Permit : CITY. OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00086
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DEVELOPMENT SERVICES DATE ISSUED: 2/6/2006
�'�" 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09779 SW WASHINGTON SQUARE RD D -11 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
Project Description: (3) branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASHINGTON SQUARE LLC PEGASUS ELECTRIC INC
BY THE MAC ERIC H COMPANY 17057 SW 123RD AVE
9585 SW WASHINGTON SQUARE RD TIGARD, OR 97224
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 502 -0340
FEES
Description Date Amount Reg #: LIC 148906
[TAX] 8% State Surcharge 2/6/2006 $4.81 ELE 34 -574C
[ELPRMT] ELC Permit 2/6/2006 $60.15 SUP 47545
Total $64.96 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Speaalty Codes and all other applicable laws
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 than 180 days ATTENTION: Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC at
503 - 246 -6699 or 1 -800 -3 344
Issued By: " --� ci. - 7 Permittee Signature:
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:
CONT OR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE: 2-- - C>
LICENSE NO: 4 7 5 1 .S
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.
El VE
Electrical Permit A l o k . r(Ili OFFICE USE ONLY
• City of Tigard Received
13125 SW Hall Blvd., Tigard, OR 97223 FEB ' r
O Date/B . / I / f •
1 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 4k. I Date/B •
Inspection Line: 503.639.4175 � . 1.� _ I _ Date ReaReady/By kris. ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TI - Noti6ed/Method: Supplemental Information
:, ` ►,,1L j D VISION • -. 1 PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: DSc over 225 amps, come' ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGO OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential
❑ 1- and 2 - family dwelling Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi - family ❑Master builder ❑Other: ['Building over three stories ❑ Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION 0 Egress/lighting plan RV park
a Q 5 w � 1 q1 'fl �� �) ❑Healthcare facility ❑der
P)
Job no.: Job site address: L I /1�[d/
Submit 2 sets of plans with any of the above.
City/ State/ZIP: 17 j4) r 0 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE'
Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: /04-S if 744 , Q/hZe. M/A-4-e— New residential single- or multi- family dwelling unit.
Includes attached garage.
Vr r 117 9 C , 4 - rTD 5 4-n,. 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
17 L f"1 � dwelling, service and/or feeder 90.90 _ 2
^( Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
„EaPPLICANT I ❑ CONTACT PERSON A Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: • branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, / 46.85 //( �J�2
Address: first branch circuit
Each add'I branch circuit ' , 6.65 j,, 9 U 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone:( ) Fax::( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 17E (, /1��, � L , 2/ G ,C r 4 L.
Address: �' • �j� Each additional inspection over allowable in any of the above
7 5 [23- /ice Per inspection 62.50
City/ State/ZIP: 4 /41,7_,D Qirz-. q 7 Z 'L V Investigation per hour (I hr min) 62.50
Phone: (578 )5-0 Z d 6 , ax: (,zj') (6, 7 C� / 3 7 Industrial pla per hour 73.75
ELECTRICAL PERMIT FEES°
O CCB Lic.: /4g fV( Electrical ' . 3y - Suprv. Lic.: 4 Subtotal tce7 13 .---
.N �
Suprv. Electrician signature, req 6, Plan review (25% of permit fee)
r ; Print name: 'T f j v G K_---;- 2 Date: 0 , , _ b State surcharge (8% of permit fee) y
.N !/ TOTAL PERMIT FEE
Authorized signature: J'3 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tn - County Building Industry Service Board
• • Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PeannApp.doc 12/03 410.4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system. $75.00
(SEE OAR 918 260 - 260)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i \BuildingWemiipNELC- PamitApp.doc 04/03
•
CITY OF TIGARD - .
BUILDING DIVISION PERMIT #: ELC2006 -00006
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 21G/2006
Phone: (503) 639 -4171 �rIli •
Inspection Requests (24 Hrs.): (503) 639 -4175 _
INSPECTION WORKSHEET FOR DATE: 2/7 /2006 TIME: 7 :02AM PAGE: 14
SITE ADDRESS: 0077 SW WASHINGTON SQUARE RD D-11 CLASS OF WORK:
SUBDIVISION: WASH1 ' GTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: BOM13A' \ CO
DESCRIPTION: (3) branch ;rcuits.
OWNER: WASHINOT SQUARE LLC, PHONE #:
CONTRACTOR: PEGASUS EL :CTRIC INC PHONE #: 503 -502 -0340
Inspection Request Scheduled For: Date: 21712006 Pour Time:
Code # Inspection Description ' Confirm # Contact # Message
195 mica- infipectiap 026417 -01 603 -402 -0340 Y
I C A AL,
Corrections /Comments /Instructions:
lavt• - (TOn Nf
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ F. ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 Phone #: (503) 718- 'LPN