Permit •
CITY OF TIGARD ELECTRICAL PERMIT
ip
3.: -. COMMUNITY DEVELOPMENT Permit #: ELC2012 -00548
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/20/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9455 SW WASHINGTON SQUARE RD Al 5
Project: Things Remembered Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (20) branch circuits and (1) 200 amps or less and (1) low voltage for Audio and Stereo Systems for TI
Contractor: A & A ELECTRICAL CONTRACTORS INC Owner: PPR WASHINGTON SQUARE LLC
1588 SKY TERRACE PO BOX 847
SALEM, OR 97306 CARLSBAD, CA 92018
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PHONE: 503 - 949 -3193 PHONE:
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FAX: 503 - 378 -9085
FEES
Quantity Description: Date 'Amount
1 ea Services or•Feeders - 200 09/20/2012 $100.70
Specifics: amps'or less
20 crt . Branch Circuits w /Purchase 09/20/2012 $148.40
Type of Use: COM Service or•Feeder,
Class of Work: ALT 1 ea 12% State Surcharge - 09/20/2012 $29.89
Electrical
Type of Const: 1 ea Limited Energy 09/20/2012 $75.00
Occupancy Grp: 0 ea 12% State Surcharge - 09/20/2012 $9.00
Electrical
Total $362.99
Required Items and Reports (Conditions)
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• 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. hose rules are set forth in OAR
952- 001 -0010 through OAR 5 - 001 -00 0. You may obtain a co y of the rules or direct questions to OUNC by calling 503.232.1 • :400 :2.2344. •
o
Issued By: Permittee Signature: di /lmr
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent. •
•
OWNER' SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
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SI I F PR. ELEC' Date:
LICENSE NO. S 9 6 9-5
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 Mica • EIVED FOR OFFICE USE ONLY ••ttA�
City of Tigard Date/By: PetmitNo.e/L( - ppo '
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.7�60G / ., t Received
Date/By: other Permit:
T1 GA R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov CITYOFTIGARD Notified/Method: n 4, Supplemental Information
TYPPUILM4 DIVISION 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
❑ Emergency system. larger separately derived system.
S Pa J OB S ITE INFORMATION AND LOCATION (� ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
I00HP or more. occupancy.
5
Job no.: I Job site addres f _ 5 Iii lilac itI parks.
UU Six or more residential units. 0 vehicle
City/State /ZIP: `r a C S 0 Health -care facilities. ❑ Supply voltage for more than
(J Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: A i s-- 1 Project name: ` , R eM ep' L.—.I ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
H New residential single - or multi- family dwelling unit.
b ( ) (L � S� �/1� /V e� Includes attached garage.
�� // 1,000 sq. ft. or less 168.54 4
Subdivision: �OD�' C ` Lot no.:
n o.: Ea. add'I 500 sq. R. or portion 33.92 1
Tax map/parcel
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
s Limited energy, multi - family 75.00 2
TP M ct.)-4 T rC� 4 `' r ` G (� residential (with above sq. ft.)
Services or feeders installation, alte ation, 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
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ 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'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
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: \ p- f e J 4 '1/1 S.4 G panel, alteration or extension. Page 2 2
c c Each additional inspection over allowable in any of the above
Address: / S D a S K f / 1" r q4 C e J Additional inspection (1 hr min) 66.25/ hr
) Investigation (1 hr min) 66.25/ hr
City/State /ZIP: SI ( / e'w � C--
,
Q 973 d -, --- Industrial plant (1 hr min) 78.18 / hr
Phone: (. 3) ciy _319 3 Fax: (g3) 3 y 6 ) Inspections for which no fee is 90.00 / hr
specifically list (V2 hr min)
CCB Lic.: / 3'7 / ( Electrical Lic.: 36 g( Suprv. Lic.: 3176? 5 ELECTRICAL PERMIT FEES
j Subtotal: _
Suprv. Electrician signature, required: . / Plan review (25% of permit fee):
Print name: j efi ` j v4 ' Date: (j I State surcharge (12% of permit fee):
/ TOTAL PERMIT FEE: ,
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. 4
Print name: Date: • Number of inspections allowed per permit.
a
1:\Building\Perrnits\ELC- PermitApp.doc 07/01/10 440- 4615T(1 I /05 /COM/WEB
Electrical Permit. Application - City of Tigard -
Page 2 Supplemental Information .
' LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: -
• Fee for Al residential systems combined ... $75.00
Check.Type of Work Involved: .
❑ Audio and Stereo Systems* .
❑ Burglar Alarm
❑ Garage Door Opener* ' ' ,
El Heating, Ventilation and Air Conditioning System*
• ❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
. system
(SEE OAR 918- 309 -0000)
c c yp k Involved:
Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
• El Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
-❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
L\ Building \Permits\ELC- PermitApp.doc 07/01/10