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Permit ,� CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00238 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2011 Parcel: 1S1260000300 Jurisdiction: Tigard Site address: 9355 SW WASHINGTON SQUARE RD T19 Project: Verizon Wireless Subdivision: WASHINGTON SQUARE MALL Lot: Project Description: Sign lighting for (2) wall signs. Contractor: EDS SIGN Owner: PPR WASHINGTON SQUARE LLC P.O. BOX 2376 BY THOMSON PROPERTY TAX SERVICES WILSONVILLE, OR 97070 ATTN HILARY RAYMOND CARLSBAD, CA 92008 PHONE: 503 - 582 -8400 PHONE: FAX: FEES Quantity Description Date Amount 2 ea Sign or Outline Lighting 05/06/2011 $135.68 Specifics: 1 ea 12% State Surcharge - 05/06/2011 $16.28 Electrical Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $151.96 Required Items and Reports (Conditions) This permit sued s t to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be don- n accordance with a rove. • ans. This permit will expire it work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law _ equir • ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -1.1 -0010 thr• gh OAR 952- 11 =.0091 You ay obtain a cop of the rules or direct questions to OUNC by callin• : -. 32.1987 or 1.800.33 2344. ' . 6 Iss ed By: �) / Q Permittee Signatu _i ./ - � - - v 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 A SIGNATURE OF SUPR. ELEC' � �� �,I. I � ���, 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 TOR Ol I I( L ( .Si.. 0\1.1 - City of Tigard Received DaDate /13 : Permit No.: g A.. -4 a3 ' 00 p • 13125 SW Hall Blvd, Tigard OR 97223 Plan Review �� Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit: T I G A K D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard - orgov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/iteins 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 building& y � less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2-family dwelling la Commercial/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 ❑ Addition of f new motor load of syystem. 5 5 l00HPormore ❑ `A'; "E", "1-2", "1-3 ", 94 Job no.: Job site address: 7 `, _ �, 5,62 tc `� ❑Six or more residential units occupancy. City/State/ZIP: T /� j� ( f ❑ Heauh -care faciioi s. ❑ Recreational vehicle parks. l �Cb v '� ❑ Hazardous locations ❑ Supply voltage for more than Suite/bldg. /apt no. ' 1 Project name: V n - civ � �; - ' t ess 0 ,e^'ice or feeder 600 amps or 600 volts nominal Cross street/directions to job site: . A 1 . c 1 OJ SI ) � I n FEE SCHEDULE �V � J \_ �� r Description I Qtr. I Fee I Total I+ New residential single- or multi family dwelling unit Includes attached garage Subdivision: I Lot no.: - 1,000 sq. ft. or less 168.54 4 Tax map /parcel no.: Ea. add'l 500 sq. ft or portion 33.92 1 DESCRIPTION OF WORK Limited energy, residential 75.00 2 (with above sq. ft) 1 „ A. I • I. T - IS • • 4 Limited energy, multi family 75.00 2 residential (with above sq. ft) Services or feeders installation, alteration, and/or relocation ❑ PROPERTY OWNER I ©— TENANT 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: \,L0 4 7 1/4_ L4 ) . -, o CO t J 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 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 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 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel ❑''APPLICANT I BCONTACT PERSON A. Fee for branch circuits with above service or feeder fee, 7.42 2 } c c each branch circuit Business name: I9 ` ? t -) ‘ i (1 B. Fee for branch circuits Contact name: +1 - B. fi rst branch service s ir c circuit feeder fed 56.18 2 TTT """"` l �lllrrtttrrrl _ first brch c iru Address t) C � m : i Each add'! branch circuit Z42 2 �L r�cst C I ►� f9 A Miscellaneous (service or feeder not included) _ City/State/ZIP: f ' ) . I- V l l..Q. l OR C1' 7 a -Ja Each manufactured or modular 6Z84 2 Phone: (L�i Z) v ((�' Fax: ( ) dwelling, service and/or feeder �I.v �� - � �T7 Reconnect only 6Z84 2 E - mail: Clll t L� t i Qc15 ) (n Pump or irrigation circle 6Z84 2 CONTRACTOR Sig jl or outline lighting a 6Z84 ',35. 2 Signal circuit(s) or limited - J Business name: S S l v , , energy paned alteration, or Pa e 2 2 extension. g Address: h � J � � / � C y A � C s Each additional inspection over allowable in any of the above City/State/ZIP. C i t crly, U 1 4✓ 9 O 0 Additional inspection (1 hr min) 66.25/hr 99 y Fax: Investigation (1 hr min) 66.25/hr Phone: (a-3) r9 i 27, 3 ( ) Industrial plant (1 hr min) 78.18/hr CCB Lic.: 1135 aa Electrical L' • e . S .- S I Suprv. Lic.: 3c19 -S I 4, Inspections for which no fee is 90.00 /hr specifically listed (% hr min) Suprv. Electrician signature, re 1 uir • ' ELECTRICAL PERMIT FEES �� _ t1 y Subtotal: 135 6 Print name��s� Dl/ 1 Lt(S Date:. `S // Plan review (25% of permit fee): name:___ 71:4w State surcharge (12% of permit fei Authorized signature: Print name: Date: TOTAL PERMIT F a : l . 6 This permit application expires if a permit is not ob n n 180 after it has been accepted as complete 1:IBuildinglPermitseELC- PermitApp.doc 07/01/10 440- 4615T(11 /05/COM/WEB