Permit 1
CITY OF TIGARD ELECTRICAL PERMIT
' o COMMUNITY DEVELOPMENT Permit #: ELC2009 -00289
Date Issued: 06/16/2009
T.(GARD 13125 SW Hall Blvd., Tigard OR 97223 503 639 4171 parcel: 1S126CD00300
Jurisdiction: TIGARD
Site address: 9500 SW WASHINGTON SQUARE RD Q01
Subdivision: Lot: 0
Project: J C Penney
Project Description: Altering (2) branch circuits.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY J C PENNEY 0288 -1, TAX SERVICES, PO
BOX 10001 2 crt Branch Circuits 06/16/2009 $53.50
wo /Purchase Service or
PHONE Feeder
54 da Investigation Fee (Equals 06/16/2009 $53.50
Permit Fee)
Contractor: 6 ea Investigation 12% 06/16/2009 $6 42
PRAIRIE ELECTRIC INC Surcharge
6000 NE 88TH ST 1 ea 12% State Surcharge - 06/16/2009 $6.42
VANCOUVER, WA 98665 Electrical
PHONE 800 - 573 -2750
FAX
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $119 84
Required Items and Reports (Conditions)
This permit is is - • • ect to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and at other applicable law All work will
be done • - ccordance with approved • -ns This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days • TENTION Oregon la equires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
95 101 -0010 through OAR 952 -r1 -0100 -u = obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1.800 332,2344
I i
Issued By: k 1 y 7M � � Permittee Signature: '1 .e
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:
CONTRACTO INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' A __......S `,I ,`r�� �' co-A---- Date:
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.
Electrical Permit Application ---- n r, h - FOR OFFICE list: ONi
INI City of Tigard
/ Permit No.. and DateBed `� i „,F..
`J
• 13125 SW Hall Blvd, Tigard, OR 97223 JUN 2009 Plan Review
Phone' 503 639 4171 Fax: 503 598 1960 Date/B : Other Permit:
lit; n r t) Inspection Line 503.639.4175 C I \' Date ReadyBy lures El See Page 2 for
Internet www.tigard -or gov °" 0 , Notified/Method Supplemental Information
, .. • 111 O F W . _ ,, <;� •.l . ' 'a *n
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4 a ? 1p `is r " — � 4 /V� ! v -4 "' ,, I'‘'"'.-.A''' : ". ,' ' 1 r�:
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❑ New construction ® Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑Other:
El Service or feeder 400 amps or more ❑ Building over three stories
where the available fault current ❑ Marinas and boatyards
: � ". " -O ; exc eeds 10,000 amps at 150 volts or Floating CATEGORY OF 'GOIVSTROON ; : `` -
, ; P ❑ Floatin 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
- y _
. :. ;;:; :- . - --, ❑ Emergency system. larger separately derived system
- `- :., B SI T E >IN 1�wyht_ I ON ,fin :LgeA - ' , ' { , • -
- •. , - . . .. , � ;, - ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: IOOHP or more occupancy.
9500 SW Washington Sq . Road ❑ Six or more residential units. ❑ Recreational vehicle parks
City/State /ZIP: Tigard, Oregon 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more
J.C. Penney Store _
s - ,6 d4'� :r:�,1afi �, -, _,.: >� �' a• ,tr + y .. ,•; � s • 4 -
',
� :._� l' _ . ��ri!!' ..�" -.o.: 9 � � I ,. :+ Nrt'm;y {,- '� : ?ta�. .% ;
Cross street/directions to job site: Description Qty. Fee. i Total 1 •
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'l 500 sq ft. or portion 33.40 1
Tax map /parcel no.: Limited -. energy, residential
- DESCRIPTIO ;OF, WORK . . - 71 :; ; i` ` `i"" gl' 75.00 2
.. d (with above sq. ft )
Limited energy, multi- family 75.00 2
Altering 2 circuits residential (with above sq ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
-0 PROPERTY OWNER O T NA1 . - ^; :__ • ' 201 amps to 400 amps 106.85 2
P P
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, er panel
Owner signature: Date: A. Fee for branch circuits with
_ - above service or feeder fee,
C ] , arPl r� a • c oN1 AC'I; r>�Its >
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit 1 46.85 46.85 2
Address: Each add'I branch circuit 1 6.65 6.65 2
Miscellaneous (service or feeder not included) _
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone:
( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
. • • , - CONTRACTOR - - _ - ' ' Sign or outline lighting 53.40 2
Signal circuit(s).or limited -
Business name: Prairie Electric dba St. Johns Electric energy panel, alteration, or
Address: extension Describe: Page 2 2
6000 NE 88th Street
City/State /ZIP: Vancouver, WA 98665 Each additional inspection over allowable in any of the above
Per inspection 62 50
Phone: ( 360 ) 693 -5100 Fax: ( 460 ) 576 -7422
Investigation per hour (1 hr min) 62.50
/ f
CCB Lic.: 60178 5141( Electrical Lic.: 37-491C ! Suprv. Lic.: 35625 Industrial plant per hour 73.75
Suprv. Electrician signature, required: °� t o "tin ' C 53.
0 x Subtotal: 53.50
Plan review (25% of permit fee).
Print name: Bill Halberg Date: 6 -16 -09
State surcharge (12% of permit fee): 6.42
Authorized signature: , ( TOTAL PERMIT FEE- l 59.92
This permit application expires if a permit is not obtained within 180
Print name: Bill a lberg Date: 6 -16 -09 days after it has been accepted as complete. 62. 9
• Number of inspectto L l ' owe per - -"
/
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