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Permit
CITY OF TIGARD ELECTRICAL PERMIT 111- COMMUNITY DEVELOPMENT Permit #: ELC2012 -00556 T [C ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/25/2012 Parcel: 1 S 1260000300 Jurisdiction: Tigard Site address: 9585 SW WASHINGTON SQUARE RD OFFICE Project: Electric Room Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108 Project Description: (1) 200 amps or less Terminate panel feeders in landlord electrical room 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 1 ea Services or Feeders - 200 09/25/2012 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 09/25/2012 $12.08 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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 oobtaaiin /r a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 11.880 (��T / � 0.33332.2 / 344. , I 4� Issued By: . % Ate Permittee Signature: aid 4.o/� 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. RECEIVED Electrical Permit Applicati FOR OFFICE USE ONLY City of Tigard ; = G 4 ' 7 Received Q , C EL.Gao a- Y II y g Received ` °`+ P— Sot Permit No.: ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ' III ' Phone: 503.718.2439 Fax: 503.WPFOF TIGARD Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready /By: kris: ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: 1 VO Supplemental Information TYPE OF WORK 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 0 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 ❑ I - 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 ", "1 -2 ", "1 -3 ", Job no.: 69799 Job site address: 9585 SW Washington Square Road 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: Tigard, Ore. 97223 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: kin c , B/ , 7 n S. E legy IG 0 Service or feeder 600 amps or more. M 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: Lot no.: 1.000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 Terminate panel feeders in landlord electrical room. residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation Please call Adam Etherington for directions to electric room. 503 939 8229 200 amps or less I 100.70 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 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 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps l0 599 amps 168.54 2 Branch circuits — new, alteration, or extension, per panel _ Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ 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 J Business name: RA -rne . U ha F E1ec-Iri c panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: / tego SGf 6 rL. J 1 /' Additional inspection (1 hr min) 66.25/ hr , © "^/y Investigation (I hr min) 66.25/ hr City /State /ZIP: Industrial plant (1 hr min) 78.18/ hr Phone: (5 , -Wok 7 Fax: (5a3) 4 3q- 4413 Inspections for which no fee is specifically listed ('f hr min) 90.00/ hr CCB Lic.: /9 7/ 7y Electrical Lic.: e n / Suprv. Lic.: 5//)6 ELECTRICAL PERMIT FEES Subtotal: icy, 7,0 Suprv. Electrician signature, required: raTimiL7 Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): /A,0,11 TOTAL PERMIT FEE: / /a, 7 " 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. :t BuildingWermits \ELC- PermitApp.doc 07/01/10 440- 46t5T(11/05 /COM/WEB