Permit II CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELC2009 -00230
T { GARD 13125 SW Hall Blvd , Tigard OR 97223 503.639 4171 Date Issued: 05/22/2009
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9751 SW WASHINGTON SQUARE DR D01
Subdivision: o Lot: 0
Project: Signature Day Spa
Project Description: Install /alter (26) branch circuits
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, 26 crt Branch Circuits 05/22/2009 $213.10
2235 FARADAY AVE STE #0 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/22/2009 $25.57
Contractor: Electrical
WHITE LIGHTNING ELECTRIC CO.
7524 SE 52ND
PORTLAND, OR 97206
PHONE 503 - 772 -3009
FAX: 503 - 772 -4008
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Total $238.67
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: 0 ti' _ J) /Lk\ Permittee Signature: � Vi • Q � k c 1 1
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.
- 141Y•-20 -2009 02:43P FROM: WHITE LIGHTNING 5037724002 TO:5036656200 P.1
may cu uy tc.ocp tram RECEIVED p'
Electrical Permit Application , , , 1(' 'I 1 I • I I , ...;:.„:,,i,1_, , ,. k
City of Tigard MAY 21" 2009 R . _ l ea" p.�i�. .. 1
--- 13125 9 W Had 81vd., l5gmd, OR 97123 Phut Rewt
■ Phan: 503.639 .4171 l=air: 503.591.1 OF TIG ARD antes.: other Puma: '611P 2n Cr Q • C') ) 0 (vS
Inspeeudr 503.639A175
BUILDING oeteneadPTIV nett RI see Page 2far
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TYPE OF WORK PLAIN REVIEW
❑ New construction ® Addition/alteration/replacement Rem chat all that sgpty (sterna a seta of plans unman eroded below
0 Service or feeder 400 amps or man 0 Sanding over them swim 1)t Demolition fl ❑ Other wliae the tvtBehle fain amen 0 Marines and boatyards.
CATEGORY OP CONSTRUCTION mceacts 10,000 attars m 110 volts or 0 }2mbsg bundi1s.
lees to gonad, or marts 14,000 0 kcal -use etricwmm
❑ I- and 2 -t roily dwelling ® Comm rciat4ndustiial ❑ Accessory building amps thrall ether bindings
❑ Multi - family _ ❑ Master builder ❑ Other. , 0 Fife mom. 0 tosteihaon of75 KVA or
JOB ST E INFORMATiON AND LOCATION 0 mom lam= ely &AradMien).
D Addtreaof new motor lead Cre. E"."1,2 ",'I,7%
Job no.: I Job site adg s Washington Square Rd. 100HP 0f arm. same w.
0 IX err roars residmtid tams. 0 Ratemdonel whsle parts.
City/State/ZIP: Nord, OR 97223 OHeahbtara facilities. 0 Supply voltage for more tom
ri liazardwas least are. CO volts nominal.
Suite/bldg./apt no_: DO i Project name: Signature Day Spa 0 Service a foodtr600 tope or mono.
FEE SCHEDULE
Cross slred/directious to job site: *swipe= 1 ors. L r. I Teal i •
New residential tingle -nr maid-family dwelling unit.
Includes attached garage.
Subdivision: _ LLot no.: 1,000 sq. ft or less r 145.15 4 _
Ea. add 500 sq. fl, or portion 33.40 I
Tax ntap/paroel no.: Limited energy, residential
DESCRIPTION OF WORK (with above n2 B") 75.00 2
Liming Muzzy. multi- tinnily 7500 2
terse n ie! (with alere sa• ft.) _
Services or feeders inatailadon. amnion, and/or relocation
200 amps or berm 8030 2
❑ PROPERTY OWNER j ❑ TENANT 201 amps to 400 amps R 10685 2
Nom: 401 amps to 600 amps 160.60 2
601 amps to 1,000 tarps 240.60 2
Address Ova 1.000 amps or volts 454.65 2
City/Stale/71P: Temporary services or feeders instifadoa, alteration, and/or
rdootion
Phony ( ) I Fax: ( ) 260 amps or less 66.85 I 1
Owner installation: This installation is being made on property that I own which is not WI aWs to 400 amps 100.30 1 2
intended for sale, lease, rem or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 133.75 2
Owner lash Branch cheeks new, alteration, or esteeion.per panel
A Fee for branch circuits with
ti5 APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.63 2
exh branch circus I
Business bane: Bid All Construdion B. feu for branch circuits i
Contact rains: Ted without service or fader fee 4685 2
first branch circuit
Address: 1842/3 SE Pine St. 01112 Each add'I branch circuit Z 5 . 6.65 i , 2.j 2
M6eeQnneous (service or feeder notitcluded)
City/State/ZiP: 97233 Each mamdhcwred or mama
dwelling. seer ice and/or feeder 2
Phone: (503) 665 -6100 J Feu:: (503) 665 -6200 Rectinacct only 66.85 2
E -mail: jesaet idalkoaetreetson.eom Pwopor irrigation circle 53.40 2
CONTRACTOR Signor outline lighting 53.40 2
Business name White Lightning Electric Inn
Sigrid eimains)or limited -
ems• panel. alteration or
Address: 7524 SE 52nd Ave. extension. Desalbe: Page I 2
City/State/ZIP: Portland. OR 97206 Each additional inspection over allowable in an ortbe above
Per inspection
Phone: (503) 772-3009 Fax: (503) 772 -4008 Inmtigaslon 62.50
Investigation pct tract (1 to ndn) 6250
CCB Lie.: \ � lt (T 1 Electrical Lie.: .- Soprv. Lic. S - Industrial plait per >�r 73.75
Sup). E) cetN signature; required: I O. 1• 10 ELECTRICAL PERMIT FEES
; ) / Subtotal 213. tO
-7
Print name , - 7 �'l1`C \'C laet� 1 211 ' S \ ('hen revi (2596 of permit fool`
State surcharge (12% of permit feel` 2..`D.
Authorized signature: TOTAL PERMIT FEE G., y 3J/]� 71 a W II e
Print name I - Ts perish ap1/pesa ensues it o pemdi is sot rbeaiaad widths WI
dais after it has been accepted is teupkte.
• 'Number of inspections allowed arc permit
ITa7dna5Pam3dRGPe eilAwAoa 052:106 440-4615011M 7C0100/91