Permit CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELC2012 -00512
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9432 SW WASHINGTON SQUARE RD K02
Project: Hannah Society Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (3) branch circuits for receptacles and lights (1) low voltage for Data/Telecommunications
Contractor: BUILDERS NW LLC Owner: PPR WASHINGTON SQUARE LLC
20420 NE SUNNY CREST BY THOMSON PROPERTY TAX SERVICES
NEWBERG, OR 97132 2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 538 -7976 PHONE:
FAX: 503 - 217 -1487
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 08/30/2012 $71.02
Specifics:, Service or Feeder
1 ea Signal circuit or Limited 08/30/2012 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12% State Surcharge - 08/30/2012 $17.52
Electrical
Type of Const:
Occupancy Grp:
Total $163.54
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 OAR 9 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2232.19877 r r or 1.8 ii: 00.332.2 QN- . , r
Issued By:
Permittee Signature: Os r 1 Li / !
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.
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08/29/2012 19:49 5032171487 BUILDERS NW PAGE 01/03
Electrical Permit AppIRECEIVED r(>I; 0111( t 5I: rlNI.\
City of Tigard Received
`J '' II rr O 2012 Date/13 : a( 50 I a' s( Permit No.; giLG A0I�.- 00,5l L
13125 Sall Blvdigard. O 1t Plan Review o7D11- ODIS3—
• m • w U ., T B Other Perron.
Phone: 503.718.2439 Fax: 503.598.1960 Date :
inspection Line: 503.639.417 TIGARD ® Datc Ready/By: - See Page 2 for
TItigKU Internet: www.tigard- or.gov 11
' Notit)cd / Method: Supplemental Information
Yl t�C -- ...... PLAN REVIEW .. T r ORIi:
El New construction ® Addition /alteration /replacement
plea cheek a n that apply (.utaait 2 std of plans ./leases checked below):
❑ Service or feeder 409 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other; where the available faun current ❑ Manses and boatyards.
CATEGORY OF CONST1lUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 0 Commercial -use agricultural
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building ,roes ttr all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Vim pump. ❑ Installation of 75 KVA or
- ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "F,", "1-2 ", "1 -3 ",
Job no.; lob site address: WI sw wash sq rd K - 2 Cd Z foollro<m o� reatio .
443 y ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, Or 97223 ❑ Health - care facilities. ❑ Supply voltage for more then.
0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Hannah Society Wash SQ ❑ Service or feeder 600 amps or more.
PEE SCHEDULE
Cross street/directions to job site: By picks sporting goods or,eriptio• I Qty. i Fee L Total , •
New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: - I Lot no.: 1,000 sq. ft. or less 168.54 _ 4
Ea. add'l 500 sq. ti or portion 33.92 1
Tax map /parcel no.: .. Limited energy, residential
with above sq. ft.) 75.(x1 2
DESCRIPTION OF WORK (with
Limited energy. multi - family
75.00 2
2 circuits for recepts and 1 for lights 1 Low volt iota residential (with above sq. R.)
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 301.0 2
Address: Over 1,000 amps or volts 552.26 2
City /State! %1 P; Temporary services or feeders instllation, alteration, gad /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59,36 I
Owner installation: This installation is being made tin property that I own which is not 201 400 amps 125.08 2
intended for sale. lease, rent. or exchange, according to ORS 447, 449, 670, and 701. 401 am to 599 amps - 168.54 2
Breach circuits- new, alteration,yr extension, peryand
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT 0 CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: BuildersNW B. Fcc For branch circuits Without
service or feeder fee, first 1 56.18 56.18 2
Contact name: Russ Young branch circuit
Each add'i branch circuit 2 712 11.81 2
Address: 20420 NE Sunnycrest Miscellaneous (service or feeder cot included)
_— ._...... ..._._ _.__.. Each manufactured or modular
City /State /ZIP: Newberg, Or 97132 dwelling, service and/or feeder 67.84 2
Phone; (503) 538 -7976 Fax: : (503) 217 -1487 Reconnect only 67,84 2
Pump m hiigatiuu ch etc 67.84 2
E - mail: ryoung ®buildersne.net
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: BulldersNW panel, alteration, or extension. I Page 2 75.00 2
Each additional inspection over allowable in an of the above
Address: 20420 NE Sunnycrest Additional inspection (I hr min) 66.25 / hr
C ity/State/Z I I': Newberg, Or 97132 Investigation (I hr min) 66.25/ hr
industrial plant (I hr min) 78.18/ hr
Phone: (503) 538 -7976 Fax: (503) 217 -1487 Inspections for which no fce is 9000 / hr
specifically listed (V: hr min)
COI Lie.: 188196 Electrical Lic,; C560 Suprv. Lie.; 4159S _ ELECTRICAL PERMIT FEES -
,;" Subtotal: 146.02
Suprv. Electrician signature. required: ./�
` )- .. d''' _'��,, Plant review (25 %of permit fee); _..
Print name: Russell Young Date 8 -29 -l2 2 State surcharge 02% of permit fee): 17.52
TOTAL.. PERMIT FEE.: 163.54
Authorized signature: This permit application expires if a permit is not obtained witbin 180
Print name: Date: days after it has bean accepted as complete.
• Number of inspections allowed per permit
ouoic.rrg\ tit r_nn,..e dM Mlnu.n 4404615rrt Iros/coM/WEB
08/29/2012 19:49 5032171487 BUILDERS NW PAGE 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Informatiion
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined... $75.00
Check Type of Work Involved:
❑ Audio and Stcrco Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ I Dearing, Ventilation and Air Conditio System*
❑ Vacuum Systems*
❑ Other
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(Shh: OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data 'Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ J,andscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
EI Other
Total number of commercial systems_ 1
*No licenses are required. Licenses are required
for all other installations
1, \ Buildineermit01 retariinnn.Aeo 07/011;0
CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELC2012 -00512
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9432 SW WASHINGTON SQUARE RD K02
Project: Hannah Society Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (3) branch circuits for receptacles and lights (1) low voltage for Data/Telecommunications
Contractor: BUILDERS NW LLC Owner: PPR WASHINGTON SQUARE LLC
20420 NE SUNNY CREST BY THOMSON PROPERTY TAX SERVICES
NEWBERG, OR 97132 2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 538 -7976 PHONE:
FAX: 503 - 217 -1487
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 08/30/2012 $71.02
Specifics:, Service or Feeder
1 ea Signal circuit or Limited 08/30/2012 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12% State Surcharge - 08/30/2012 $17.52
Electrical
Type of Const:
Occupancy Grp:
Total $163.54
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 OAR 9 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2232.19877 r r or 1.8 ii: 00.332.2 QN- . , r
Issued By:
Permittee Signature: Os r 1 Li / !
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.
•