Permit CITY OF TIGARD ELECTRICAL PERMIT
111 q
COMMUNITY DEVELOPMENT Permit #: ELC2012 00525
T t G A.R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/13/2012
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD OFFICE
Project: Nordstrom Kiosk Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (3) branch circuits for power and data conduit; (1) 200 amps or less
Contractor: JRA INC Owner: PPR WASHINGTON SQUARE LLC
11860 SW GREENBURG RD PO BOX 847
TIGARD, OR 97223 CARLSBAD, CA 92018
PHONE: 503 - 639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
3 crt Branch Circuits w /Purchase 09/13/2012 $22.26
Spec ifics: Service or Feeder
1 ea 12% State Surcharge - 09/13/2012 $14.76
Type of Use: COM Electrical
Class of Work: ALT 1 ea Services or Feeders - 200 09/13/2012 $100.70
amps or less
Type of Const:
Occupancy Grp:
Total $137.72
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 952- 001 -0090. You may ` obtain , a - copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
I 1
Issued By: OL \,VL.C6L�f Permittee Signature: 0 Al /1P ./e� /)D kL
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.
Electical Permit Applica P 0 C E VED .I FOR OFFICE. USE ONLY . My�`
1,1 City of Tigar Date/B Q / S� _ CVO COS? y
h Permit N.
• 1 3125 S W Hall Blvd., Tigard, OR 97 Plan Review
Phone: 503.718.2439 Fax: 503.5985406P 1 2 2092 Date/B : Other F=it:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: WI la See Page 2 for
Internet: www.tigard- or.gov j �! off b ' Notified/Method: Supplemental Information
TYPE g Q Y T /' s .,' . PLAN REVIEW
®Addition /alteration replacement
❑ New construction Please check all that apply (submit 2 sets of plans w /items chocked 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 ", "l -2 ", "I -3 ",
Job no.: 69754 Job site address: 9585 SW WASHINGTON SQUARE RD 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: TIGARD, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: _ I Project name: WASHINGTON SQUARE KIOSK ❑ Service or feeder 600 amps or more.
it.e. StAi 'JIULL
Cross street/directions to job site: Description Fee,
i Qty. 1 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.)
PROVIDE POWER AND DATA CONDUIT TO MICROSOFT KIOSK IN Limited energy, multi - famil 75.00 2
NORDSTROM COURT residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less I 100.70 100.70 2
201 amps to 400 amps 133.56 2
❑ PROPERTY OWNER I ❑ TENANT
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
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
200 amps or less 59.36 I
Phone: ( ) I Fax:( )
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
above service or feeder fee, 3 22.26
❑ APPLICANT I
❑ CONTACT PERSON each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
_
Each add'I branch circuit 7.42 I 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State /ZIP: dwelling, service and/or feeder
Reconnect only 67.84 2
Phone: ( ) I Fax: : ( ) 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: JRA dba FRAHLER ELECTRIC panel, alteration, l inspection extension. Page 2 2
Each additional nspection over allowable in any of the above
Address: 11860 SW GREENBURG ROAD Additional inspection (1 hr min) _ 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: TIGARD, OR 97223 Industrial plant (I hr min) 78.18/ hr
Phone: (503) 639 - 4627 Fax: (503) 639 - 4673 Inspections for which no fee is 90.00/ hr
specifically listed (V2 hr min)
CCB Lic.: 197172 Electrical Lic.: � Suprv. Lic.: 51105 ELECTRICAL PERMIT FEES
�861 Suprv. Electrician signature, required: Lid
Subtotal: 122.96
Su
P � eq 7� Plan review (25% of permit fee):
Print name: ADAM ETHERINGTON Date: 09/11/12 State surcharge (12% of permit fee): 14.76
TOTAL PERMIT FEE: 137.72
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB