Permit CITY OF TIGARD ELECTRICAL PERMIT
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°. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00116
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 03/10/2009
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9563 SW WASHINGTON SQUARE DR BO2A
Subdivision: Lot: 0
Project: Gymboree
Project Description: Install (3) branch circuits
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES,
2235 FARADAY AVE STE #0 3 crt Branch Circuits 03/09/2009 $60.15
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/09/2009 $7 22
Electrical
Contractor:
MT HOOD ELECTRIC INC
PO BOX 1270
WELCHES, OR 97067 -1270
PHONE. 503 - 622 -1305
FAX: 503- 925 -3525
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $67.37
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 thr ugh OAR 952- 001 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800 332.2344
Issued By: mart( \ jQ Permittee Signature: Q , A • av,n,
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' Date:
LICENSE NO.
Call 503.839.4175 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.
4,—Sent ; 13608857636; 05 Mar 09 11:57AM;Job 178;Page 2/2
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Electrical Permit AppiicatifiEcENED ‚° OFFICE USE ONLY
City of Tigard Receised 0 . ,
r):11E D.c..t : () 4 1. tgeeS Permit Nn : * ). 0 stl II I
--Clita.-:/.-1, i le
IIII m 13125 SW 11411 vd., Tigard, OR Plan ReN'ICW
Oilier Poinit.
; I/ r Phone SO3 639 -1171 Fate 503 5 A 9
? 0 4 2009
Date _
T 1 G AR D Inspection Line: kO3639.4 175 D Readviny k: ' fa Ste Vuge 2 for
Internet: wwv, tigard-or gm CITY OF TIGARD Notitied,t.i.h.d. r C Supplemental Information
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As,',',', ...„ „ ::;:'S 5 :', , f : .filk.::i I T' . 'Mali . VI l : / ;'.. 1 :A';'•a:.;, , ,
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masa cheek all that apply (submit 2 sets of plans V.ittems checked below):
0 New construction iyi Addition/alteration/replacement
0 Service or feeder 400 amps or more 0 Building over three Stories
0 Demolition i 1:1 Other: ,vheie. the available fault current 0 Marina, awl boat) anis.
r • '' ' '::;-:':"-'::'''' ''''''' ' ''':‘ '''. : ' klit040% ll* `••• .•' -''''':;"... -, OxCcedS 10,000 amps at 150 volts ar 0 float ,n2 billidingS.
ICS:, to gruund. or e m..ccd, 14.000 0 CfM11.11eleial apeollto II
ID I - and 2-family dwelling : 0 Commercial/industrial C I Accessory building amps for all other tosrallatimr... building
0 Multi-family 1 . 0 Master builder 0 Other 0 Fin: pump 0 installation of 75 KVA Cr
1 0 Emergency systcm lamer separately (talked Nr tent
... ' , ' . '' ,1.!:..-:.'-'•-'-.':::''' ' :.46314 . 0f ": ! l iiiifOtilliiIIIM,7:1:::1:' , . ::: - ' • :: 'A 0 Addition of IleV /710101' toad r
I) p 1 100HPut more. Woolley
Job no.: isile uddres::::: 9. 1 -00A14 fa(740 - 0 si, ,s1- push:10,i(icnii:,) wort 0 Rex: rativnal veltick. pall,
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CitylState/ZIP: M , 0 97,2,2 C) tit:Ail-cam facilities. 0 Supply s oltage for 6 inure than
0 ilarardints locations 00 soIN nominal
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Suite:bldg./apt. no.: // i
I Project name: Gvpy)it) 1 - 0 2., 1 o sm. or feeder/4Q amps or
• _ — 1 f ' ■.:::' .,"' 14 0,;:.:;:'r' • .,:. ".41 :--- = '','
Cross street/directions to job Site: s. I- "11" ' - r7;"1 -- "f1
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nem ration
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Nevi residential single- or multi-family dwelling unit.
Includes attached garage.
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Subdivision: Lot no.: L000 sq. R. or less 145.15 4
Ea add') 50(1 sq. II. or portion _ 33.40
Tax map/parcel no: .•
.
Limited energy. residential
75.00 ,
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Limited energy, multi-tan
Pe..444ock.i al e Smace. residential (wilt, above sq. a.) 75 00 2
Services or feeders installation. _ littera ion, andior relocation
200 amps or less _______ 110.30 1 2
l 201 amps to 400 amps l068 - El
401 amps to 600 amps 0 60
Name: 16
...._......
601 amps to 1.110)) amps 240 60 2 1
I Address: . Over 1.000 amps or volts — --- - -- - - 474.65 - "-- - 71 - T1
1 ----
C IN/State/71P.
— '
:
_ - -- , '( emporitry services or feeders ustairation, al and/or
1 relocation
I Phone. ( ) i Fax: ( ) 1 200 amps or less 66 I
400 s to amps
Owner installation: This installation is being made on property that f own which is not 20) amp _, 100.3(1
i intended for sale, lease. rent 41. exchange. according to ORS 147, 449. 670, and 701. 401 amps to 599 amps 133.75 -- 72
Owner signature: __ Date: _ ____ Branch circuits - new, alteration,or extension, per panel
; __ _ _ _ , _ _ ;___,
___,_ ___ _ __ . _ • ----- .- . t_ -
A. Fee for branch eircons wait
I: :.-. ,• ',..'4V" ' '' - :: 7 7. -1 , atiatkoot9,--:i,:,,, i , above. service or feeder fee.
6.65 1 1 2
each branch circuit
1 Business name: .
1.I. Fee tbi branch CiltAillS
, . .
without service or feeder fee,
Contact name: i 1 46 85 2
i — — first branch circuit
Address: Each adcP1 branch circuit ,2. 6.65
-- ' Miscellaneous (service or feeder not included)
City/State/ZIP: '
Each manufactured or modular -
1 dwelling, service and/or feeder 90.90 2
Phone: ( ) • Fax: : ( )
: Reconnect only 66.85 2
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1;,-mail: - Pump or irrigation circle 53.40 - 2
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i' 7 .1qg'-ii:', .4.V.!l:,g''re:1 ;''',:` t:' ;, :.'-.- iii,- C" -';'.:-:.. :, ':". ';: 4 Sign or outline lighting 53.40 2
Business name: n1+, HOOP E lec4f-- Signal circuit(s) or limited-
_
. energy panel, alteration. or
1
Address: p_0. b i_:,, c9r .i : 1 2 ?(:) extension. Describe. Page 2 2
.._ 1
Ci(yiSlatc/ZIP: t,a)c 1 0 k 57--C...6- 5 , 3 - Each additional injection over allowable in any of the above
1- Per inspection I I 62 50
Phone: ( 33) 6 —3:33 Fax: ( ' 1 95g5 Investigation j)el 110111 ii hr min)
CC -I
1 13 Lic.: N7640
Fleetrical Lie.: s - 517c &Try- 1 - 1 c- - 116 ed...■ S Industrial plant per hour 73.75 _
___.._. ." !"•;,, ,,_' .
Suprv. Electrician signature. opquired Subtotal
:
- : — — - ------ — ____ ,
Pim, review t25% ■ir permii fee):
Print Millie: 0 a „ ; f r I Date:05 -06---03
State surarge ch (12% amain. fee) 72
Authorized signature: 1 TOTAL PERMIT FEE 67, 7 j
permit application cxpirob if a permit is not obtained --
Print name: i 'eka fr: 1, ere_ z 4 ,,,.,, .._ I 1)ale: 0 -OS' —05 clays after il has been accepted n within 14T
s eomplete.
-....--
--- This ' Number of insper.iions allowed per 15000 11.
I flui;doys..VrtymWdit C•PermoApp dor 0,01.0-, 440-46011i FOS.COM1vi.a.
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