Permit CITY OF TIGARD ELECTRICAL PERMIT
8 COMMUNITY DEVELOPMENT Permit #: ELC2012 00588
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 10/10/2012
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9355 SW WASHINGTON SQUARE RD T19
Project: Venzon Wireless Subdivision:VASHINGTON SQUARE ESTATES NO Lot: 108
Project Description: Add (1) branch circuit for new ceiling mounted Move -N -Cool unit
Contractor: MCKINSTRY ELECTRICAL LLC Owner: PPR WASHINGTON SQUARE LLC
16790 NE MASON STREET SUITE 100 PO BOX 847
PORTLAND, OR 97230 CARLSBAD, CA 92018
PHONE: 503 - 278 -3954 PHONE
FAX: 503 - 331 -6907
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 10/10/2012 $56 18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/10/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification enter Those rules are set forth in OAR
952 - 001 -0010 throu_ • •AR • 2 -00 •!, r You may obtain a copy of the rules or direct questions to OUNC by calling 2 1987 or 1 800,332. 344
Issued By: • � . � �' 6- Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FROM :MCKINSTRY RECE1VE Oct. 10 2012 10:10AM P1
Electrical Permit Application OCT 10 2012 1.0R OrFI`:I', i ;S : ONLY
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of , �4a -ooSd g
City Tli surd , � TIGIflRD 1>„te/Uy: is Permit No.: ez e
u 13125 SW Hall Blvd., Tigard, OR 97223 Plan Roviow
7,1,....- I Phone: 503.718 2419 Fax: 503.598.1 L G !Jl A tr a uiy (Mier remit:
I r. A ,; 1, Inspection Line; 503.639.4175 pppp���� t Date Ready/By Aids. Bf Soo rage 2 for
IA l Internet: www.tigard- or.gov 1 Noti$i /Method: Supplemental Information
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❑ Ncw construction ® Addition/alteration/replacement Plaits chock all that apply (auhmit� of plane w /itam� chenkod twkrw).
0 Servloe or feeder 4(10 amen more ire ❑ Iluilding over three valrie..
❑ Demolition ❑ Other:
`+ tf �, �p when; the available fault cement ❑ Mariana and boatyards.
IN , i'�t�, !Tarim L'it ry �1, n 1 , tf � r G n tatt P �I I 4 t, +, r x Ir I r xr r n -- I amps ❑ Floating bnlldlM9.
if t ��}II�t i �t --,,��** � � '1 I rnnhi.il :r :�l ?.{_'li ?k 19[ _fJ :E.i+rdnR exceeds Ot I$OVOIteOi
34 ' tat 1 swim +l l b, �llarr ua 1 ' , ! h 7 11i nl,ilUhi,Iwx i u,1, ,, HittA + i Eig- ll'� less to ground, or exceeds 14.000 ❑ Cnntmc+cisl -sae agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings•
❑ Multi-family ❑ Master builder ❑ Other: 01. ire pomp 0 Installation of 75 KVA or
rl r l {'} :', "' ' 1 r I;Ir i� � 11 mu +tu+ • i it n{n;ry,sa nmamn , i q • n I + W +�+' ' - 4,:i! • , . I .'.114; 'r. - - r - -- ❑ Pmrrxrm•y system, lacer sc aratel derived system.
I n nm 1 d .': t n' F"X(i a 1'' 11 D (; ! Y,y� i ,, 'p. , is E ;ISki PilLlimi i ii i Tr, , g P y y
�h unVl 5� ll t7 a�dk11a0&�111MM+ilihiefrlli dl,tRr a a�G+1Ay>rl:�h; i = nr„ I. , I N, ❑ Addirilm of new motor land of CI "A "E ", "1 - "1 - ",
Job no.: 73056 Joh site address) SW Washington Sq. Rd 100HP ormorc. occlmnrey,
-- - O Six or more residential units. ❑ Recreational vehicle parka
City/State/ZIP: Tigard, OR 97223 98SS 0 Health -care fltcilrtros O Supply voltage for more than
1 . Pro ect name Verizon 600 volts nominal .. _ Hazardous lale!�iet ` ?' amps or mare,
Cross street /direct site: Hall Blvd & Washington Square Rd ... :Iry 1 h ",' . „l,n i '! ",' a , :,'•,ar M......;:-rt,frr:; ; •^Mtln„ -1r
Suite/bldg./ay. • T- 9 0 S ry car (Coder 600 t ,I ,y i I,
-- - - I.UL .,. .: {� i k �I� ed..l ll+i, _
nrlaet•Iprion ! rL Fee__ " rams J
- New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: i Lot no.: 1,000 sy ft. or leas - 168.54 4
Ea. ndd'l 500 sg. ft or portion 33,92 1
Tax map/parcel no.: Limited energy, residential
t!l=iiIiit igl✓j i t 1 [y p I 1 1 g1 ,1 N %',3 i 1I � n 4 I . 0 ' .. 'n l • a i , l , • 111 r 1 I + e! ' R1 , ' all null+ t r: h 1�11a4tI+lRlilnu!ia, r 75.00 2
l24,7,41-,i14,6EF Et t V l u+l rl Nil�Iipme- l , , , I , e ,, .I, ..,.,:,,,,.,a- „+ 1 k 11u 1ll; Iin ;li1ri111ia,111111iri111rPru,t ( (with a11� ve x1. ll.)
bh�11l.,crr,,, :.• :. L energy. multi- family
Add circuit for new ceiling mounted Move -n -Cool unit that Is being installed rasidatlial (with above sy. Il.) 75.00 2
Services or feeders installation, alteration, and/or relocation
} j 200 amps or less 100.70 2
111 !1lIiNiltirlll}laria ; ti llin S lim �lna u sPi - -. Jfilil ll 11 '9 1
j1+ i1kt11lkHli(ij 1+'Fi i C, t.'-- iiI14- iirli'ftl1n7�t 201 amps to 400 amps I33 2
,S6 -
l�u�ubnkr ' 4k
401 amps to 600 anlpa 200.34 2
Name: Verizon Wireless .-
- -- -- - 601 amps to 1,000 amps 301.04 2
Addresa: 9585 SW Washington Sq. Rd Over 1,000 amps or volts 552.26 2
City/State/ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)620 -0395 Fax: ( ) _ 200 amps or lees 59.36 I
Owner installation: This installation itt being mado on property that i own which is not 201 amps to 400 amps 125.01 2
intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 101 amps to 599 amps 1 68,54 2
Branch circuits- new, alienation, or extension, per panel
Owner signature: _ Date: A. Fcc For branch cirvuita with
It I ;,f pppggql r d
r ltfnre , - ,• 1 r li in.:: •., li '+ w _ 1514‘1111‘1.1-61041 �1 above service or feeder fee.
, 1 1 4 lit n,i( 1'i ' 1 I iii it I,'1 I t11 T I . f it , II a r . I ' I 1.
• , lllil -
,..iii uuyc• x, l,,h ,-- - , „ra,ItHrnl, :,,.1-, each bran circuit 742 2
Business name: McKinstry Electric B. Pea for branch circuits without
- °° service or feeder fee. that 1 56 18
Contact UMW: Doug Cole branch circuit 56,18
— .. Each add'I branch circuit -- 7.42 2
Address: 16790 NT. Mason St, Suite 100 _ MIaeellaneous (service or feeder not included)
City/State/ZIP: Portland, OR 97230 [act manufactured or modular 67.84 2
dwelling, service and/or fecdet
Phone: (503) 331 [ Fax: (503) 331 - 6906 Rccnnn'xl only 67.84 2
L -. Pump or imgation circle 67.84 2
E -mail: sharouw(dmckinstry.com - ••• —
�fI U 1t11fyl ' 11 R
11 NINWIF49g31. p G!i, • 1 qn t- Sign or outline lighting 67.84 2
tklk Ile. 1 ■�11 1ti11+1, e'NgiaMCQ em- ea yb ,' t etlh - 1 t
i t It1 11x, 13 l ll gn ;r ll l l• li )nul dt'lll1gi4 ; !hl
n �M I ih1 • W�,, ,,, „r,,,+t + + +'l�cn Signal circuity) or limited-energy
Business name: McKinstry Electric _Lapel, alteration, or extension. Page 2 2
- . Each additional inspection over allowable in any of the abov
Address: 16790 NE Mason St., Suite 100 Additional inspection (I hr min) 66 25/11r
City /StatdLII': Portland, OR 97230 — Investigation (1 hr min) - 66.25/ hr
^. ..
.. _ Industrial plant (I lir min) 78.18 / hr
Phone: (503) 331 -0234 Fax: (503) 331-69116 Inspections for which no fee is
90.00/ hr
s 'Moll listed ''Ahrmin
CCB Lie l Li 37-930C S • .: 148685 I F.lectricac.: -uprv. Lie. 5428S - '
., ' +, l', ^ 11 I; '� "�
_... i, __ �ir .. .,,eS.l +lei :�.l.f'�th�l.,.1J!li!iltl�t. I S llllu'll�
Suprv. Electrician signature. required: Subtotal: 56.18
- - Plan review (25% of permit fee): 0
Print name: Andrew Crali Date: 10/10/12 State surcharge (12% of permit fcc): 6.74
Authr,ri7ed signature: �j,,I ,-- .f _.0 J� TOTAL PERMrr EPA: 62.92
-- - -_.. , „ mow ! v �t-�"^ 1'h permit applkatlo expires If a permit is not obtained within 180
Print name: Andrew Crali Date: 10/10/12 days after It has been accepted as complete.
• Number aim :pections allowod per permit.
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