Permit CITY OF TIGARD ELECTRICAL PERMIT
., - ':_ COMMUNITY DEVELOPMENT Permit #: ELC2009 -00507
T I GA:RD 13125 SW Hall Blvd., Tigard OR 97223 503 639.4171 Date Issued: 09/30/2009
Parcel: 1 S 126CA00700
Jurisdiction: Tigard
Site address: 9350 SW WASHINGTON SQUARE RD
Subdivision: Lot: 0
Project: JC Penny
Project Description: (1) branch circuit for seasonal outlets in ceiling
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY J C PENNEY 0288 -1, TAX SERVICES, PO
BOX 10001 1 crt Branch Circuits 09/30/2009 $46 85
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/30/2009 $5.62
Electrical
Contractor:
ADVANCED WIRING SERVICES INC
PO BOX 644
CLACKAMAS, OR 97015
PHONE: 503 - 310 -3655
FAX 503 - 698 -6372
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
- Total $52 47
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 t - 180
days. ATTENTION: Oregon law r • ires you to follow the rules adopted by the Oregon Utility Notification Center T• • = rul,e are se OAR
952 -001- rough 52-0 -010i ou may obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or�� r 32.00
Iss ed By: / _ _ l Permi ttee 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' �.,, � , ; I C Date: F4047
LICENSE NO. ,(6 7C-
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
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.
itl'ectrrcal Permit Application FOR OFFICE USE ONLY
City of Tigard DateBed diP MAW. Permit No �+
1114 L�I.C, 1r 6 09 )
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' 0 Phone 503 639 4171 Fax 503 598 1960 Date/13 Other Permit
T I G A R D inspection Line 503 639 4175 Date ReadyB El See Page 2 for
Internet. www tigard -or gov Notified/Method 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 ❑ Mannas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 El Commercial -use agricultural
❑ I - and 2- family dwelling ` ' Commercial /industrial El 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 denved system
❑ Addition of new motor load of ❑ "A ", "E ", "1 2 ", "I - ",
Job no. :,0 3C/ Job site address: .735- S lad, or more occupancy
K �
GARr ❑ Six Six o or r more residential units ❑ Recreational vehicle parks
City/State /ZIP: yhQ O / 172 2 3 / 12 Health-care facilities El Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no : Project name: l 1.2 ❑ Service or feeder 600 amps or more
'" /� t°itJ�//f/ FEE SCHEDULE -
Cross street/directions to job site ..7 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 145 15 4
Ea add'I 500 sq ft or portion 33 40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ) 75 00 2
Ii
Limited energy, multi - family 75 00 2
residential (with above sq fl )
Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106 85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454 65 2
City /State /ZIP Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6 65 2
/� each branch circuit
Business name: /9,0 a/fiet ' 52 /lei riel c B Fee for branch circuits
without crvi r or 46.85 L
feeder fee, /gs 2
,l� 14,,/, ' first t branch circuit �
Contact name 9
Address: /7 t6 i3 (till Each add'I branch circuit 6 65 2
/ Miscellaneous (service or feeder not included)
City/State /ZIP: ,4 , 5 "iE y 7oir Each manufactured or modular 90 90 2
Fax: . U ; Reconnect only 66 85 2
,��� dwelling, service and /or feeder
Phone:
( ) 513 — g33 - �j- QU ( 3 D %6y'7y
E -mail: ,.¢sriS0nf9 /ft�� , /O/yf Pump or irrigation circle 53.40 2
CONTRACTOR • Sign outline lighting 53 40 2
Business name: Signal circuit(s) or limited -
energy panel, alteration, or
Address: extension Describe Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone. ( ) I` Fax (
�t I lb Investigation per hour (1 hr min) 62 50
CCB Lic.:/�� �yy I l Electrtcal Lic : �' 7 upry Lic. G��7Js Industrial plant per hour 73 75
' ELECTRICAL PERMIT FEES
/
Supry Electrician signature, required / 101ti v Subtotal gigs" /// Plan review (25% of permit fee)'
Print name: / Date: C-.
�"� �/,
Sl State surcharge (12% of permit fee).
Authorized signature: � � � i�y� TOTAL PERMIT FEE
r��.�f
/ This permit application expires if a permit is not obtained within ISO
Print name: _.$2,1-,/ A Date: — Zd O � days after it has been accepted as complete.
• Number of inspections allowed per permit
I \Budding\Permits\ELC- PermitApp doe 05/23/06 440- 46t5T( I I /OS/COM/WEB .
Electrical Permit Application - City of Tigard 1 '
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls •
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I \Bwldmg\Permits\ELC- PermitApp doc 03/23/06