Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 00497
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9477 SW WASHINGTON SQUARE DR A07
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Best Buy Mobile
Project Description: Electrical for TI.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 5 crt Branch Circuits 09/14/2010 $85.86
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/14/2010 $10.30
Electrical
Contractor:
SUNRISE ELECTRIC CONSTRUCTION LLC
2831 NE 59TH AVE
PORTLAND, OR 97213
PHONE: 503 - 281 -6832
FAX: 503 - 289 -0614
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $96.16
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 issuan , or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cen r. Those are orth in OAR
952 - 001 -0010 through 0. • • 2- 001 -0100. You may ob ain a co ._..,1 a_direct questions to OUNC by calling 50 . 4 6 r 1.800.332 , 34
Issued B _ _ lc ' i Permittee Signature: IL 1 111#
IP
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.
Electrical Permit Application
City of Tigard 4 �1 R ece i v e d
` 1� yam,
1 14 13125 S W Hall Blvd., Tigard, OR .'... k = �' s Date/By: Plan R I � �� PenultNo.: � �Gv v 1 � — 00 -: a
0 Phone: 503.639.4171 Fax: 50 3.63 ,.-1: 1 - ;• � 1 rak� Date/By: Other Permi ( 140010 , 0Clic C9 •
l c ; n It D Inspection Line: 503.639.4175 � Date Ready/ By: Anis: la See Page 2 for
Internet: www.tig 1 ��• N..' ied/Method: d/Method: Supplemental Information
TYPE OF WO C1t<X it.. .. PLAN REVIEW
4 t
• ` . ' ' Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New constructionAddition/alterat:` t t \ ,, i•: .
_ ,
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: . `\, \ ` _ where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CI ' UCTION 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 ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "I -3 ",
Job no.: I Job site address: q 41 1 ski wA tt J 1V pJ ¢ 4 � ❑ S i or � x or or more occupancy.
❑
l" U more residential units. Recreational vehicle parks.
/State
Ci /ZIP: .f; ( $ CY /J. 7) tyzoi& ❑ Health -care facilities. ❑ Supply voltage for more than
•
City/State/ZIP: I l l: "!✓ ��
l ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 4O'7 I Project name: Des E ranbj It l , ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage. .
Subdivision: 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, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Mall Limited energy, multi- family
• A re lnan-I' I v�odvfAneki Mall S/� �ae-e 1"q r JJ 1 i residential (with above sq. ft.)
75.00 2
1 1 Services or feeders installation, alteration, and/or relocation
$(‚€ � xtpM!� ( n • J . IStt 11 sa Gcu comio..f ' (M J•h j 200 amps or less 100.70 2
❑ PROPE OW1ER TENANT
�f J 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: ( ) I 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
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
X APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: 5(/ a 0.4 s6 (., B. Fee for branch circuits without
service or feeder fee, first ( 56.18 2
I
Contact name: v /0 pe /e branch circuit a,./8
1 n Each add'l branch circuit 7.42 0 77, (8 2
Address: d; - 3/ W 4. ` Miscellaneous (service or feeder not included) _
City/State/ZIP: Tt )b,A Each manufactured or modular
Ci
ty Poi-" J "`) O'2 -2 ( 3 dwelling, service and/or feeder 67.84 2
Reconnect only 67.84 2
Phone: ( 3 ) ( 694- Fax: • ( C 30-29- j.1 Reconnect
or irrigation circle 67.84 2
E - mail: e h // See C.' CA !/1") Sign or outline lighting 67.84 2
CONTRACTOR . Signal circuit(s) or limited- energy
Business name: �j(J se %/ tl'/ panel, alteration, or extension. Page2 _ 2
J - �`'- ( Each additional inspection over allowable in any of the above
Address: ,V.,?.., 3 1 9 7+6 i✓1(4' e. Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: po 1 - cA -*J�l, , 0 q • 1a 1 3 Investigation (1 hr min) 66.25/ hr
Phone: ( 57)3 ') 92,1_6,2,39. I Fax: (5a3 )2 s'! /� - 0 6 / ¢ Industrial plant (1 hr min) 78.18/ hr
CCB Lic.: 1 aq(P I Electrical Lic.: 4-4 co I Suprv. Lic.: 4'7 a5 S Inspections for which no fee is 90.00/ hr
_ , specifically listed Ch hr min)
Suprv. Electrician signature, required: Y _ ELECTRICAL PERMIT FEES
Subtotal: ��5 _gg
Print name: T4)kr BRleye Date: 9/ /0/0 Plan review (25% of permit feat
Authorized signature: 4,...., State surcharge (12 %ofpermit fee): . 3a
TOTAL PERMIT FEE:
Print name: 4 0 ma 6 - ''0 ( Date: 1.104
•