Permit a
n CITY OF TIGARD ELECTRICAL PERMIT
- R COMMUNITY DEVELOPMENT Permit #: ELC2009-00182
T I G AR D 13125 SW Hall Blvd , Tigard OR 97223 503 639.4171 Date Issued: 04/27/2009
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9530 SW WASHINGTON SQUARE RD H10
Subdivision: Lot: 0
Project: Apple Store
Project Description: Install (16) branch circuits, and (1) restricted energy for voice /data
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, 16 crt Branch Circuits 04/27/2009 $146.60
2235 FARADAY AVE STE #0 wo /Purchase Service or
PHONE: Feeder
1 ea Signal circuit or Limited 04 /27/2009 $75.00
Contractor: Energy Panel
JC ELECTRIC INC 1 ea 12% State Surcharge - 04/27/2009 $26.59
118 NW 184TH STREET Electncal
RIDGEFIELD, WA 98647
PHONE: 360- 887 -7889
FAX: 360- 887 -5584
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $248.19
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 Center Those rules are set forth in OAR
952- 001 -0010 th ough OAR 952 -001 -0100. You may obtain a co.y of the rules or direct questions to OUNC by calling 503 246 6699 or 1 810 332.2344
\ n
Issued By: ` ' �� : ; 1 i 1 . _ Permittee Signature: 0 • •!' J r\
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.
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.
.• 04/23/2009 13:55 3608875584 J.C. ELECTRIC, INC. PAGE 01/03
r
Electrical Permit Application FOR OFFICE. I.USF. ON1.1'
1 � g RECEIV te;>3`y 4.2�• cat gte2c •50182
City o Tigard P ertttit r10
. 'e 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone. 503.639.4171 Fax 503 598.1960
Date/13, Other Permit.
I 1 r; A FZl, Inspection Line. 503.639 4175 APR 2 3 200: Date ReadyBy ruris ® See Page 2 for
Internet, www•.tigard -or gOv Notified/Method II ` Supplemental Information
N:, ' J i '''''' R "1:1,': i s i:i i I laii11191):' �rim 1 , 11 "ml �I„ ,ro • , , om rno1 Tf� .� ' I \ ' I II i I i ii I'' I'.� •''b;
�o,�, , ,r„ f� � ..I ,I, ,t, � �; I i I i 1 ' i i t',;r, l ' I 10 ' 1 ' i II 1 ' PI`i ' � � I, I c
1 „,.1• � :'1 1n�!ll IY � 1 � i .o . , .0 mil I id ii- I 1 II ' C I O d .1 ! 1 .? k 1, I ,..- I ri ,l 4 , a, I
1 1 1 1,•, ' � ., -, ' 1 1
IJ �(�• I I i l llii, l ; 1? i, I51i i; i;( Dili " i i i)� l i � '1 T 4' • r l 1 - �e'1Wr IM,iI I � IFdd Ill+ 1, � ..' ..� +•� � �, ,,�• � •'�+' � •�', +' � +,;. '
i �1 Sy � I� I id ■ � '?� I'i. 1
❑ New construction A Addition /alterationn4 ,91 i D Y tS U.N Please check all that apply (submit 2 sets of plans w /Items checked below)
El Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition
❑ Other. where the available fault current ❑ Marinas and boatyards
7.7. ,,',n: : :i;j11 r1: :!1; "11'"��"1" "' ;Nl i i ' ; +' Ill : i ;; ;P fill"lI'i l % ii' r,l;!'mil!iii{ exceeds 10,1100 amps at 150 volts or ❑Hoeing buildings
;I," ' ";Pi's,, .1i +a�'1,, 1 1 'l ,a :;� . c 1 ( „I�, I I „ I,if i , l 11
-, • ' .. °•;;� . , Y'!i. I d.,1. ,•,4f ' � i � � 1„ � � r , 1111. ;n,(I� I ' dilli ,.,,, I, 1,1,1.;,,1. less to ground or exceeds 14,000 ❑ Commetctal -use agricultural
❑ 1 - and 2- family dwelling I Commercial /industrial ❑ Accessory building amps for all other installations buildings,
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
” „, ,, ° , ` 1, , , ,,, „,a ��� ; f, , I p, ;1 - ❑ Emergency system larger separately derived system
1 ,::1 1 . I i , 1 , 1 ' ; . , r,1 1 1
, ;,1; -Y;: .lbf 1 I � iii I '' 1 !II , Ir '' , I „ , ,,i ,fl
” j(
'� i 1 ';'H, 1„ •G,:1;!�' , L n,w+�� �.��in ,uamm i mnu un. "n,','la,' „ �; , „I ,, ,,,,;r'.' ,t",„1; ,I, +MIL •tldlllillillll;;ll;; fal�;;!i;1,Igi�ll ❑ Addit of new motor load of ❑ "A °, "E” "1 2 ", "1 3"
Job no.: aC rim Job site address: C\ S30 •LrJ l ,i`r• 1001IP or more occupancy.
CI Six or mvre residential units ❑ Recreational vehicle parka
City /State/ZIP: d� 0 \ - A "),4-4', ❑ Health -care facilities. 1:1 Simply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.• A\ Project name. A L % - C 1 0 Service or feeder 600 ..• • s orr more {
` P.; ; i` Il I !!Ir 1 i j; 1 ” 3 ilYlitt ,'i: I :, ;IPi i• li 1 1 1 li;;j !! 141 ill l(' "'' ,Il
Cross street /directions to job site: A . nn ' C , , P .� ' Dw ".
cr;peion Q• Fe . Total •
w� R^\ �'+�C• Yt, New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: - I Lot no.: 1,000 K.11 or less 145.15 4
Tax map /parcel no.: Ea add'l 500 sq. ft or portion 33.40 1
;I r? i { {S r
� ( ri� 4 iYr Limited energy, residential 75 00 2
p I L ' ' '',” , q ' t. ,', " ,,, 1i'i' ,L ]l i . :' ,„ -J, .? .17'',. , . O IF C FI ' '', , . , r „I . ��I 1I;� 11' 1;' I
Limited energy, multi - family 75.00 2
(with above Sq. ft.)
�
T- • k \ tL residential (with above sq ft )
Services or feeders installation, alteration and/or n r locati
e o
l s 4" r m(i , 1 , 111'1' ' ' ;; ; 200 amps or less 80 30 2
' .'.1,;ii ,; ' 11, , 9 i " a •ls i , ` , I, ' , „ ,i, ;il. I ; i ! , , L i } S I y; i I�il'�'I:' !1,1 I i;i( �j • i ll It ;I I , }1; iii i4.ril d' ;:; is 1 ' 1 ' . ' 201 amps to 400 amps 106 85 2
1 1, . t 1, rim id. n 1 1 , 101 , 1,
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 1 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. avid 701. 401 amps to 599 amps _ 133.75 2
Branch circuits - new, alteration or eatension,�er panel
Owner sip ature: Date: A. Fee for branch circuits with
2.' „ '•L•;'''•''•, ,. Ia i'Ii '1 . i ; y , l .i l l , 4I f ll l`lIII i n ll' �,' l i . Mh I t r Ii i ;i'll 'u' • '; ? j 1111 ; ,iii ' Il'I,11 ;11;'(Ibl �tldElI� i �i 1i''11 " above service or feeder tee; 6.65 2
each branch circuit
Business name: B. Fee for branch circuits i
Contact name. without service or feeder fee 1 46.35 `1b 2
first branch circuit '
Address: Each add'1 branch circuit i 6.65 , Reps 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
41,',.;:!. ' e %!' ;,' '' ';!'' bd ;b•hl' L 11dr l ' :; : ;I;, ,i' il �
�1' •.1d•• Ib� ,1:1:, I;i,1,��. � Il li�'ii; ll ' ;; ;'
N'' i,�, • 1 ,, �,I, � 1�,, i' i' '
F, ' Sign or outl lifihtin $3 40 2
Signal circuit(s) or limited-
energy panel, alteration, or
Address: . ` f1‘. extension. Describe 1 Page 2 '3,s�' 2
City /State /ZIP: {21. Each additional inspection over allowable in any of the above
Per inspection 62 50
Phone: (3\ ; -,... Fax; (' \) $ - - 'S 4 Investigation per hour (I hr mitt) 62.50
CC13 Lic.: s • _ ; •, . Lic.: X s Industrial plant per hour 73.75
�� � ,ulil:3al l'iiIS I, lliaili'1 }!1l : 1 0'4 `tW'l� 4'
�
I,' ia':II'li 'I'
Suprv. Electrician si • p1rt Subtotal
as —
Plan review (25% of permit fbe)'
Print name U .. State surcharge (12% of permit fee)
Authorized sign.tuaillilIME TOTAL PERMIT FEE: 1 1 4 , x . 101
— _ • - '--- This permit application expires if a permit is not obtained within 180
s �j✓ Date: �- days after it bas been accepted no complete.
• Number of inspections allowed per permit,
I, 1Buildineermns1EU :.PermitApp,doc 05/23/06 440- 4615T(11 /05 /C.OM/WFf3
04/3/2009 13:55 3608875584 J.C. ELECTRIC, INC. PAGE 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�'��"{�T� 1 � :'i7 u�. i.?�! "I�uirnrrr.4h�'16L•��{'lr� �� � .��n�.,, ,�.;� .. , . � �I::I
Fee for residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
:.;!0141404
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
J4 Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ 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: 114r.iIAins1Pwmi,g \F1 e- PCrmitApp Ant nVai /OR