Permit CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELC2010 -00491
T1 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9669 SW WASHINGTON SQUARE DR CO3
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Express
Project Description: Electrical TI, (1) 350a service, (55) branch circuits and (1) low voltage for audio /stereo wiring.
Owner: FEES
• PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 1 ea Services or Feeders - 201 to 09/14/2010 $133.56
400 amps
PHONE: 55 crt Branch Circuits w /Purchase 09/14/2010 $408.10
Service or Feeder
1 ea Signal circuit or Limited 09/14/2010 $75.00
Contractor: Energy Panel
FRAHLER ELECTRIC CO 1 ea 12% State Surcharge - 09/14/2010 $74.00
11860 SW GREENBURG RD Electrical
TIGARD, OR 97223
PHONE: 503 - 639 -4627
FAX: 503 - 639 -4673
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $690.66
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in a ance wiith-41pproved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT TION: Oregon I re ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules age set forth in OAR
952 -001- 10 through OAR 95 1 -01 0 You may obtain a copy of the rules or direct questions to OUNC by call'::-13.2. 6.6699 or 1.800.332.2344.
r -
Issu d By: 4 ` _ '� Permittee nature: _ .1 ,E l�f
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE • Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' ( ��� Date:
LICENSE NO.
Cali 503.639.4175 by 7:00 a.m. for an Inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Electrical Permit Application 1_OR c►1 1 IcE list:. (►N -
City of Tigard RECEIVE B e /o Per No.:
114 /0 eke Ao /D - Gr4 ,7
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
G Phone: 503.639.4171 Fax: 503.598.1960 S E P 1 f 204 Date/By: Other Permit:
I 11 n I: n Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard ocgov CITIt'Iffirk . ' (,i�
likOd/Method: Supplemental information TYPE •OF WORI$U1 1 M 03IO' . PLAN REVIEW k . . • •
❑ New construction El Addition/alteration /replacement Please check all that apply (submit a 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 ® 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 A
❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "i -2 ", "1 -3 ",
I00HP or more. occupancy.
Job no.: 67780 Job site address: EXPRESS - WASHINGTON SQUARE ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 9669 SW WASHINGTON SQUARE ROAD, #2049 ❑ H Hazardoa ar l ❑ 600 p ltage al more than
. Suite/bldg. /apt. no.: I Protect name: EXPRESS T.I. ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Otv. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
/ arcel Ea. add'I 500 sq. ft. or portion 33.92 1
Tax ma no.:
map /parcel Limited energy, residential
DESCRIPTION :OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
TENANT SPACE WIRING residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation -
200 amps or less -100.70 • 2
❑ PROPERTY OWNER ' . . ... .• . ❑ TENANT ... _ .! - 201 amps to 400 amps - (350a) • 1.• 133.56 133.56 2
401. amps to 600 amps • • 200.34 2
Name: _ - _ . - . - - - 601 amps to 1,000 amps _ 301.04 2
Addre .. Over 1,000 amps or volts '552.26 12
Temporary services or feeders installation, alteration, and/o
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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 ' , I : ❑ • CONTACT .PERSON _ above service or feeder fee, 5 5 7.42 408.10 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
branch ri..
n - Each add'l branch circuit I 7.42 I 12
Address: Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 67.84 2
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: FRAHLER ELECTRIC COMPANY panel, alteration, or extension. 1 Page 2 75.00 2
Each additional inspection over allowable in any of the abov
Address: 11860 SW GREENBURG.. ROAD Additional inspection (1 hr min) 66.25/ hr .
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: TIGARD,._ .OR - - .97223 - . - - - • - -- - • - - -- - - -- - Industrial plant (1 hr min) 78.18 / hr
Phone: (503i 639 -4627 . _ - _. _ Fax:_( 503)_. 639 -46.73- - ... Inspections for which no fee is
specifically listed (%A hr min) - - 90.00/ hr
CCB Lic. 37410 - - Electrical Lic.: - 34 -13 i Su Lic : 1816S - - -.. ELECTRICAL PERMIT !TEES
�� / G / f subtotal: 1 616.66
Suprv. Electrician signature, re ed: Pla review (25% of permit fee):
Print name: R. W. Date: 09/09/10 State surcharge (12% of permit fee): 74.00
TOTAL PERMIT FEE: 690.66
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:\ Building \Pennits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11 /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 $75.00
Check Type of Work Involved:
U 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 $75.00
system
(SEE OAR 918- 309 -0000)
•
Check Type of Work Involved:
IN Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
1:\Building\Pe nits\ELC- PrnnitApp.doc 07/01/10