Permit CITY OF TIGARD ELECTRICAL PERMIT
t Permit#: ELC2020-00646
COMMUNITY DEVELOPMENT
T(G ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/23/2020
Parcel: 1 S 135DA04600
Jurisdiction: Tigard
Site address: 11157 SW HALL BLVD
Project: Village at Washington Square-Building A Subdivision: 1998-038 PARTITION PLAT Lot: 1-2
Project Description: Building A: (41)branch circuits for units 1-16.
Contractor: INDUSTRIAL COMMERCIAL ELECTRIC COMPANY Owner: VILLAGE AT WASHINGTON SQUARE
PO BOX 21282 LIMITED PARTNERSHIP
KEIZER, OR 97307 BY CPAH
PO BOX 23206
TIGARD, OR 97281
PHONE:
PHONE: 503-981-2383
FAX: 503-981-0053
FEES
Quantity Description Date Amount
41 crt Branch Circuits wo/Purchase 12/23/2020 $352.98
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/23/2020 $42.36
Type of Use: MF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $395.34
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 ORR1952-001-Q090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
� r
Issued By: �,. ? � =s"d"12 v..-._._—. Permittee Signature: c ,v. ;J.`<• .�r -'l j%i.�
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.
E - 12( 15 (20
Electrical Permit Application RECEIVE i . ,: , , , ,, . / ,
City of Tigard / f�t/3� Pamitx: ��/ `
13125 SW Hall Blvd,Tigard,OR 97223 DEC 1 5 Z0Z0 Plan Review / yyy,��� �`' �1 {.
I Phone: 303.718.2439SI A,clB�; n//�s} Aelaled PUmit N: �p s}. i'�v ;,
Email' Line: n ts5Tig tern.: www d TIGAPC Received e/By: v I / kris! 0 Sir Pge:tor
Inspection Line: 503.639.4175 Internet: www.0 or. v Notibed/Mettnd: / ,a.1/'�; ,/krr Supplemental loforautloa
TYPE OF WOR�RUILDING i'�iVIS4C1�7 •1 ' '!711,1 PLAN REVIEW
❑New construction .Addition/alterationlreplacement Please check all that apply(submit j sets of plans wlibnu coated):
❑Demolition ❑Other. Service or feeder 400 amp or mote ❑Building over them stories.
where the available Milt cumin! 0 Marius and bentyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buidinas.
❑ Y 1-and 2-fernil doneelets aesa to ground,or exceeds 14.000 ❑Commercial-use agricultural
g ❑CommerciaVindustrial ❑Accessory building
•Multi-family 0 Master builderamps m all other installations. buildings.
❑Other: 0Erse pump. ❑IoahWtiom of 150 KVA or
JOY SITE INFORMATION AND LOCATION /� ❑Emergency system. larger separately derived
Job#:I-G E.S/7 6j I Job site address: 11 (S7 S W #e/f 8l u rl D Addition of ems moor load or syslen
�p /� �qp qt.y 100HP m month. ❑"A',°'E"."1-2""1.3"
City/State/ZIP: Tu N/'pf, 1()L ( / 22 ❑Siror muse msideotpl usda. occupancy.
'! ❑Health-care Facilities. ❑Reurnional vehicle pane.
Suite/bldg./apt.#: ell', 4 I Project name: yip apt{- p ❑Hawdousleestions. ❑Supply vo�gefirmwvthan
Q/ it nJ ism ,St 600 vWw nominal- (,
J ✓✓ ` ❑&rvia or feeder boo amps or thus.
Cross street/directions to job site: PEE SCHEDULE
Denerlt4.a I On. I La I Toad I
New residential single-or s ulti4'amily alwdlag welt
Subdivision: I Lot#: includes attacked garage.
Tax map/parcel#: 1,000 sq.ft.a l� 168.54 4
Es.add'/500 sq.R or portion 33.92 1
cD� l7ON OF WORK. : L. Limited allergy,residential 75.00 2
8(ci 16 U/1/'1'"S - e 1- e FC -I- el /tctriti, iwithebovy,mult)
,� ( /I✓ �''h +. limited corny,multi-family
41/i} (12a>`C✓ 3Cs4ftl4�/YeCvnnGe,t,5t1tL1,irC {{tyJ ��34w �+'C,nlr<#
rcaidenti fwith above sg.ft) Pageec 2 2
® morarry owNER .I p TExwxr Services
❑ eion,and/or 2
n /1 0� ��l Ssavlem or feeders IIIstallatl0 alteration, relocation
Name: �vi/n/nte4,4,/ i4 r-�h�� l,r- Hfi-rd'ft(�16i(2 lecis ,C,,', 200 amps or less 100.70 2
AddyAddress: 63 S G/ Cap {o7r'^/j s A �! J 201 cope to 400 amps 133.56 2
tate/ZIP: 401 amps to 600 amps 200.34 2
City/SPtx-Xr,•,J o 1Z ' 72.3 601 amps to 1,000 amps 301.04 2
Phone:(yf/3 ) Z. (3 - C/d.Zg Ova 1,000 amps or volts 552.26 2
Email: Temporary services or feeders IIIsmUstloo,alteration,and/or
relocatios
Owner installation:This installation is being made on property that I own which is not 200 amps or leas 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
•,APPu1cANT I ❑ CONTACT PERSON Brandt circuits-new,alteration,or extension,per panel .
_ A.Fee for branch circuits with
Business name: , f, yf/(gym .e.• / ./€cii--Z /e_ v9 V i above service orfeeda fee. 7.42 2
_�-9 / each branch circuit
Contaciname: 70/7`/ 6-c,414, i" /BeFhSfrn9Ci / sfmne Otneii B.Fee for branch cinvitswitout -
Addrcss: " D 3 C) Sr✓ Term 7 CQa/I Sa, rI C # l service a rmda fee resat 1 56.18 go./g 2
Z 9 lcP0P 7i II branch circuit
City/State ZIP: ka../ l/ CJ(Z 9 70 7 O ada911raodr atcun yes 7.42 2 af6.¢0 2
Spr/4 r Miscellaneous(service or feeder sot included)
Phone:($a3) 9t i -23$3 E: aelss471cecoetti;c-Eric.wry, Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: 7b/77 .2-c E co, ejeL�,c .cc n 6'• y+smireo')I ce(oelaer't(, Reconnect only 67.84 _ 2
CONTRACTOR Lnets Pump or irrigation circle 67.84 2
Business name: .-104--it.a! C�,ri m¢,C.al �deck,t" 4.9ntfart V Sign or outline lighting 67.84 2
Address: Z cJo3 c S r✓ Signal circuit(s)or limited-energy 0 See Page 2 2
TU'//t Clit�/ /�«f See•{-- 7yZ. 1 - /S-9 panel,alteration,or extension.
Each additional laapection over allowable In any of the above
City/State/ZIP: Ls/./Sgaii .//i 0 Q q Zm7O Additional inspection(1 hr min) 66.25/hr
Phone:(c-b-3 )9/(I -Z,3g3 Investigation(1 hr min) 90.00/br
Email: To'ri e ,�(� cp dec fy,L. co Industrial Plato(1 hr min) 78.18/to
Inspections for which no fee is 9p,00!hr
CCB Lie: 1/� Electrical Lic.. c 3 i S specifically l l% 30� C SZ Suprv.Liar; I y listed('h hr min) 1
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: CUV�,is� !../ Subtotal: 3 C . q
1� , $
Print name: 10 y7 ,-(, /.'+i- / 10 Date: I Z/I6 f� ❑Plan Review Required(25%of permit fee):
9 State surcharge(12%of permit fee): Lit•ub
Authorized signatture'. i TOTAL PERMIT FEE 3 qs,S�
' � pd (//jl Y Thispermit application aspiro ifa permit le met obtained within L80
Print name: T- (,- r TT..f- Date: I"L/ �'z p Jaya after it has been accepted u complete.
• Number of impatient allowed per permit
l:'Batidm¢IPemitUELC_Perm'vAp 1I.R_OtEdoc Rev 10/26/2017 4404615T(11/05/COM /
Branden Taggart
From: Branden Taggart
Sent: Monday, December 21, 2020 7:10 PM
To: tom@icecoelectric.com
Subject: Permit for Village at Washington Square: ELC2020-00646 - 11157 SW Hall Blvd
Attachments: Invoice.pdf
Hi Tom,
The Electrical permit for the Village at Washington Square is ready to issue now. The balance due is$395.34, and I have
attached an invoice above for you to reference. The permit fees can be paid online through our
website: https://aca.accela.com/tigard/Default.aspx. From there, click on the Building tab, enter the permit number
(ELC2020-00646) in the Record Number field, and click Search. Once paid, please notify us at
TigardBuildingPermitsPtigard-or.gov, and we will email the permit paperwork to you.
Thank you,
Branden Taggart
a City of Tigard
,. Senior Permit Technician
Community Development
"FIG AIttT
13125 SW Balk Blvd
Tigard, OR 97223
(503)718-2449
brandent@tigard-or.gov
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