Permit . CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2010 00319
' ` . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/29/2010
T l GARI) Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9771 SW WASHINGTON SQUARE DR D08
Subdivision: Lot: 0
Project: CCS
Project Description: Electrical for TI.
Owner: FEES
PPR,INASHINGTON SQUARE LLC Quantity Description Date Amount
22352FARADAY AVE STE #O
CARLSBAD, CA 92008 31 crt Branch Circuits 06/29/2010 $278.78
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/29/2010 $33.45
Electrical
Contractor:
A & A ELECTRICAL CONTRACTORS INC
1588 SKY TERRACE
SALEM, OR 97306
PHONE: 503 -949 -3193
FAX: 503-378-9085
Typetof Use: COM
Class of. Work: ALT Type of Const:
Occupancy'Grp:
Total $312.23
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
pp p permit will .expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
dayss, , ATTENTION: Oregon law requires res you 'to . follow the A
• daythrough O 952 You rules adopted by the Oregon Utility Notification Cent Those rules are set forth in OAR
TTEaequi _
co. rules or direct questions to OUNC by calling 503.2 46 800.332.234 •. -
•
Issued B - i — �_ - Permittee Signature:
4110%). '
OWNER INSTALLATION ONLY
The installation is being made on property I own which is notintended 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.
Electrical Permit Application 4 , ;y r � 4% .z .° m t 1' G t' * O R O ''O : L.. \` ,E
V e ��
Permit No.:
City Of. Tigard D/ Rec Datr
etB ed : 6
III
° 13125 SW Hall Tigard, OR 97223 � Plan Review
- - --
: C "" ` ' Ot her Permit:
Phone: 503:'639.4171 Fax: 503.598:196 ��t Date/B :, . Mo. -. i% it, O ♦ .
7 I G °A R D, Inspection Line: 503.639.4175 UA` L " ` Date Ready/By: Juris: r See Page 2 =for
Internet: www.tigard -orgov J N 4, t Supplemental Information
TYPE OF WORK 14.0 ' S 0' - - ' • PLAN REVIEW
t .
` i
❑ construction ❑ Addition /alteration/repl g t�
� l } � Please'check all that apply (submit 2 sets of plans'w /items checked below):
B 'ti ❑ Service or feeder 400 amps or more. ['Building over three stories.
❑, Demolition ❑Other: where the available fault current ❑ Marinas and boatyards.
- " E
- ` . exceeds 10,000 amps at 150 volts or ❑'Floating buildings.
" � ° � CATGORY O F CONSTRUCTION :. - . - ■ , -
less'to ground, or exceeds 14,000 ❑ Commercial -use 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;,AN L OCATION ❑
- . _ ❑ Addition of new motor load of ❑ "A ", "E , "t -2 ", "i -3 ",
Job no.: Job site address: 100HP or more. occupancy.
1 L L Imo — 4 1:. — ❑ Six or more residential units. ❑ Recreational vehicle parks.
_
- ❑ H ealth -care f Supply voltage for more than
City /State /ZIP: �3 dVIC.( ( 600 volts nominal.
❑ Hazardous locations.
Suite /bldg. /apt. no. Project name:' s "� � ` / '❑ Service or feede 600 amps or more.
El ( FEE S CHEDUL E
Cross street/directions to job site: 1 r� I f' Description I Qty. I Fee. 1 Total I •
I — ` T -- )L �!` p i /� ` y` New residential single- or multi - family dwelling unit.
S i 1 ..- k, a Includes attached garage.
Subdivision: 0,c /I ' 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,
DESCRIPTION OF WORK. - " (with sq ft.) ntial 6 4 2
" h abo
Limited energy, multi- family
1 (0�a ,L/ Y residential (with above sq. ft.)
67.84 2 Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
. ._ _ .
' 11 PROPERTY OWNER, ' = , ❑ ` TENANT !.. , 201 amps to 400 amps 133:56 2
401 anips; 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
City/State/ZIP: /State /ZIP: Temporary services or feeders `installation, - alteration, and /or
Y relocation
•
Phoney( ) 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
d for sale, lease, rent, or exchange,. according to ORS 447, 449, 670, and 701. 401 antes to 599 amps 168.54 2
Owner
Branch circuits — new,,alteration;•or extension, per panel
• Ownersignature: Date: A. Fee for branch circuits with
-- ; • T • I, - - above service or feeder- fee
❑ APPLICAN , '• - . ® . . 1CO NT ACT ,PE . " 7.42' 2
each:branch circuit . (01
Business name: B. Feefor branch circuits withou
`service or feeder fee, first . "--/ Contact name: branch circuit .. 56.18 J Lo i'l 2
Each,add'I; branch circuit 7:42 2
Address: Miscellaneous (service orfeedernot;included)
/S Each Jnanufactured'ormodular
Ci
ty tate /Z1P dwelling, service and/or feeder ' 67:84 2
Phone: (' ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E =mail' -
Sign or outline lighting 67.84
n � '' li 2
- - Signal circuit(s) or limned energy
Business name: � �'�l��� / panel, alteration, or extension. Paget
A?� ��L LL2 Each additional inspection over allowable in any of the-above
Address: (3.---i' E l S S Additional ,inspection (1 hr min) 66.25/.hr
City /State /ZIP: Investigation (I hr min) 66.25/ hr
��� �` Industrial plant (1 hr min) 78.18/ hr
Phone: .— .. l O 0 Ins coons for which no fee is
( c �/ 93 F specifically listed( %z hr;min) 90.00 / hr
CCB Lic.` tl ( Electrical Lic.:' Suprv..L"ic.: - ' . • ELECTRICAL PERMlbT S'.
Subto
Suprv. Electrician signature, required: � ' c 7,, _ -
I Pl an review (25% of permit fee):
Print name: a ' 1' Oat': State surcharge (12% of permit fee): 33 t L s --
TOTAL PERMIT FEE: '' ( )„ „a3
Authorized signatur` - . 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.
3 f \ 13Y IV(V c-3u
I\Building\Permits\ELC- Permit pp.doc 10/01/09 440- 4615T(I1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
, - 17114NTIAL WORK ONLY: 1
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System* _
❑ Vacuum Systems*
❑ Other:
j, .COMMERCIAL 'WOW ONLY: r . - 71
Fee for each commercial $67.84
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation •
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
L\ Building \Permits\ELC- PermitApp.doc 10/01/09