Permit U CITY OF TIGARD ELECTRICAL PERMIT
• • COMMUNITY DEVELOPMENT Permit #: ELC2011 -00227
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/03/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9534 SW WASHINGTON SQUARE RD H -12A
Project: AT & T Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Sign lighting.
Contractor: EDS SIGN Owner: PPR WASHINGTON SQUARE LLC
P.O. BOX 2376 2235 FARADAY AVE STE #0
WILSONVILLE, OR 97070 CARLSBAD, CA 92008
PHONE: 503 - 582 -8400 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/03/2011 $67.84
Specifics: 1 ea 12% State Surcharge - 05/03/2011 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes : • 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 ' work is sus ended for more the 180
days. ATTENTION: Oregon law requires you to follow the rul•: - •opted by •e Oregon Utility Notification enter Those rul' are •
952- 001 -0010 through OAR 952 - 001 -0090. You may obtain - • • • he • - . • - • •• • •.OUNC by callin• 503. 2.19: or 1.800.33
Issued By: _ _ / z " Permittee Signet e: - �. / ��
ER INSTALLATION ONL / G c
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.
Electrical Permit Application Received Fc) ' R OFFI( I. I St ON I,)
City of Tigard ceN./..\) , Date/B : Permit No.: —: , /
13125 SW Hall Blvd., Tigard, OR - e ++ Plan Review
■ . 1 Q `` Other Permit: ,.
Phone: 503.718.2439 Fax: 503.5` -.:.' - 3 `L Date/Et : �' Al t —
3 - l G A R D Inspection Line: 503.639.4175 P C ti, O Date Ready/By: JSuds S `age 2 for
Internet: www.tigard- or.gov M \VV Notified/Method: I. Supplemental Information
n
` TYPE OF WORK.-*" . C?O��,J Q
PLAN REVIEW
New construction ❑ Addition /alteration/repiac� W ent 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ,ommercial /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 ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: / // p n 10OHP or more. occupancy.
9y /3 y U)AS � iAi � ow ❑ Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: L l` iv ❑ Health-care facilities. El Supply voltage for more than
1 7 , ,' 1 j El Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: (Project name: ,/� �f— a ❑ Service or feeder 600 amps or more.
Jd /// FEE SCHEDULE
Cross street/directions to job site: 60 0,9 A ip iCrty -- , Description I Qtv. I Fee. I Total
W 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'l 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
--c.) N Q ,/j i 6 (/∎ v D / u f residential (with above sq. ft.)
/ `C Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 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
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
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
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, 7 42 2
each branch circuit
Business name: �' T , j "0 B. Fee for branch circuits without
service or feeder fee, first 56.18 2
!7
Contact name: A ,/f / 7 / ti 2 ,f Z 4 / r branch circuit
` /V Each add'l branch circuit 7.42 2
Address: "G3 x :/� -' . Miscellaneous (service or feeder not included)
or
City/State /ZIP: �, 15 e s) L/ 1 v �, J /f' ` e72 ( ` / to / -�/ dwellin se Each mg se rver
rvi e a ndd/ or r feeder
67.84 2
/�
/ a/
Phone: (5 ) l /0 i_ / 9 9i / I Fax: : ( ) Reconnect only 67.84 2
J (— � J 7 Pump or irrigation circle 67.84 2
E - mail: Signor outline lighting I 67.84 67, g� 2
CONTRACTOR /� Signal circuit(s) or limited - energy V
Business name: 7 /0 /� y / / / panel, alteration or extension. Page 2 2
t Each additional inspection over allowable in any of the above
Address: t l Ei , 9 "7 4, Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: H( / 5 X/ 7 /// 6) n ` P d 7 !' n Industrial plant
Investigation (1 mm) 66.25/ hr
' l ( hr min) 78.18/ hr
Phone: ( ' ) 5/e5) /) < 9/ J Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (% hr min)
CCB Lie.: 79T c ,� ,-� 1 Electrical Lic.: �h S prv. Lic. �,C"? 9/ b.. ELECTRICAL PERMIT FEES
/� J
Suprv. Electrician signature, require . Subtotal: (07.`(
J / l I - _,404.--t.—• Plan review (25% of permit fee):
Print name: 4g. Date —* 9' 11 State surcharge (12% of permit fee): 8- Authorize si n ature' TOTAL PERMIT FEE: g ys This permit application expires if a permit is not obtained within 180
G days after it has been accepted as complete.
Print name: A y/ A . i� l4, , 5 - :: 1 -- AA" Date: - 3.--. lit • Number of inspections allowed per permit.
I:\ Building \Permits\ELC- Permmi 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:
❑ 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
❑ Instrumentation
❑ 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