Permit „ CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00254
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/13/2011
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9412 SW WASHINGTON SQUARE RD K10
Project: Braganza Tea Subdivision: WASHINGTON SQUARE MALL Lot:
Project Description: (1) sign lighting
Contractor: VANCOUVER SIGN COMPANY INC Owner: PPR WASHINGTON SQUARE LLC
2600 NE ANDRESEN RD #50 BY THOMSON PROPERTY TAX SERVICES
VANCOUVER, WA 98661 ATTN HILARY RAYMOND
CARLSBAD, CA 92008
PHONE: 360- 693 -4773 PHONE:
FAX: 360- 693 -2747
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/13/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 05/13/2011 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in ordance with op. •ved . This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ENTION: Oregon law r> ores yo, to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 -0010 thr OAR 952 -001 =0. Y. ay o Itain a copy of be rules or direct questions to OUNC by calling 503.232.1•87 or 1.80x
Is ued By: 0 ` Vii! i Permittee Signature ��
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
k
Electrical Permit Application REr REC EI V E E Received FOR OFFICE USE ONLY
City of Tigard f — gym Permit No.: l ►QQ
13125 SW Hall Blvd., Tigard, OR 97223
Date/Bed: ./� �'� 5, Phone: 503.639.4171 Fax: 503.598.1960 MAY 1 2 2011 Plan Review
: Other Permit:
.111 q T 1 G A RD Inspection Line: 503.639.4175 Date Ready /By: lurk: El See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF WORO U 1 L UlVl 6 PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
($ New construction ❑ Addition /alteration/replacement
❑ 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
❑ I- and 2- family dwelling IA 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 system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ". "I - ".
` I00HP or more. occupancy.
Job no.: Job site address: 9 y Z Cl ; nth) I'L 2l9 12 Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: CAC 0 a J l� ❑ Health -care facilities. ❑ Supply voltage for more than
1 1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: f3f aCSwnza, TP,c..... ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: I ) as \, i rust() n �, _ Description I Qty. I Fee. 1 Total I
t ""� New residential single- or multi - family dwelling unit.
P bdiet F L CO I, t Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
. DESCRIPTION OF WORK (with above sq. ft.)
i) \ Limited energy, multi - family 67.84 2
i 11LoVI,i YL a.t et waif S i Vl residential (with above sq. ft.)
J Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER , IX TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
ca.? 11 Z a' - lJ, C n 601 amps to 1,000 amps 301.04 2
Address: Cr y i Z 5 (43 4)0_611; y .o tc f coq Art Over 1,000 amps or volts 552.26 2
City /State /ZIP: ���, �� J l� Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 l
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
A. Fee for branch circuits with
jz APPLICANT pr CONTACT PERSON above service or feeder fee,
7.42 2
e each branch circuit
J &v. L
Business name: ' tA.t/ e, (' Sill B. Fee for branch circuits
Contact name: R 1 J without service or feeder fee,
W St or rin • first branch circuit 56.18 2
Address: Z 60o N E Arart , e,n R ,L 4PS 0 Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: vatL r LA 48441 Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: (5) 03 g773 Fax: : ( 3470 ) 0 3 Z7'1 7 Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting (i) 67.84 2
Signal circuit(s) or limited -
Business name: VGLYLLt? Liu 61 - 1,4 17 energy panel, alteration, or
Address: Z to 0 0 ^7f; A vi4 C64.4 / Q _/ extension. Describe: Page 2 2
City/State/ZIP: 7,�L/ Each additional inspection over allowable in any of the above
y U✓LGO I lVt°i�f' IA � Rlo 6 I p y Per inspection 66.25
Phone: ( 360 ) 6Y3 7 3 Fax (390) 4/3 27117 Investigation per hour (I hr min) 66.25
CCB Lic.: 6 3 C/ s ( I Electrical Lic.: 3 7 - y(o GL$ Suprv. Lic.: 5,2616 Industrial plant per hour 78.18 _
f • ELECTRICAL PERMIT FEES
-0 " Suprv. Electrician signature, required: /5111F - - Subtotal:
,�,,� _ t ge Date: 5/2/// Plan review (25% of permit fee):
Print name:
aL" `— State surcharge (12% of permit fee):
Authorized j 5.--- zed slgna[ure: . / _ • TOTAL PERMIT FEE: •
iiilTl � l This permit application expires if a permit is not obtained within 180
Print name: R6 / d. sto r lin Date: 5// z/ f/ days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits \GLC - PermitApp.doc 10/01/09 440- 4615T(II /05 /COM/WIIB