Permit CITY OF TIGARD ELECTRICAL PERMIT
111 g COMMUNITY DEVELOPMENT Permit #: ELC2012 -00117
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9611 SW WASHINGTON SQUARE RD L03
Project: Jos A Bank Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Sign lighting.
Contractor: RAMSAY SIGNS INC Owner: PPR WASHINGTON SQUARE LLC
9160 SE 74TH AVE BY THOMSON PROPERTY TAX SERVICES
PORTLAND, OR 97206 ATTN HILARY RAYMOND
. 2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 777 -4555 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 02/28/2012 $67.84
Specifics: 1 ea 12% State Surcharge - 02/28/2012 $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 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 O • : 952- 001 -0090. You may obtain a co. • .1 = rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ ' Permittee Signature: x.
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.
- Electrical Permit Application FOR OFFICE USE ONLY
FEB City of Tigard Permit No.:
City g Date /B : e . O j ! YAW r 6
q 13125 SW Hall Blvd., Tigard, OR 97223 Re
i
I C Phone: 503.718.2439 Fax: 503.598.1960 CITY 0' g� an Other Permit: J
T I G A R D Inspection Line: 503.639.4175 PLANNING /: ' le 1 �: El See Page 2 for
Internet: www.tigard- or.gov on / Supplemental Information
6
TYPE OF WORK PLAN REVIEW
® New construction ❑ Addition/alteration/replacement 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 ® 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 ", "I -2 ", "1 -3 ",
Job no.: Job site address: IOOHP or m ore . occupancy.
q R v„.65. w AS we a t� 6% RD • ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: — ` - s A b el k • y1 t. ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: z7S t.
10 � 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
S N 0,,i,QC1/4A1 -T residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ 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
h relocation
Phone: ( ) 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
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: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
h dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting % 67.84 j % 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: panel, alteration, or extension. Page 2 2
t2Aw�sta� S ►gll.) CO Each additional inspection over allowable in any of the above
Address: A tlez e..E _ ,,. yTh Au a , Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Investigation (1 hr min) 66.25/ hr
v OThtAN 1� R • C i• 4 industrial plant (1 hr min) 78.18/ hr
Phone: Inspections for which no fee is
7 7 Ts, Fax: (503) 7 •.02.-Lo p 90.00/ hr
specifically listed (% hr min)
CCB Lic.:( Electrical Lic.:n •t O tau& Suprv. Lic.: Lffa t t ELECTRICAL PERMIT FEES
(.+� Subtotal: (Ali
Suprv. Electrician signature, required:` °
J Plan review (25% of permit fee):
Print name : `. N%.lL STC t GE R._ T • 46 (2012., State surcharge (12% of permit fee): g ly
TOTAL PERMIT FEE: i 5
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\Pefmits\ELC- PermitApp.doc 07/01 /10 440 -4615T(I I/05 /COM/WEB
'EYecirical 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
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ I - -IVAC
❑ 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
I:\Building\Pe mits\ELC- PcmitApp.doc 07/01/10
Ii CITY OF TIGARD FEE AND PAYMENT HISTORY
ffi . I' 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
ELC2012 -00117 - 9611 SW WASHINGTON SQUARE RD L03, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Sign or Outline Lighting 220 - 0000 -43103 $67.84 $67.84 $67.84 2/28/12 Credit Card 185684 $0.00
12% State Surcharge - Electrical 100- 0000 -24001 $8.14 $8.14 $8.14 2/28/12 Credit Card 185684 $0.00
Totals for Fees $75.98 $75.98 $75.98 $0.00
Receipt # Payment Method Check # Pavor: Receipt Date Receipt Amount
185684 Credit Card Ramsay Signs, Inc. 02/28/2012 $75.98
Total Payments: $75.98
Balance Due: $0.00