Permit b q IN '�' '' CITY OF TIGARD ELECTRICAL PERMIT
U COMMUNITY DEVELOPMENT Permit #: ELC2010 00138
' ; Date Issued: 03/25/2010
T1GARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
iT ;. __.:,; , Parcel: 1 51260000300
Jurisdiction: TIGARD
Site address: 9508 SW WASHINGTON SQUARE RD J01
Subdivision: Lot: 0
Project: Clearwire
Project Description: Add /alter (1) branch circuit.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 1 crt Branch Circuits 03/25/2010 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/25/2010 $6.74
Electrical
Contractor:
FIVE STAR ELECTRIC, INC.
PO BOX 555
BANKS, OR 97106
PHONE: 503 - 324 -0948
FAX: 503- 324 -0973
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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 OAR 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: C1 � (� � JD Perm ittee 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' "-.S) Q /1 Date:
LICENSE NO. `C �
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.
From: ,° � �'.� #� 03 /25/2010 11:16 #003 P.002/003
Electrical Permit Application MAR 2 5 ' 2010 , i�OR QFFIC L t SE ONLY .
City of Ti and t Received p ermit No.:
g , • :, • . ., DateB : �. 4 A' 4 ,,,,,20. „,,,20. q 13125 SW Hall Blvd., Tigard, OR 972230. ' ., ” i ' Plan Review Now
III
6 Phone: 503.639.4171 Fax: 503.598.1960 •,' ' 't t ;. Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: �t ^r}`' El See Page 2 for
T I GAR D Internet: www.tigard- or.gov Notified/Method': ` _ Supplemental information
TYPE OF. WORK PLAN REVIEW
❑ New construction dditio Vaalter /replacement
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 -usc agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. Larger separately derived system
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ ' A ", "E "1.2 ". "1.3 ",
r, I0011P or more. occupancy.
Job no.: F5 60 Job site address: ` 1f 1 % � , ' t ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP , {r�,1� G �J
❑ Health -care facilities. ❑ Supply voltage for more than
r '1
■ ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: _1 n ' ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: a r \, re Description _ 1 Qty. i Fee. 1 Total r •
New residential single- or multi- family dwelling unit.
. LLw ,it ti -_ , - l' , 1 _a... Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or Tess 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPT8UN OF WORK ' (with above sq. ft.) 67.84 2
akii . l ( l 4 ' �l / 1 L energy, multi-family ) 67.84 2
�Q C �(,,1 residential (with th above sq. ft.
` 4 Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 I 2
.• . • , ❑ PROPERTY: OWNER • • ❑ TENANT - 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
ty relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 4Q0 amps 125 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 168.54 1 2
Branch circuits — new, alteration, or extension, per panel _
Owner signature: Date: A. Fee for branch circuits with
0 APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, ` 56.18 42 , 2
first branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( ) 1 Fax:: ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
' CONTRACTOR - Sign or outline lighting 67.84 2
Signal panel, er or limited -
Business name: Five Star Electric, Inc.
energy panel, alteration, or
Address: PO Box 555 extension. Describe: Page 2 2
City /State /ZIP: Banks, OR 97106 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 324 -0948 I Fax: (503) 324 _ '
Investigation per hour (I ltr tntn) 66.25
CCB Lic.: 158231 Electrical Lie.: 34-665C S . •rv. Lic.: 4622S Industrial plant per hour 78.18
. • ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ' ,.1 Subtotal: 5L, , 1 dio
Print name: Royal Stearns j D ate : o 2 r ' I 0 Plan review (25% of permit fee):
- -- / L 1 State surcharge (12% of permit fee): U .A
Authorized signature: TOTAL PERMIT FEE: (.0cQ °O.--
This p ermit application expires if a permit is not obtained within 480
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
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