+1 n�7O��Q.1d•7 - I > 401 amps to 600 amps 200.34 2
City/State/ZIP: Tf 6i4i--f� 0�
� 4� r��7 601 amps to 1,000 amps 301.04 2
Phone:O)fit 3— LI-7--29 Fax:(` vu))6R3— L7 417 Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
VYl t ( e if z, v Cl v\J C r-,c o t L-,0 1A/N relocation
Owner installation:This installation is being*Ade on property that I own which is not 200 amps or less 59.36 I
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
0 APPLICANT 0 CONTACT PERSON Branch
ocr ianics—cinceuiwt,s awlittehration,oextension,per panel
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without 1
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
ail: dwelling,service and/or feeder 67.84 2
Em
Reconnect only 67.84 2
1 ; ' Pump or irrigation circle 67.84 2
Business name: 'ti(/ k—t0 X)X(e/L /5ti , ' Sign or outline lighting , , 67.84 /;S' 2
Address: aii000 i/J .A11)PpS� U.° Signal circuits)orlimited-energy Page alteration,or extension. ❑ See Pa e 2 2
l .gala f Each additional inspection over allowable in any of the above
City/State/ZIP: V�N CO U•J e z Gyp,
t Additional inspection(1 hr min) 66.25/hr
Phone:.) & ?,-L(77 3 Fax:(3'U)
��pZ-`�41 7 Investigation(1 hr min) 90.00/hr
Email: I i ��n `) Industrial plant(I hr min) 78.18/hr
I 1 < t V1 w- /c,/(/AC) Inspections for which no fee is
CCB Lie.:4,��7 i,Electtical
Lie.- Suprv.Lie.: ,��'f (.J specifically listed(%z hr min) 90.00/hr ELECTRICAL PERMIT FEES
Suprv.Electrician signature,r red�'� KL e 5 ""°
/� Subtotal: 1 'S ,(,,SS`
Print name: �4(N, It-I I I Date:/b/0,//
5 0 Plan Review Required(25%of permit fee):
////// State surcharge(12%of permit fee): t(j,[1 Q
Authorized Signa e: ilitta2,,,&___
TOTAL PERMIT FEE: /57, ,
Print name: Date: /b7, l�T. daysafteri lhasbeenaccepted as complete.
C/ // J * Number of inspections allowed per permit.
IABuilding\Permits\ELC_PennitApp_ELR_ERF..doc Rev 06/17/2015 440-46151(11/05/COM/WEB