Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2010 -00616
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/02/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9581 SW WASHINGTON SQUARE RD B08
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Sony Style
Project Description: (3) branch circuits.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 3 crt Branch Circuits 11/02/2010 $71.02
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 11/02/2010 $8.52
Electrical
Contractor:
MT HOOD ELECTRIC INC
PO BOX 1270
WELCHES, OR 97067 -1270
PHONE: 503 - 622 -1305
FAX: 503- 925 -3525
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 • by the Oregon Utility Notification Center. Those rules are set forth in OAR •
952- 001 -0010 through OAR 952- 001 -0100. You ay obtai . • _ 1 • - questions to OUNC by calling 503.246.6699 or .80. 32.234.. •
Issued By: f�� %�/ _ _ Permittee 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:
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 E FOR OFFICE USE ONLY
III City of Tigard w� Perm No d _ ` C2(0
-' ' 13125 S\\' Ilall Blvd.. Tigard. OR 9 IC Plan Rev
C • Phone: 503.718.2439 Fax: 503.598 9 , 1Sy e ther Permit
f 010 UaIr -
1'1( GA hlspectiun Line: 503.639.4175
NO`V Date Rcadv� /13}': Jun, El See Page 2 for
• Internet: w'ww'.tigard- or.gov p Q Notified/Method: Supplemental Informal'
❑ Nett' construction V] Addllloll/alteratlV � ��hif e1 Please check all that apply (submit 2 sets of plans tv urns: checked helots
❑ Sen or !ceder - tun amps or mnrc ❑ 1 tending over three stories
❑ Demolition ❑ Other: where the available I;wlt current ❑ \Innnas and boatyards
t ;n
• , to t •h I
amps 1. In r Float td .m
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: :< r #� �l :> :car : :> cps: �r# � �. �tc�N .. ......... . ....... . . . .. ... .........................
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.... :. : :.
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less to errand nr exceeds 14 )( ❑
........, nmmyrVi.d uni agricultural
❑ 1- and 2-family dwelling r Commercial/industrial ❑ Accessory building amps for all other installations. buildings
❑ IVltllti- fa11111\' El Master builder ❑ Other: ❑ Puy pump. ❑ Installation of 75 K\':\ or
I ?mrmrnev sys0.•m larger separately derived system
04 �» ss:!;:: w: a::;: w2;:::;;::;;%;;;;; �:;;:;;::;;;;:; 2:;;; �;`;;%;;;`. Zr':; `;;;; %`�s : :•; :c; :C :>;; : : : :a;;r:
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..... „ .;: . : : : :. #. : .fX#:. : : :. ; ... ; .t . ;..:::::::.: . . . : :. : \ddiunn nl new motor load of - Al -1.1-. .. ..
110.: Job site address: Q eQ , , / 6 ❑ Inn(11' or more.
Job occupancy
J VGA 3W cT�� . Si e 0_ ❑ Six or more residential units ❑ Recreational vehicle parks.
Cite /State/" /11 q 3 s( ( go8 ❑ I Iealth -care facilities. ID Supply voltage for more than
�t7� O c J .1a / ❑ I lazardous locations nu volts nonnnal
Stlllc/bIdg. /apt. no.: 1 Proiect name: ❑ Syr is or Redrr bun amps or more
./\ - r .x
Son (fie
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Cross street/directions to job site: k_ 5 ti Description ............ ................... ... Fee. Iota)
r New residential single- or multi-- family dwelling unit.
Includes attached garage.
SUbdiVision: I i.ot no.: 1.0(1(1 sq. 11. or less 168.54 4
1111 Iia. add( 500 sq. It or portion 33.92 1
Tax map /parcel no.:
I,imilcd energy, residential 750) 2
(with I rs •
a c e s q' 11 '
Limited energy. multi-family
75.00 2
residential (with above sq. 0.)
Services or feeders installat• , alteration, and /or relocation
200 amps or less 11)0.71) 2
" S
� r -110 s 1.. 2
: » : : < : > : > : > : >: < » : ::
211am amps amps .
401 amps to 600 amps 200.34 2
Name:
601 amps to 1.000 amps 301.1)4 2
Address: Over 1.(10(1 amps or volts 552.26 2
City /State/ /,IP: Temporary services or feeders installat• ,alteration, and /or
relocation
Phone: I 200 amps or less 59.36 1
201 amps to 4110 amps 125.08 2
Owner installation: "Ibis installation is being nmdc on property that I own which is not
o o ( 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchan accordin to ORS 447, 44 ), 670, and 701. -
Branch circuits - new, alteration, or extensdon, per panel
Owner signature: 1)atc: A. Fce for branch circuits with
oveservice o' - Icrfee
Move 1 I
7
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. ;.; ^` iiii: 111111
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.....................................................................................::. ............................... .
each I ranch cereal
Business name: 13. Fee for branch circuits without
service or feeder fee. first r 2
)6.15 t �
Contact name: branch circuit 5(D r t. '
Each add] branch circuit 2 7.42 1,i' VI 2
Address: i\lisccllancous (service or feeder not included)
City/State/ZIP: Each manufactured or nodular 67.M 2
dwelling. service and /or feeder
Phone: ( ) I Fax: : ( )
Reconnect only 67.84 2
l'untp or irrigation circle 67.84 2
E Sign or outline lighting 67.84 2
::CQ:..'i.k�tt. ...#'?E 1t� : :::'.:: ):'sa :: ) ::'sax's: >:'.:: >::'.: >::'.:: >: »:::'.:>:'.: z:::::'. : :'.:::'.: : > : :'. : : :<!':z :'!! ::
.>:::.::.::.:::..::.:.:::::.;;.: .......................................................................... ............................... Signal circuit(s) or limited-energy
i3tlslness mime: y y Ic� m� G ) � c 4 . y kt_c panel. alteration, or extension. _ Paue 2 2
n r I t ^ 7 r +•` Each additional inspection o%'er allowable in any of the above
Address: PO � ^,
. �^ ( � 7 Additional inspection (1 hr min) 66.25 hr
CiIv /State/ZII): CA � �c ' , 2 / 0 - 97 �� Investigation (1 hr min) (16. hr
( Industrial plant (1 hr min) 78.18' hr
Phone: ( g O) 1 501-E5'- Inspections for which no fee is
`� �_ l3oS Fax: ( spcciliealh' listed ('S hr min) 90.00 lo'
CCI3 Fie.: Electrical i,l(,.. - buprv. Fie.: >;. �. �� a:'��?~5� :.�0< :k1,1+� aka; 1? �: « >« : > : > : : > : : » : < : : > > : > : : > ::
1 -7_6(40 3 51�C � S
...........
Subtotal: - 7/.0)-
Stiprv. Electrician signature, required:
( Plan re vi . v (25 "0 of permit Icy):
` I'rinl n ame: rn /�' Dale: State surcharge (12 "o of permit tee): 4
-------- TOTAL PER \11 FIT: 71. S l
Authorized signature:
This perm(( application expires 11 a permit is not obtained within 180
_ p g � day's after it has been accepted as complete.
Print name: I ¢a(G(/ g C v`- Dale. I - Z"• v * Number of inspections allowed per permit
I: \Building Permit. El.('- Penult: p.r , e 0" 0 1.10 /! .110 4o15T111,0g('O ?I WER