Permit Support Document .,teFJAbLLif/riilliLfF1!)4'{iia.•ititN4fFNJ1tkNINtlJtliNtbFfHeJA4Mditae4NeN#ieANONEin/aeeSrsaAUCUNIisIAieJNAUJ4tflJJsilliis.uaatMR kUN•e •• •.•••,••• Y8• •'.`..uY rr....:... .r als.t: a.a..ex. -'sriai..xri ..iai.F:ia..r:, uuuua i.tiu.aa.u.r.,.:.n,....
CITY OF TIGARD ELECTRICAL PERMIT
7C
' COMMUNITY DEVELOPMENT Permit#: ELC2021-00700
Date Issued: 12/7/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9393 SW WASHINGTON SQUARE RD S07
Project: Cotton On Subdivision: None Lot: None
Project Description: (16)Circuits for store remodel.12/13/21 Reprint-address change.em
1
Contractor: JC ELECTRIC INC Owner: PPR WASHINGTON SQUARE LLC
1°41°118 NW 184TH STREET BY MACERICH RET
RIDGEFIELD,WA 98647 PO BOX 4085
SANTA MONICA, CA 90411
PHONE:
PHONE: 360-887-7889
FAX: 360-887-5584
FEES
Quantity Description Date Amount
16 crt Branch Circuits wo/Purchase 12/07/2021 $167.48
Specifics:
Service or Feeder
1 ea 12%State Surcharge- 12/07/2021 $20.10
Type of Use: CMS Electrical
Class of Work: ALT 45 Misc Administration Fee 12/13/2021 $45.00
Type of Const:
Occupancy Grp:
Total $232.58
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 throuah OAR 952-001-0090. You may obtain a coos of the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344.
Issued By: Ectga.rdo-Maial0v a-do- Permittee Signature: yet. apptie-a4-Lo-w
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'N 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 RECEIVE
CityofTigard eceived 3 � �tG 2''DZ�O
25 Date/By Permit a:
r 13125 SW Hall Blvd.,Tigard,OR 97223 Z�21 Plan Review
Phone 503.718.2439 Fax: 503.598.1960 DEC .1. ,.) Date/Ba: •
Related Permit a:
Inspection Line: 503.639 4175 Ready Date:By: Furls: -I21 See Page 2 for —
1 I t,A RI). Internet www-tigard-or guy CITY OF TIGARD Notified/Method: i Supplemental Information
TYPE OF wo UILDfNG DIVISION 7 PLAN REVIEW
❑New construction JR Addition'alteration/replacement Please check all that apply(submit'sets of plans w/items chucked)
❑Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories
1 where the available fault current 0 Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings
❑ 1-and 2-family dwellingT Commercial/industrial ID Accessory building J less to ground,or exceeds 14,000 0 Commercial•use agricultural
amps for all other installations buildings.
�❑Multi-family ❑Master builder ❑Other: 0Fire pump. 0 installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Addition of new motor load of system.
Job#. 1 Job site address:4313 5t)•1,444,,n5to St„4,4 /140HPormore. ❑"A" E' I-2""l-3"
oc anc
City/State/ZIP: ❑Six or more residential units. cuP y
' �141 f Of ah j 7Z 23 ❑Health-care facilities. 0 Recreational vehicle parks
Suite/bldg./apt.#: 5 07 TProject name: J}.},r},n On 0 Hazardous locations. 0 Supply voltage for more than
r-- T� L❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: —"
FEE SCHEDULE
,.Descriplba ...- I Qty.1-_,Each I Total 1•
,�� ra New residential single-or multi-family dwelling unit.
Subdivision: ppi
itiggit Lot#: Includes attached garage,1000 sq.0,or less 1 168.54 4
Tax map'parcel#: - _.
Ea.add'I 500 sq.Il.or portion 33.92
DESCRIPTION OF WORK Limited energy,residential
' '�` J yam, (with above I'll-family
q.tt.) 75.00 2
Ci 4) Gt fc.u►e,tS ,par 6fi'C Irt/►0, J Y VtL ) 14. 144 Limued ever
.4f _ _.44 1 r• 7(,-_ {1. 4 gLCZN I-��D0 residential(with bove sq.It.) ❑ See Page 00 ?
"`!`!� w+ll �1r F gy,muki-famil
Renewable Energy 0 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
.......... . .
Address: 201 amps to 400 amps 133.56 2
••- 401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) �_—tt Fax ( ) Over 1,000 amps or volts - 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less I 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps i 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT I ID CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
- •.• A Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
_.. each branch circuit
Contact name B.Fee for branch circuits i[•ithou �................._.-•-_.._n•. ___.
service or feeder fee,first
Address: 56.18 2
( branch circuit __
City/State,ZIP' Each add.'branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax' ( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: .._ -_-____—......__—
Reconnect Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67,84 2
Business name C„ 1't e.-ar . 4— Sign- or outline lighting 67,84 2
`" - _--- - Signal circuit(s)or litnitedlenergy
Address. $/J-7i Ne 13(1 j4J ,...panel.alteration,or extension, ❑ See Page 2 2
City State.ZIP: I ' �'/ Each additional inspection over allowable in any of the above
V+�'+�e Nova' i�#7 v S
Additional inspection(I hr min) 66.25 hr
Phone:(3 o)—IC4j'7_7 vi Fax:( ) Investigation(I hr min) 90.00.hr ,
Email: ��n����G_E�(A Industrial plant(I hr hick no) 78.18 hr
Inspections for which no fee is I
90,00 hr
CCB Lie: J 1 'y S'Z Electrical Ltc. 37_ Suprv.Lie,: 2 g Si specificalh listed f Vi hr min) �T
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name: )vt e-OtAl,N,I,6I Date: ;,,/ t 0 Plan Review Required(25%ofpermit fee):
State surcharge(1254 of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I:$addnig\Pormits'ELC_PcrmiiApp_ELR ERE doe Res06:17.2015 440-4615T(11'05/COMAVEB