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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 -00265 fi Date Issued: 06/02/2010 T FGARF3 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S1260000300 Jurisdiction: TIGARD Site address: 9785 SW WASHINGTON SQUARE DR D12 Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project: Radio Shack Project Description: Installing sign lighting. Owner: FEES PPR WASHINGTON SQUARE LLC Quantity Description Date Amount 2235 FARADAY AVE STE #O CARLSBAD, CA 92008 1 ea Sign or Outline Lighting 06/02/2010 $67.84 PHONE: 1 ea 12% State Surcharge - 06/02/2010 $8.14 Electrical Contractor: RAMSAY SIGNS INC 9160 SE 74TH AVE PORTLAND, OR 97206 PHONE: 503 - 777 -4555 FAX: Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $75.98 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 folk adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. • •• - obtain - - •r direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: /.G� _ �� 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' 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. i t q M� t,�'�F i iP "r fi +` c} V �l t :.:, u L Mf + d t 7 C + r I 4 + " Electrical Permit Application � � ±; �; + , t ut,oi op I ic1, 1SH ,ON Y ' "� - , ,i , ; K a MI /p 1 '+'�a'+ Received �" /� + I °��r City of Tigard �� Date/By V /iO I Pc rmn No.: 6 Itt `�,P S 13125 SW Hall Blvd., Tigard, OR 9722_ ,,II © Plan Re view tJ uV t(J a •v h Phone: 503.639.4171 Fax: 503.598.1960,'- Date/By: Other Permit: T l G A R Inspection Line: 503.639.4175 0 Date Ready /By: lulls. 10 See Page 2 for I 4 U', r ", Internet: www.tigard or.gov �� � ∎ 4fiied /Method: TO Supplemental Information ■ • TYPE OF WORK 1 ' S `I V G� I �IS , PLAN REVIEW 56 New construction El Addition/alteration/rep `(0 Please check all that apply (submit 2 sets of plans whtems checked below): V v l=1 Demolition El Other: El Service or feeder 400 amps or more ❑ Building aver three stories. where the available fault current ❑ Marinas and boatyards. . . CATEGORY OF CONSTRUCTION ' . exceeds 10.000 amps at 150 volts or ❑ Floating buildings. Tess to ground. or exceeds 14.000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling NI Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder 111 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' "I 2" "I �" Job no.: Job site address: 9 185 1OOHP or more. occupancy. .......... W • ��� , 0 • ❑ Six or more residential units. ❑ Recreational vehicle parks. /� f� /� ❑ Health -care facilities. ❑ Supply voltage for more than City /State /ZIP: �]' •� �+� �� <J ❑ Hazardous locations. 6(5) volts nominal. Suite /bldg. /apt. no.: Project name: RADb A t/ ❑ Service or feeder 600 amps or more. `� 0..J �h�� FEE SCHEDULE ' Cross street /directions to job site: Niv T,_ IN ALL. Description 1 Qt). 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.) 6284 2 ' Limited energy. multi - family 67.84 2 1 ft3 STALL Lot+er=r S�t� residential (with above sq. ft.) t�l Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 0 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 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 above service or feeder fee. ❑. APPLICANT ❑ CONTACT PERSON 7. 2 - each branch circuit Business name: B. Fee for branch circuits without service or feeder fee. first Contact name: branch circuit 56.18 2 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 1 67.84 Ca? 2 . ' CONTRACTOR _ ' Signal circuit(s) or limited-energy panel, alteration. or extension. Page 2 2 Business name: fzt�w►S Iq 1a,,,, eo • Each additional inspection over allowable in any of the above Address: (11 !a0 S.E . 14174 A E Additional inspection (1 hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City /State /ZIP: �� Iq�` f V EG • ( 4'120( 4 Industrial plant (1 hr min) 78.18/ hr Phone: (5)01, lt+ + �� ' Fax: �� Inspections for which no tee is 90.00/ hr 11�V7 O � ��� specifically listed ('h hr min) CCB Lic.: l t Electrical Lic.: 'J 49 tit4 Suprv. Lic.: 14C43s I G • ELECTRICAL' PERMIT - FEES yy �� Subtotal: Suprv. Electriciadl'i at required: 0a���a/`/� I 1 11 o �� 1..../..."P' Plan review (25% of permit fee): ,,/ Print name: ?h LL C i / ", C� D e: /_ - / _!71 State surcharge (12% of permit fee): gig- v V w L i `l TOTAL PERMIT FEE: 7611 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. 1: \B uildinglPcrmi6AELC -Perm itApp.doc 10/01/09 440- 4615T/ t 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 H Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* ❑ Other: COMMERCIAL .WORK ONLYi Fee for each commercial $67.84 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* n Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1:\ Building \Permits\ELC- PermitApp.doc 10/01109