Permit ELECTRICAL PERMIT
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° CITY OF TIGARD � �� COMMUNITY DEVELOPMENT
,Permit #: ELC201.0 -00010
T IQRD 13125 SW Hall Blvd. Tigard OR 97223 503.639.4171
Date iss ued: 01/08/2010
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Parcel: 1S1260000300
Jurisdiction:. TIGARD
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Site address: 9677 SW WASHINGTON SQUARE DR CO5
Subdivision: Lot: 0
Project: Aeropostale
Project Description: (16) branch circuits for TI
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 16 crt Branch Circuits 01/08/2010 $167.48
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 01/08/2010 $20.10
Electrical
Contractor:
A & A ELECTRICAL CONTRACTORS INC
1588 SKY TERRACE
SALEM, OR 97306
PHONE: 503 -949 -3193
FAX: 503 - 378 -9085
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $187.58
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 a • -- ' h approved plans. This permit wit expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. AT - TION :'Oregon law r t -'res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 1010 through OAR 952 -I ° -0100. may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6• •9 or 1.-00.332.2344.
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I r, e ued By: ! , _ .. ' i ' � Perrnittee 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: g` /e,
LICENSE NO.
Ca11 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'sitei completion of the project.
Approved plans are required on the job site at the'time of each inspection.
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El Permit Application ; 0 , �� .� pFORO FILE U SF [ION , � �, '�'{'�
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Cl>ly Of Tigard DateB ' / f w elFiir Permit No.' - ESC v /0 l0
111 111 1 13125 SW HaII`Blvd., Tigard, OR 97223. 'Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
. 1 - 1 GA R D Inspection Line: 503.639.4175 Date Ready /By: luris 0 See Page 2,fo`r
N otified/Method: . T f Supplemental , information
Internet: wwwaigard- or.goy
„ :` TYPE OE WORK PLAN REVIEW "
❑ New construction ❑ Addition/alteration /replacement Pleaseicheck all that apply (submit 2 sets of plaris w /stemschecked below)':
❑,Service or feeder 400,amps;or more - ❑ Building over three stories.
,0 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 ❑ 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 'El Addition of new motor load of ❑ A>, `` -E , I -2 " ,
/ '� �7 / tl 100HP or more. occupancy.
Job no.: Job site address:
�N / / i-) ((�CP j r^C71/1
0 Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: � ❑ Health -care facilities. ❑ Supply voltage for more than
•� --t a4.-c -? ❑ Hazardous locations 600 volts nominal., ,
Suite /bldg. /apt. no.: Project name: 11 c . 4 a / - UJ h .� ❑ Service or feeder 600 amps or more.
Ai-g- ' 1 - �G a FE E SCHEDULE
Cross street/directions to job site: Description I Otv. I ? !Fee: 1 Total' ' I •
( A ) .. ew residential single - or multi- family dwelling unit.
La-� fi r- ' '' ` f1.�. . d ce e l a- eit �� K q w* Includes attached garage.
Subdivision: Lot no.: QQa_ 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33:92 .1
'Fax map /parcel no.: Limited energy, residential • v - DESCRIPTION OF WORK , " - ' :' •e (with above sq. ft.), 67.84 2
Limited.energy, multi- family 67,84 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or.relocation
. 200 amps or less 100,70 2_
❑ PROPERTY OWNER ❑ kT ' , 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: . Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property I own which is not 201'amps to 400•amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 4.47, 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
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APPLICANT , .3 NI tCONTACT ,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, i 56.18 5 to ' u 2
first branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 62.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or. irrigation circle 67.84 2
1:7. ' " " .., '' CONTRACTOR a `... " °' Sign or outline lighting 67:84 2
Business name: �[ ' / (J / ✓,, Signal circuit(s) or limited-
✓ J / �( �GCX `tl�5 `c� C C energy panel, alteration, or
Address: C extension. Describe: Page 2 2
r S & C K•i'j t '1�airC C
City/State /ZIP: S � e- _Each additional inspection over allowable in any of the above
(
S - c C
,_— Per inspection 66.25
Phone: ( ) �j ' -_ l I Fax: (S ) � l O t ..S Investigation per hour (1 hr m 66.25
CCB Lic.: �S� /53:7 It Electrical Lic.: 5 L -3 il C 1 Suprv. Lic.: 3 26 C � < Industrial p lant, er p. . hour 78.18
' ,`. ,t , LELECTRICAL;:PERMiT PEES"_ "" , ,
Suprv. Electrician signature, required: _ "� f / Subtotal: /67. «
Print -name: /Q � / Dat: /� / (� Plan review (25% of permit fee): 1:9— �� r� v ( ((( State surcharge (12% of permit fee): AO. /0
Authorized signature: ' TOTAL PERMIT FEE: / p.61
This permit application expires if a permit is not obtained within 180
Print name. Date. days after it has been accepted as complete.
* Number of inspections allowed per permit.
I: \ Building \Permits\ELC - PermitAppdoc 10/01/09 440- 4615T(11/05/COM/WEB
• Electrical Permit Application City of Tigard
•
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
rRESIDENT;IAL:WORrK;ONLI'?
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Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY;
Fee for each commercial $67:84
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
• ® Fire. Alarm Installation
❑ HVAC
❑ Instrumentation
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❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ 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
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09