Permit .II
CITY OF TIGARD ELECTRICAL PERMIT
::-.-- _... '.,
32 0 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00486
Date Issued: 09/17/2009
TN GAR 13125 SW Hall Blvd , Tigard OR 97223 503.639.4171 parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9402 SW WASHINGTON SQUARE RD P01
Subdivision: Lot: 0
Project: Dicl's Sporting Goods
Project Description: (1) branch circuit for cord reel and electrical power Job No 321543
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #0 1 crt Branch Circuits 09/17/2009 $46 85
CARLSBAD, CA 92008 wo /Purchase Service or
PHONE Feeder
1 ea 12% State Surcharge - 09/17/2009 $5 62
Electrical
Contractor:
ROSENDIN ELECTRIC INC
2925 NW ALOCLEK DR #170
HILLSBORO, OR 97124
PHONE 503 - 615 -8189
FAX: 503- 615 -0689
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 . • • . - . ith approved plans This permit will expire if work is not started within 180 days of issuance, or it work is suspended for more the 180
days • ENTION: Oregon la -quires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -0 -0010 through OAR 95 -101-0140 ou may obtain a copy of the rules or direct questions to OUNC by calling 503 246.6699 or 1 800 332.2344
Issu: d By: 1 ( -- -) 5
Permittee Signature: 1 nature: `(' / 2 /
_
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 —7
SIGNATURE OF SUPR. ELEC' ��� Date: C� 7 /DQ
LICENSE NO.
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.
Erec rical Permit Applicati r,ENED FOR OFFICE USE ONLY
City of Tigard e p * r� 1009 D a t eByd ( ( / 7 6 t Permit No tut �/y�j��(�g /
° 13125 SW Hall Blvd , Tigard, OR 97223S E' - E Plan Review ( ( "V
C : Phone 503 639 4171 Fax 503 598 1960 C ARp Date/By Other Permit
T I G A R D Inspection Line 503.639 C Q f 1 T 1 G r l Dat Ready/By Juno ® See Page 2 for
Internet' www.tigard -or gov BODING p1 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 ❑ 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 ", "I -2 ", "I -3 ",
100HP or more occupancy
Job no.: 321543 Job site address: 9402 Washington Square Rd ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: 97223 ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: Dick's Sprtg- Jordan Cord ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
@ Washington Square Mall 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. ft ) 75 00 2
Limited energy, multi - family
install cord tell & electrical power 75.00 2
P residential (with above sq ft )
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: Macerich Company 401 amps to 600 amps 160.60 r 2
601 amps to 1,000 amps 240.60 2
Address: 16495 NE 74 Ave Over 1,000 amps or volts 454.65 2
City/State /ZIP: Redmond, WA 98052 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 I ® CONTACT PERSON above service or feeder fee, 6 65 2
each branch circuit
Business name: Rosendin Electric, Inc. B Fee for branch circuits
Contact name: Steve Hogberg, Project Manager first r service or feeder fee, 1 46 85 46 85 2
first branch circuit
Address: 2925 NW Aloclek Drive, Suite 170 Each add'I branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Hillsboro, Oregon Each manufactured or modular 90 90 2
dwelling, service and /or feeder
Phone: (503 ) 924 4968 Fax: : (503) 615 0689 Reconnect only 66.85 2
E -mail: shogberg @rosendin.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53 40 2
Signal circuit(s) or limited -
Business name: same as applicant
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: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: 103939 Electrical Lic.: 37 -692C Suprv. Lic.: 91S Industrial plant per hour 73.75
c--* 4 2 ....._ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal $46.85
Print name: Stephen Lawhead Date: r Oi Plan review (25% of permit fee).
S tate surcharge (12% of permit fee): $ 5.62
Authorized signature: TOTAL PERMIT FEE $52 47
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit
t \Bwlding\Permus\ELC- PermiApp doc 05/23/06 440- 4615T(11 /05 /COM/WEB