Permit h W.r ELECTRICAL PERMIT
, �`` fge CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00241
T 1 GArib 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/19/2010
,„ Parcel: 1S1260000400
Jurisdiction: TIGARD
Site address: 9800 SW WASHINGTON SQUARE RD
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Sears
Project Description: Extend (2) branch circuits for cash register in the appliance department.
Owner: FEES
SEARS ROEBUCK AND CO Quantity Description Date Amount
DEPT 768TAX, B2 -116A, 3333 BEVERLY RD
HOFFMAN ESTATES, IL 60179 2 crt Branch Circuits 05/19/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/19/2010 $7.63
Electrical
Contractor:
ADVANCED WIRING SERVICES INC
PO BOX 644
CLACKAMAS, OR 97015
PHONE: 503 - 310 -3655
FAX: 503 - 698 -6372
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit i • - • • t to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance with - • •roved •tans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TTENTION: Oregon la quit s y• to follow the rules adopted by the Oregon Utility Notification Center .e rule,, . set forth in OAR
95 01- 0010 th ough OAR 952 -0• -0100. Y. y obtain a copy of the rules or direct questions to OUNC by calling 503.246.6• • • • * • 2 � s i t
Issued By: / ` 4 L I/ /'l:. 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 /
SIGNATURE OF SUPR. ELEC' 4i 4Q� c5
Date: 91 v
_....._ ____
LICENSE NO.
CaII 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 Application 1 .10 4 '' .�� " O ) Nisi i Si x ) N' I \ , 1 , "'* 4 '
"' � ✓• ) : i YCt�S;6zito.,& ii' . iiio w''t " vnr g�IG�93i`' ". a W'�.'#ti�ti�"rdd:q'�,`'�ai ear,'
City of Tigard R 6 Permit No.: „ p /p•- t Z 2
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
: :; ; 0 ..q, Phone: Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date/B
"` Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
1,16 ,v „„ I) Internet: www.tigard or.gov Notified/Method: Q Supplemental Information
TYPE OF WORK - • PLAN REVIEW -
❑ New construction X Addition/alteration /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 -use agricultural
❑ 1- and 2- family dwelling 14 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ 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 ", "1 -3 ",
100HP or more. occupancy
Job no.: Job site address:
.. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP:
gf00 61.E H-/ �ao 7'Z ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: CGo`fgS ❑ Service or feeder 600 amps or more.
. FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 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'I 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
/`� cn Jb Cleat )-is On g ( � residential (with above sq. ft.)
ri Y� Services or feeders installation, alteration, and/or relocation
(/,1 11� t r 200 amps or less 100.70 2
�� 14 0• - .t-k. ^^ ' ❑ �• 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 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 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 5 �p - /g 2
Contact name: branch circuit 1
Each add'I branch circuit j 7.42 7. II 2 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
Business name: AmAN,� v 1/41,2, Alf_ icE 11.1C , panel, alteration, or extension. Page 2 2
/ Each additional inspection over allowable in any of the above
Address: P OV, 4,4 Additional inspection (1 hr min) 66.25/ hr
n �((J 9---761_.c
Investigation (1 hr min) 66.25/ hr
City /State /ZIP:
CvA�A Ut` -
Industrial plant (1 hr min) 78.18/ hr
Phone: (S O3 ) ;JO - 36,.. Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%A hr min)
CCB Lic.: 1,Z5 / / Electrical Lic.: C 7 / Suprv. Lic.: 1/475. . . ' ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: � r Subtotal: 1); , ( 0
d / / AP Plan review (25% of permit fee): - '®---
Print name: Saw Nu A177 ro :To^ f Date: 5//q// 6 State surcharge (12% of permit fee): 7. 4'5
TOTAL PERMIT FEE: 7/ • jL 55
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
I.\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(1 I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
•
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
H Heating, Ventilation and Air Conditioning System*
H Vacuum Systems*
H Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
H Audio and Stereo Systems
❑ Boiler Controls
H Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
H Intercom and Paging Systems
❑ Landscape Irrigation Control*
H Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
t\BuildingPermits\ELC- PermitApp.doc 10/01/09