Permit CITas OF TIGARD ELECTRICAL PERMIT
T PERMIT #: ELC2007 -00701
1 1 .: ":1 COMMUNITY DEVELOPMENT DATE ISSUED: 10/11/2007
T1GARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 135BA -00102
SITE ADDRESS: 10104 SW WASHINGTON SQUARE RDA - 2A ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE TOO LOT : 001 JURISDICTION: TIG
PROJECT: AT & T
Project Description: (1) sign lighting.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASHINGTON SQUARE LLC RAMSAY SIGNS
BY THE MACERICH COMPANY 9160 SE 74TH AVE
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97206
TIGARD, OR 97223
Phone: Contact #: PRI 777 - 4555
FEES
Description Date Amount Reg #: ELE 26- 106CLS
'TAX] 8% State Surcharge 10/11/200' $4.27 LIC 63422
IELPRMT] ELC Permit 10/11/200' $53.40 SUP 493S1G
Total $57.67 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: 4B C,. .p.,6. 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
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
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.
Electrical Permit Applic ti d > a : ` ` c. ` � U SA ONE Y 1 ` ;t
Q,.(>>k4k1T n t'i T i- I , T ITI t4 +r ,aT? .trri ... [ ITI:4 .,.t, -:: , •;j=' ! 2t
� City of TigQard r i y Received
Pc rn,il No. _ C(57 0
` r y' tr _. y b S'' 1 . 001 D ate /B} (4 . r l r V/ 6 Q.( i
a r ° 13125 SW Hall Blvd., Tigard, OR 9 7 2 2,, Plan Review
1 (
4' ' Phone. 503.639.4171 Fax: 103: +9 .I9/JO„ c r. i ,: Date/By Other keno.
''A Inspection Line: 503.639.417 2 - -I �-F-I i I Date Ready /B )��ris: ® See Page 2 for
TICARD �; . I NIG Z DIVISION lied /Method
li • m
Supplemental
x. tom , I nternet: www.Ugard or.g
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
El New construction Er Addition/alteration/replacement
❑ Service or feeder 40(1 amps or more ❑ Building over three stories.
E l Demolition ❑ Other: where the available Paull current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.00)) amps at (5)) yobs or ❑Floating buildings.
less to ground. or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1- and 2- farnily dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA of
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition or mew motor load of ❑ 'A ' h . °I I -�'.
n
c I(N)HP or more occupancy
W
Job no.: Job site address: / b /6 G� St ask', �I re)- � Jc 0 or more residential units. ❑ Recreational vchick parks.
CI[ /Slate /ZIP: ❑ Health-care facilities. ❑Supply voltage for nwre than
y I '{r 0 1` ❑ Ha¢ :rd )us locations. 600 volts nominal.
Suite /bldg. /apt. no.: tei D 2 Project name: A •t- 7-- ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Wel (J 0, P L.e Gk__ Description 1 Qty. 1 Fee. 1 Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision:
Lot no.: 1.000 s9. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy. residential
75.00
'DESCRIPTION OF WORK (with ahovc sq. ft.)
p p Limited energy, multi- family 75.(10 2
ci.t v' a I a2� . / __e (L_ -e._,§.--1-:` ' residential (with above sq. It.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
Er PROPERTY OWNER ❑ TENANT • ' 201 amps to 400 amps 106.85 2
^� c_ 4 / / 401 amps to 600 amps 160.60 2
Name: // Q C �ic� 601 amps to 1.000 amps 240.60 2
L '
Address: / v) /6 A re , g / V '-/ 5..„ e o Over 1.000 amps or volts 454.65 2
City/State/ZIP: p L ]� Temporary services or feeders installation, alteration, and/or
S 0_4416k_ GL J'1 O 3-7 1 C Gs A . relocation
Phone: (5 7 ) 3 5 Z ' q Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is heing made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease. rent, or exchange, according to ORS 447. 449, 670. and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
la ❑ CONTACT PERSON ' above service or feeder fee.
6.65
each branch circuit
Business name: J `'tit S /, , cry yy c B. Fee for branch circuits
- without service or feeder fee, 46.85 2
Contact name: 5„Fe ,t4_e ijA / h -e4- first branch circuit
Each add'I branch circuit 6.65 2
Address: 9/ 4 0 S 7 �?"' r" -
Miscellaneous (service or feeder not included)
City /State /ZIP: /4 Oi� Each manufactured or modular
90.90 r / dwelling, service and /or feeder
Phone: (503) 77'7 `'f 5" Fax:: ( ) Reconnect only 66.85 2
E - mail: Pump or iiTigation circle 53.40 2
CONTRACTOR Sign or outline lighting / 53.40 5 3 yo 2
Signal circuit(s) or limited-
Business name: Rehr) t' �N�
' ��//J energy panel. alteration, or
Address: � ' ` extension. Describe: Page 2 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5t j ) 77 9 c3 Fax: ( ) Investigation per hour 11 hr min) 62.50
CCB Lic.:63y L Z Electrical Lic.: i _S Suprv. y35t - S Lic.: Industrial plant per hour 73.75
7 6/0 C ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: Date /
/�, %/.' �/ $ fe z y e' r /O/i/ / (5 State surcharge 18 °/r of permit Ice): L/
Authorized signature: „ - - ° TOTAL PERMIT FEE: 57, ( -7
This permit application expires if a permit is not obtained within 180
Print name: 5 fi e v e (4,4 / k e. },- Date: ([7 /� i / D 7 days after it has been accepted as complete.
x Number of inspections allowed per permit.
hi APermitsVl'1_C I'enniiApp. 05 /22/06 44(1- 4615'FI 1 I /05 /COM /WEB