Permit CITY OF TIGARD ELECTRICAL PERMIT
¢`1 2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00155
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9534 SW WASHINGTON SQUARE RD H -12A
Project: AT & T Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Electrical for TI.
Contractor: BRIDGETOWN ELECTRIC Owner: PPR WASHINGTON SQUARE LLC
22732 NW GILLIHAN ROAD 2235 FARADAY AVE STE #0
PORTLAND, OR 97231 CARLSBAD, CA 92008
PHONE: 503 - 621 -7122 PHONE:
FAX: 503 - 621 -7123
FEES
Quantity Description Date Amount
38 crt Branch Circuits wo /Purchase 03/29/2011 $330.72
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/29/2011 $39.69
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $370.41
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 952-001-0090. You may o• - • • • r s;uestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i 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 the next available inspection date.
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.
Mar 25 2011 8 -4 Bridgetown Electric 503 - 621 - 7 123 p.l
l,lty OI 1 Ig81'tl Rt alved
--kip' 13125 SW Hall Blvd., Tigard, OR 97223 tw Permit No.:
IN
Phone. 503.639.4171 Fax 503.59 &.19fi0i�' * '' Dom R sew �r ' �� 1 11 'VO��
+ �' Dale/ Re: Other Permit: &j,/ e Pa �I for
5
r i ,„, It i> (ntpation Line; 503.639.4175 �� r � • Dale Reedy/By. furls: J"'
Internet: www.tiga rd -or.gov Notified/Method &i pie Page 2 nsr
---- r Supplemental teformauon
❑ New construction ❑ Addition /alteration /replacement . Please check alt that apply (submi setsof
F w/items checked below):
❑ Demolition ❑ Other: 0 Service or feeder 400 snips or snore 0 Building over three stories.
where the available fault current 0 Marinas and boatyards
exceeds )0.000 amps at ISO volts or 0 Floating buildings.
❑ 2 - and 2 family dwelling ❑Commercial /industrial less to ground, or exceeds 14,000
❑ I- and f2-tf a ❑ Accessory building amps for all other installations. ❑Commercial- use.gna,htual
Y ❑ Master builder In ati
❑ Other: ❑ Fite pump. ❑ Installation of 73 K VA or
: - 0 Emergency system. larger separately derived system.
t .3 Job site address:
° Addition of new motor load of 0 "A ", `1.2 "I.3^
Job no.: J )A ' 1001-1F or more. ewer nc
City/State/ZIP: �
�� '�� 0 Sea or more residential units. 0 Recreational vehicle parks.
//' /9,0S6/11) a 1 ❑ }toslth -care facilities. ❑Supply voltage for more than
Suite/bldg./apt. no.: Project name: /4/� - ' O Hazardous o Service locations. 600 volts nominal.
�0 / ce or feeder 600 amps or more.
Cross street/directions to job site: ,X0,4✓d0... X r ✓e, 4 , , l Damnation „� *t';',.• (�/� ''� j New residential single- or mold- family dwelling unit rem
'dal 11 g ..w 4, i Includes attached garage.
Subdivision:
Lot no.: 1,000sq. R. or less i I 16 &54 4
Tax map/parc,1 no.:
Ea. add 1500sq. ft. or-portion 33.92 l
Limited energy, residential '
�� (with abovesq• ft.) 75.00 2
ia i�r�✓✓ 7^ ,c6 re Limited energy, multi - family
�' s.7/L�,♦'Pi t�ll/ IL�V���� , residential (with above sq. ft.) 75.D0 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
' I l 201 ampsto400amps 13356 2
Name: 401 amps to 600 as 234'
101 2
Address: 601 amps to 1,000 amps 301.64 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders lnataAatioe, alteration, and/or
relocation
Phone: ( ) f Fax ( ) 200 snips or less 59.36 I 1
Owner Installation: This installation is being made on property that I own which is not 201 am to 400 amp 1 125A8 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
f
f
Owner signature.
Date: c Branch circuits new, alteration, or extension, per panel
A. Fee for branch circuits with
above service or feeder fee,
each branch Circuit 7.42 2
Business name: B Fee for branch circuits without
Contact name service or fender 2e, first ` ,� 2
branch circuit f 56.18
Address: • Each add'! branch circuit ~ J a� 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular -
Phone: ( ) dwelling, service and/or feeder _ 67.84 2
Fax: : ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 6714 2
Sips or outline l ighting 67.84 2
Signal circuit(s) or limited - energy '
Business name: ' o M V ,c m E.`EA , c' panel, alteration, or extension. Page i 2 2
Address: Each additional Inspection over allowable In any of the above
� - - 132 NW QsILL►HA■J - (ka Additional inspection (I hr min) 66,25/hr j
City/State/ZIP: �oa3>, c7 Investigation (I hr min) 66.25/ hr
Industrial plant (1 he min) 78.18/hr
Phone: (Sp3 )42..i `'1(7..2.. Fax: (C,03 )42, ins pections for which no fee is
'' Electrical ++ f0'Z t -7 � Z �
CCB Lic.: 1b3 aZ'7 ectrica LLt.: 'fleas listed '/)hr
90.00/hr
r - s al L I Suprv. Lia: q 177 5
Suprv. Electrician signature, retittire • �Dater '���'a Subt - -22. '' Phut review (25% fee
of permit fee)
Print name: �,(Et tis C
S tele lurch C�
�� surcharge permit fee): 1- 1
Authorized sr � t._.2 ,........ 7 ...- / ` TOTAL PERMIT FEE: 3 76. 4'I
A
This permit application empires Ira
Prins name: p i days niter it has beep accepted Al complete witAla t
Date:
• Number of inspections allowed per permit.
IVsuiidimphealiatE.C- ParnirAm elec 07/01/10
410-46 t 5 r i to s/coM/wE B