Permit CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2012 -00130
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9459 SW WASHINGTON SQUARE RD A14
Project: Footlocker /House of Hoops Subdivlsion:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Electrical for demising wall TI.
Contractor: A & A ELECTRICAL CONTRACTORS INC Owner: PPR WASHINGTON SQUARE LLC
1588 SKY TERRACE BY THOMSON PROPERTY TAX SERVICES
SALEM, OR 97306 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 949 -3193 PHONE:
FAX: 503 - 378 -9085
FEES
Quantity Description Date Amount
11 crt Branch Circuits wo /Purchase 03/08/2012 $130.38
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/08/2012 $15.65
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $146.03
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 accord 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. ATT N: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 through OAR 95. -I : -Os "'. You may obtain a copy of the rules or direct questions to OUNC by 1987 or 1.800.332. 44.
4
Issued _ —L _ � „ � Permittee Signat • � r r.`� � _
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. 376'9N S
Call 503.639.4176 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 Applicatio \ 'I) FOR 01+1( 1. usi; ONLY
' ,, - or
City of Tigard ti f irsk , / Permit No.: � [ 2_ �p
13125 SW Hall Blvd., Tigard, 23 % t. Plan Review
'' C Phone: 503.718.2439 Fax: 50 3. 9 5 Other Permit:
$.I�� Date/By: Inspection Line: 503.639 �i� {\� ,,S Date Ready/By: tom: ® See Page 2 for
r i G n It D
Internet: www.tigard -or.gov & \ ,� i\C���� Notified/Method: Supplemental Information
TYPE OF ' "I 4 -
El `I PLAN REVIEW
iii6 ❑ New construction Addition/alt s on/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 dwellingommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: El Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATI��CATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E", "1 -2 ", "1 -3 °,
Job no.: / b Job site address: SW w�� 100HP m more. occupancy.
❑
1 ��IIN�- ❑ Six or more residential units. Recreational vehicle parks.
City /State/ZIP: p d ❑ Heal h-care facilities. ❑ Supply voltage for more than
� `) �'� r^ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: ``KJGI�.Q 4 N c( 2 s ❑ Service or feeder 600 amps or more.
� I � FEE SCHEDULE
Cross street/directions to job site: ccJaS{l S go rt Fit u_Are. roil Q ,` I Description I Qty. I Fee. I Total I •
J New residential single- or multi- family dwelling unit.
5 Pa- C A PI 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
DESCRIPTIO OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
._.f » tt a �'�' rte, nf- () 24-5 ¢ R pD residential (with above sq. ft.)
75.00 2
'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
ty 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, er panel _
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT l ❑ CONTACT PE ' ON above service or feeder fee, , 2
each branch circuit
Business name: 4 4 56
B. Fee for branch circuits without _ �a +ais ar[R =t ∎ :.� "..� �r1 , S service or feeder fee, first d 2
Contact name: . L branch circuit i�
I► 56.18 t 0
�� t Each add'1 branch circuit l0 7.42 7 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
ty 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 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: 4/ f} g ( c_ : C el panel, alteration, or extension. Page 2 2
ii l �I�` / r S Each additional inspection over allowable in an y of the above
Address: / a 5 1.g_ r re ( , . - Additional inspection (1 hr min) 66.25/ hr
Investigation �..a ✓1 / ."3 (' 6 Industrial patpnlannt t (I hr m mm) 66.25/ hr
in) 78.18/ hr
Phone: ( sb 9 (( 9 , g 3 Fax: (1.8 3 ) 3 9 ( r S Inspections for which no fee is 90.00 / hr
v specifically listed (i4 hr min)
CCB Lic.: / s3 71 f Electrical Lic.: 36, 3F G Suprv. Lic.: 376 ''S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: - Subtotal: ( 3 U 3Y r Plan review (25% of permit fee):
Print name. . t ( 42 f iv( r C , k_ Date: State surcharge (12% of permit fee): ( S', (o
TOTAL PERMIT FEE: I l7 6, ,..,"Z
Authorized signature: J
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
I :\ Build ing\Pennits\ELC- PermitApp.doc 07/01/10 440- 4615T(1l/05 /COM/WEB