Permit CITY OF TIGARD ELECTRICAL PERMIT
11111 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00457
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/08!2009
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9659 SW WASHINGTON SQUARE RD M06
Subdivision: Lot: 0
Project: Spencer Gifts
Project Description: (1) 200 amp service and (30) branch circuits for TI
Owner. FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVICE,
2235 FARADAY AVE., STE. #0 1 ea Services or Feeders - 200 09/08/2009 $80.30
amps or less
PHONE: 30 crt Branch Circuits w /Purchase 09/08/2009 $199.50
Service or Feeder
1 ea 12% State Surcharge - 09/08/2009 $33.58
Contractor: Electrical
FIVE STAR ELECTRIC, INC.
PO BOX 555
BANKS, OR 97106
PHONE: 503 - 324 -0948
FAX: 503 - 324 -0973
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $313.38
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 through 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: Permittee Signature: D/✓ 4 fr/'L/ 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 603.639.4176 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.
1
'From: 09/03/2009 08:41 #755 P.001/001
Electrical Permit Application' ' i OIZ (lri 1( E t' L 0NI..1
City of Tigard S'LP ,n i. 9 e B� ? ,' , 4 PermitNo CLCeZD09-0OY52
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi
- 111 Phone: 503.639.4171 Fax. 503.598,1960,, . Date/By: Other Permi� /446:409.-"67/..5.-5 7 -1 G h D Inspection Line: 503 639.4175 ' s Date Ready/By. kris. h``^"' HI See Page 2 for t/
Internet: www.tigard or.gov : ' Notified/Method 17 G Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /Hems checked below)
❑ New construction EkAddition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stones
El Demolition 0 Other:
where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
❑ 1 - turd 2 - family dwelling Commercial /industrial ❑ Accesso buildin l m s to ground, other or installations 14,000 ❑ commercial -ice agricultural
building amps for all other mstallanons bwldmgs
❑ Multi- family Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION � / qq y ❑ Emergency system
❑ Addition of new motor load of larger separately derived system
❑
100HP or more. occupancy
Job no.: 5 SL�� Job site address: �1 .)h /d5PI //0G 1
/ ❑ Six or more residential urns ❑ Recreational vehicle parks.
City/State /ZIP: - < / 2e T?'i 6 CI Health-care facilities ❑ Supply voltage for more than
L• / �` ❑ Hazardous locations 600 volts nominal
Su ite/bldg. /apt. no.: Project name: 5/2(./ 3 t ( � /5 ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
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'I 500 sq. ft or portion 33.40 1
/...)'
Tax map /parcel no.: /S/W6 /) /o ago () Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft ) 75.00 2
C.
! �d ,� Li mited energy, multifamily 75.00 2
residential (with above sq. ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less I 80.30 K/ 5 2
❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 106 85 2
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: ( ) l 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A Fee for branch circuits with
( APPLICANT I ❑ CONTACT PERSON
7 / above service or feeder fee, i 6 65 c ) 2
e j each branch circuit
Business Ham
: r P / i /L / n B . Fee for branch circuits
c without service or feeder fee,
Contact name: �' first branch circuit 46 85 2
Address: IJ 2 ,0 7-)by 6 Each add'I branch circwt 6.65 I 2
Miscellaneous (service or feeder not included)
City/State /ZIP: C Each manufactured or modular
�7 �` C dwelling, service and/or feeder 90.90 2
Phone: ( j) 3 7(7,_ r Fax: : (50) 32C/ —61 73 Reconnect only 66.85 2
E -mail: � A./fl'/' 6-{- v / s A� J ct .7 - c lerf i c / elrg Pump or irrigation circle 53.40 2
(� CONTRACTOR Sign or outline lighting 53,40 2
Business name: 5 u 6LS /� n energy panel, alor teration, limited- o or
c-(- � � _ 1/`� energy panel, alteration, or
Address: extension. Describe. Page 2 2
City/ State/ZIP: Each additional inspection over allowable in any of the above
Phone: ( ) : ( } f
Per inspection 62.50
4.. 4 /investigation per hour (I hr mm) 62 50
CCB Lic.• , l E lectrical Ltc.: � � Su rv. Lic.. Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 1. Subtotal: ,2 7C, go
t Print name: if i -, l Date: c _3 e G Plan review (25% of permit Gee)
State surcharge (12% of permit fee)' 33 C '
Authorized signature: TOTAL PERMIT FEE' _ ,15,_;
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.