Permit a CITY OF TIGARD ELECTRICAL PERMIT
II I COMMUNITY DEVELOPMENT Permit d: ELC2010 -00587
Date Issued: 10/2212010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1 51260000300
Jurisdiction: TIGARD
Site address: 9522 SW WASHINGTON SQUARE RD H07
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Eddie Bauer
Project Description: (7) branch circuits for replacing lights throughout store.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O 7 crt Branch Circuits 10/22/2010 $100.70
CARLSBAD, CA 92008 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/22/2010 $12.08
Electrical
Contractor:
FRAHLER ELECTRIC CO
11860 SW GREENBURG RD
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 $112.78
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 follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By:
Permittee Signature: e / 7-79 / — 4./ eel-7-70 A /
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 603.639.4175 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 VktC19 of Tig ard �� 111 ecei s � /
:�
q 13125 SW Hall Bl vd., Tig ard, OR 97223 • o D •'t; y .. �Q��,7�p Permit No� �� . D`�3
Phone: 503.639.4171 Fax: 503.598.1960 �` �`G t r . w Other Permit:
T 1 G A R D Inspection Line: 503.639 G` � 1N Not i : . eady/By: iurii fa See Page 2 for
Internet: www.tigard- or.gov BO..1) i fied/Method: 1---f Supplemental Information
TYPE OF WORK Pt�JJ PLAN REVIEW
❑ New construction l Addition /alteration/replacement Please check all that apply (submit 2 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.
❑ 1 - and 2 - family dwelling ®Commercial /industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 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 ❑ Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ "A ", ` E ", "1 -2 ", "1 -3 ",
Job no.: 67935 Job site address: 9522 SW WASHINGTON SQUARE RD Si orre. R c
❑ Six x o or r moo re e residential units. ❑ecreational vehicle parks.
City /State /ZIP: TIGARD, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: EDDIE BAUER ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 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
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
Limited energy, multi - family 75.00 2
REPLACE LIGHTS THROUGHOUT STORE residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 1 . ❑ TENANT • 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: ( ) 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 . ❑ CONTACT PERSON above service or feeder fee
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without 1
service or feeder fee, first 56.18 56 2
Contact name: branch circuit
- -- - -- Each add'l branch circuit 1 6 7.42 44.5212'
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
E - mail:
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR • Signal circuit(s) or limited -energy
Business name: FRAHLER ELECTRIC COMPANY panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 11860 SW GREENBURG ROAD Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Investigation (1 hr min) 66.25/ hr
TIGARD, OR 97223 Industrial plant (1 hr min) 78.18/ hr
Phone: ( 503 - 639 -4627 503) 639 -4673 Inspections for which no fee is 90.00 hr
( specifically listed (V2 hr min) CCB Lic.: 37410 Electrical -Lic.. I/ 4_ 13C Suprv. Lic.: • 1816S ELECTRICAL PERMIT FEES
//f / Subtotal: 100.70
�/ Suprv. Electrician signature, r red: ( Plan review (25% of permit fee):
gv �� Print name: R . w FRAHLER Date: 10/20/10 State surcharge (12% of permit fee): 12.08
TOTAL PERMIT FEE:
Authorized signature: This perm applic expir if a per mit is not obtained within 0
Print name: Date:
days after it has been accepted as complete. to/
' Number of inspections allowed per permit.
I: Building \Permits\ELC- PermitApp.doc 07/01/10 440-4615T( /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:
❑ 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:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instr *umentation
❑ 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 07/01/10