Permit CITY OF TIGARD ELECTRICAL PERMIT
Per
° COMMUNITY DEVELOPMENT
Permit #: ELC2009 -00185
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/28/2009
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9585 SW WASHINGTON SQUARE RD MGMT OFF
Subdivision: Lot: 0
Project: Macys Court Kiosk
Project Description: Install (1) 60 amp panel and (2) branch circuits. Panel location H -block electrical room.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, 1 ea Services or Feeders - 200 04/28/2009 $80.30
2235 FARADAY AVE STE #0 amps or less
PHONE: 2 crt Branch Circuits w /Purchase 04/28/2009 $13.30
Service or Feeder
Contractor: 1 ea Signal circuit or Limited 04/28/2009 $75.00
GLOBAL ELECTRIC, INC. Energy Panel
PO BOX 162 1 ea 12% State Surcharge - 04/28/2009 $20.23
NORTH PLAINS, OR 97133 Electrical
PHONE: 503 -647 -5650
FAX: 503 -647 -5649
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Total $188.83
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 R 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: ( I \_ .439.1 Ai Permlttee 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:
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.
_ . •
( � " V r % I . _ -
Electrical Permit Application -? v f
roll UFPICI: us!: (.)�I,l
City of Tigard 2 4 200 R
h' g AP Date ive - 2 . s Permit No • q- C • I ' S
• 13125 S W Hall Blvd., Tigard, OR 97223 _ ` a
■ : ' Phone: 503 639.4171 Fax. 503 598 1960 •
�+ y�/ � y� p ■ Ian Review Other Permit.
1,
Inspection Line- 503.639.4175 �I 1 r �✓B I� Pt' �Aate/Bs
TIGARD P r i. Page 2 for
Internet: www.tigard -orgov BUILDING DIUIS �� SS up
Internet: Information
TYPE OF WORK PLAN REVIEW
❑ New construction PZ Addition /alteration /replacement Please check all that apply (submit a sets of plans w /stems checked below)
❑ Demolition ❑ Other: ❑ Serv or feeder 400 amps or more ❑ Building over three stones
where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10 000 amps at 150 volts or ❑ Floating buildings
less to ground. or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Ea Commercial /industrial ❑ Accessory building amps for all other installations" buildings
❑ Multi- family ❑ Master builder
❑ Other: ❑ Ftre pump. ❑Installation of 75 K V A or
JOB SITE INFORMATION AND LOCATION ❑Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ . • "1.2'•. "1 -3"
' anc
100HP or more oc
Job no.: Job site address: ' r " t y; P y
�s – 5 C . vs/ f f.V,..11 s .511.6 7 2 C ❑ Six or more residential units 0 Recreational vehicle parks
City /State/ZIP — f �: /CI Y 'L Q OA ? - 7 2 t/ ❑ Health "care facilities 0 Supply voltage for more than
ti ❑Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.. Project name: 4 Y S /?;()c ❑ Service or feeder 600 amps or more
Cross street/ directions to job fleck-1m./ ob site: FEE' SCHEDULE
_ 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
Tax map /parcel no.: Ea. add'l 500 sq ft. or portion 33.40 I
Limited energy, residential 7500 2
I rr1J
DESCRIPTION p OF WORK (with above sq 5.)
rel.-.9114 6o ,4-0 j l u.•fdl Z Btzr�lC c r`r'cv� is -Jr /tosl� Limited energy, multi- family 75 00 2
residential (with above sq. fl) _
/ Services or feeders installation alteration and/or relocation
'
' I f S be, icy- % b 2 s(c: ee-J //t ii-L '6 6 - L fkicLl kV k' 200 amps or less y j , 80 30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name. 401 amps to 600 amps 160.60 2
Address:
601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
----1 a relocation
Phone ( ) Fax: ( ) 200 amps or less 66.85 I
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
Branch circuits - new, alteration, or extension, e er panel
Owner signature: _ Date: A. Fee for branch circuits with
❑ APPLICANT : I . ❑ CONTACT - , above service or feeder fee,
each branch circuit 6 65 2
Business name. B Fee for branch circuits
Contact name: without service or fewer fee, 46 85 2
first branch circuit
Address: Each add'I branch circuit 6 65 _ 2
Miscellaneous (service or feeder not induded)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66 85 2
E -mail: Pump or urigatron circle 53 40 2
CONTRACTOR Sign or outline lighting 53.40 2
� j � o Signal circutt(s) or limited -
Business name. Fl -A c ; AC
Address: 0 ex i ns onnDcscnbetinn, of
� t�X l (o� t I Page 2 2
City/State/ZIP- Nor` Pk •)A-5 O ; rip 917 / 3 3 Each additional inspection over allowable in an 10f the above
Phone: (s03) l/ J Per inspection 62 50
�v4/7 S'6 5 F ax: (5 s 3 ) k/7 56 q9
Investigation g per hour (1 hr min) 62.50
CCB Lie.: 56� 3' Electrical Lie.: ' Supry Lie.: z5 Industrial plant per hour 73 75
Supry i r
Eicf"an signature, required f -1 ` l , 1 ELECTRICAL PERMIT FEES
Subtotal: —
Print name: U i C^R / 041/07 Plan review (25% of penntt fee).
J l `ks. Date: State surcharge (12% of permit fee) 3
Authorized signature. TOTAL PERMIT FEE. /0/; ��
Print name: I Date 1 his permit application expires if a permit Is not obtained within 180
_.. A°.a ab•. it h•. M.n ..........r .. ...,_ –._._
COO /ZOO'd 917L# bZ :£l 6002 /tZ /b0 :woJd
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: • RESIDEI■TIALWORK - • . _
Fee for A ll residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK_ ONLY :.
Fee ford! commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
In Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I ` Buildinit \\Pcnnns\ELC- PermnApp.doe O3'23(O6
£00 /£00'd OL# 5Z:£l 600e /17ZI170 :woJj