Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00417
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/16/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD MGMT OFF
Project: Washington Square Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (2) feeders and (1) branch circuit for two electric car charging stations. In lower level of northwest parking structure
near Cheese Factory.
Contractor: A & A ELECTRICAL CONTRACTORS INC Owner: PPR WASHINGTON SQUARE LLC
1588 SKY TERRACE 9585 SW WASHINGTON SQUARE RD
SALEM, OR 97306 TIGARD, OR 97223
PHONE: 503 - 949 -3193 PHONE:
FAX: 503 - 378 -9085
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 07/16/2012 $201.40
Specifics: amps or less
1 crt Branch Circuits w /Purchase 07/16/2012 $7.42
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/16/2012 $25.06
Electrical
Type of Const:
Occupancy Grp:
Total $233.88
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. A NTION: Ore..' law = quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 010 through OAR 95 , 11-00 ' 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 87 or .800.332.2344.
/ a ,
Issue '
y: ��� _ 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' !lei /I Date:
LICENSE NO.
3769 5
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 A Heat' D FOIZ OFI ICI: uSE oNI.\
City of Tigard Received Date/B : 7 Permit No.. `r _ .0
. ° 13125 SW Hall Blvd., Tigard, OR 97223 I1 1 6 2012
C f ' Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598. 0 DateBy:
TI GARD
Inspection Line: 503.639.4175 CITY OF rIG� Date Ready/By: Sufis: ® See Page 2 for
Internet: www.tigard- or.gov ����niVISION
Notified/Method: Supplemental information
TYPE O PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit I 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 ❑ CommerciaUindustrial ❑ 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: ���. c+ � ! ?ST-C. g "61 I Six or oo more. R c eation.
❑ Six more residential units. ❑ecreational vehicle parks.
City/State /ZIP: OO .SQ 4 ` ❑ Health -care facilities. ❑ Supply voltage for more than
`'� c (J ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: WO & k� J6 ❑ 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: I 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 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less A a 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 Fa ( ) 200 amps or less 59.36 I
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 i
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
eE �� 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)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) I 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: .,/ /� f ir.C4 qy, anel, alteration, or extension. Page 2 2
r ` `► `"' e" ` - rC � � C Each additional inspection over allowable in any of the above
Address: /5 $ N\ Additional inspection (1 hr min) 66.25/ hr
w � Investigation (1 hr min) 66.25/ hr
City/State /ZIP: S g ( 4' 73 UC Industrial plant (I hr min) 78.18/ hr
Phone: (J� 3) rr y? 3 9 3 Fax: (9 j) 377-7o Y- - Inspections for which no fee is 90.00 / hr
specifically listed (Vz hr min)
CCB Lic.: /S37 // Electrical Lic.: 3 6 —jFC Suprv. Lic.: 3 74.1 5 ELECTRICAL PERMIT FEES
Subtotal: 0 9 ‘ 6g.ii :
Suprv. Electrician signature, required:
Plan review (25% of permit fee):
Print name: J" f Q l 0 Date: State surcharge (12% of permit fee): A5-.4
( c' TOTAL PERMIT FEE: A 5 5. oct
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.
1: \ Building \Permits\ELC- PemtitApp.doc 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*
El 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
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ • Medical
❑ r..
Nurse Calls
Y b
El Outdoor Landscape Lighting*
El 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