Permit a CITY OF T I C A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00508
,i DEVELOPMENT H PMENT r S o ERV SERVICES 639 -4171 DATE ISSUED: 10/12/01
PARCEL: 1 S 126C0 -01107
SITE ADDRESS: 09485 SW WASHINGTON SQUARE RD A -6A
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: (2) each sign /outline lighting.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 2
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PPR WASHINGTON SQUARE LLC CMR SIGN SYSTEMS
P.O.BOX 21545 1820 E BURNSIDE
SEATTLE, WA 98111 PORTLAND, OR 97214
Phone: Phone: 285 -7918
Reg #: LIC 104219
SUP 319SIG
ELE 26- 695CLS
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 10/12/01 $106.80 2720010000( Wall Cover
Elect'I Final
5PCT CTR 10/12/01 $8.55 2720010000(
Total $115.35 EXPIRED
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable
laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification
Center. Those rules are set f in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to
Permit Signature: Issued By: A�
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'N: DATE:
LICENSE NO: 14 319
Call 639 -4175 by 7:00pm for an inspection the next business day
10/10/2001 12:02 FAX 5035981960 CITY OF TIGARD Z002
ii
Electrical Permit Ap itimi i _7.- , I on ., -,... ' - ' . . :.... -. . - - • . ,
' Date receive/5..1 to D 1
Pro ect/a Pp I. no.: Permit no.:. _ 990 D i /_i� _ i
;� STI `! , Expire date:
City of Tigard
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OW Date issued: By: Recei p t no.:
Phone: (503) 639 -4171 Case file no.: Payment type:
/ F9x: (503) 598 -1960
Land use approval.
' ,. , . '; .,; T MIT , . -
1 _ . , YPC OF;PER
❑ I & 2 family dwelling or accessory (la -= mercial/industrial O Multi - family ),' enant improvement
0 New construction
❑ A ddition/alteration /replacement ❑ Other: O Partial
,
" , .3OB SITE INFORMATION : .
Job address: , ? fa�' Suite no.: J T . map /trot lot/account no.:
Lot: B - : Subdivision: lirQ-J' / -. ( `r - -
Project name: id. .A.,111111 Description and location of work on p - rniscs: j l
Estimated date of el' pletion/ins cction: 0- FEE SCHEDULE CONTRACTOR APPLICATIOl�i' ''::
�• . •.. Max
Total no. ins
lob no: • i /�/�� • i �� Description Qty. p
� �.iL E N r ®d eaid l- sittg♦e or rnittli-family per
Address: t7 ��� dwelling Includes atfacla5d 4
Serviccindude4
�� 1000 sq. ft, or less __ 4
I=aX: 7� . � p ' _ Each additional 500 sq. ft. or portion thereof 2
CCB no.: O t - ( "" Elec_ bus. tic, no: . •-• i C/ Limited energy, res == 2
City/metro tic, no.: Limited energy, non-residential
Each manufactured home or modular dwelling ME 2
p�7 ' 6)i Service and/or feeder
Signature of supervising electrician (required) ��y Date /
tratiffir aM. Services or feeders :hulanation, 1111
''' alteration or relocation.
. T R Y OWNER 200 amps or less 2
201 amps to 40 amps 2
Name (print): Q ` ••• 47., 11 401 amps to 600 amps �__ 2
6 01 amps to 1000 amps 2
Mailing address: 2
City: l ZIP: Over 1000 amps or volts _M
t tii: 1i ... r°'� 1
Phone: Fax: i ~ r ° ;• 'a :? - o r !cder s
tt -
Owner installation: The installation is being made on properly I o {nslallaN.-,a a, ca don:
which is not intended for sale, lease, rent, or exchange according to 200 amps or leas • 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps IMMIE 2
owner's signature:
D are: 401 to 600 amps _E_ 2
ENGINE' LR , " " • - RI-mid circuits - new alteration,
or extension per panel:
N ame: A. Fee for branch circuits with purchase of 2
Address: service or feeder fee, each branch circuit
B. Fee for branch circuits without purchase
City: State: of service or feeder fee, first branch circuit: 2
Phone.: Fax: E - mail: Each additional branch circuit: M_
t• •° PLAN REVIEW (Please check all that • apph•) Mlsc .(Scrvlceor feeder not included): ME
2
O Health -care facility Each pump or ini anon circle
ce over 320 amps-commercial of lal Each sign or outline li Ming PINIVA i:��
O Service Eac sn
CI Service wel l 320 amps doting of 1 &2 0 0 Building over 10, Buildings lecation �■ .
family dwellings ❑� square feet four or 5ignalcircuit (s)ora limited energy panel. 2
❑ System over 600 volts nominal
more residential units in one structure alteration, or extension'
O Building over three stones O Feeders, 400 amps or mom • Descri • non: .
O Occupant Toad over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighdngplan ❑ Other: Per ins cction - __�
Submit sets of plans with any of the above.
The above are not applicable to temporary construction service. _
Permit fee $ di " , '
' Net all jurisdictions accept credit cards, ply call jurisdiction for more information, Notice; This permit application Pl review (at %) $
O Visa 0 MasterCard expires if a permit is not obtained Se
/ 1 within 180 days after it has been Stare surcharge (8%) .•.. $
Credit cud numbs: tiepins TOTAL $ //6" a5
accepted as complete.
Naroe of cardhoider ae rhowm on credit card $
440-4415 ((„Op/COM)
Cardholder signature Amount
l_C2_D O { - c ro ms o g-
CITY qF TIGARD Plan Check #
4 125 SW HALL BLVD. r� , ' � . .L Ele *Permit Application
Recd By
Date Rec'd
TIGARD OR 97223 OCT 1 0 2001 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 CITY OF TIGARD Print of Type Permit#
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development WASHINGTON SQUARE Number of Inspections per permit allowed
Name (or name of business) SPFNCFRS Service included: Items Cost Sum
Address 9534 SW WASHINGTON SQ RD. #A6A 4a. Residential - per unit
City /State /Zip TIGARD, 0.11-, 1000 sq. ft. or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof $ 2695 1
Commercial4 X Residential ❑ Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data t Installation, alteration, or relocation •
Electrical Contractor CM /COLUMBIA INC. 200 amps or less $ 64.25 2
Address 1820 F. RI IRN S T flF 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
City PORTLAND, State OR Zip 97214 601 amps to 1000 amps $ 192.50 2
Phone No. 503 232 -8153 Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 26- 695CLS Exp.Date 10 -02 4c. Temporary Services or Feeders
OR State CCB Reg. No. 104219 Ex..Date 1_02 Installation, alteration, or relocation
COT Business Tax or Metro No .'>t Exp.Date 8 -U2 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 7� 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
License No. 319S I G Exp.Date 11 -02 see "b" above.
4d. Branch Circuits
Phone No. 503 232-8153 New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5 35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting / $ 42 75 41 • 4 09� kr
Signal circuit(s) or a limited energy
3. Plan Review section (if required):* panel, alteration or extension $ 60.00
Minor Labels bels (10) $ 497-98
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
/OO•
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N E C Chapter 5 5. Fees:
5a. Enter total of above fees $
* Submit 2 sets of plans with application where any of the above apply. 7 6-544, Surcharge ( 06-X total fees) $
"
Not required for temporary construction services. Subtotal • O ff' $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ -1 74÷?
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ - &12
is \dsts \forms \electric doc