Permit c i a CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00071
Date Issued: 02/11/2010
T[GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9483 SW WASHINGTON SQUARE DR AO6B
Subdivision: Lot: 0
Project: Pac Sun
Project Description: Add /alter (20) branch circuits and install (1) limited energy system.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 1 ea Services or Feeders - 200 02/11/2010 $100.70
amps or less
PHONE: 20 crt Branch Circuits w /Purchase 02/11/2010 $148.40
Service or Feeder
1 ea Signal circuit or Limited 02/11/2010 $67.84
Contractor: Energy Panel
A & A ELECTRICAL CONTRACTORS INC 1 ea 12% State Surcharge - 02/11/2010 $38.03
1588 SKY TERRACE Electrical
SALEM, OR 97306
PHONE: 503 - 949 -3193
FAX: 503- 378 -9085
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $354.97
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 •AR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 11111011 .1 t! . 1 1 NH ' I 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
SIGN r / ifirol SUP . C Date:
LICENSE NO. 3 7
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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Electrical Permit Applicatio i 1 s I oIZ c)I I I< I u� c)�l
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City of Tigard Received permit No.:
° 13125 SW Hall Blvd., Tigard, OR 97223 FEB 1 Date/B : ` . ki4A 9 -002°2-
g Plan Review
11 •', Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
1:1 t r n I I . u r Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: funs' 21 See Page 2 for
1 :r Internet: www.tigard - or.gov BUfl DIVISION ION Notified/Method: Supplemental Information
. TYPE OF WORK fu \� till �1 PLAN REVIEW
❑ New construction ❑ Addition ItCCaUO eplacement 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: 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 /i ustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master uilder ❑ 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.: JOb site address: u W f IOOHP or more. occupancy.
(r �: ( Jet ' f L464, 'U® Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: U ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ,Pza ❑ Service or feeder 600 amps or more.
C '� FEE SCHEDULE
Cross street/directions .to job site: Description I Qty. 1 Fee. I 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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK ' . (with above sq. ft.) 67.84 2
Limited energy, multi - family 67.84 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less f 100.70 2
. . ❑ PROPERTY OWNER . 0 TENANT • 201 amps to 400 amps 4 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Ci (State /ZIP: Temporary services or feeders installation, alteration, and /or
tY relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
Y dwelling, service and/or feeder
Phone: ( )
Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
• CONTRACTOR Signal circuit(s) or limited - energy t
Business name: panel, alteration, or extension. ` Page 2 2
�� � - (' P_ - ' mo t, C �, C.
l/ � �t Each additional inspection over allowable in any of the above
Address: / S 1 - C C c: Additional inspection (1 hr min) 66.25/ hr
' E Investigation (1 hr min) 66.25/ hr
City/State /ZIP: - SC( ( ig -74/ G� 7 3 0_6,
Industrial plant (1 hr min) 78.18/ hr
Phone: (57j 3) / 3 / / > Fax: 2) . 3 7 - ?d .% c' Inspections for which no fee is 90.00 / hr
specifically listed (' /n hr min)
CCB Lic.: ! � r?/ � Electrical Lic.: 36 J EL Suprv. L 3 7/ l.. ELECTRICAL PERMIT FEES
• / J Subtotal:
Suprv. Electrician signature, required:
!�� Plan review (25% of permit fee):
11 /1 / d
Print name: " 1 I^� f Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 654 Q'7
Authorized signature: 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.\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I, RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n C lock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n M edical
❑ Nurse Calls
n O utdoor 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- PermitApp.doc 10/01/09