Permit a CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2009 -00192
T [GA R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/30/2009
Parcel: 1 51260000300
Jurisdiction: TIGARD
Site address: 9585 SW WASHINGTON SQUARE RD MGMT OFF
Subdivision: Lot: 0
Project: Auntie Anne Kiosk
Project Description: New sub panel in D -block electrical room, and power and resztricted energy for kiosk in front of
JCrew.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, 1 ea Services or Feeders 200 04/30/2009 $80.30
2235 FARADAY AVE STE #0 amps or less
PHONE: 3 crt Branch Circuits w /Purchase 04 /30/2009 $19.95
Service or Feeder
Contractor: 1 ea Signal circuit or Limited 04 /30/2009 $75.00
FRAHLER ELECTRIC CO Energy Panel
11860 SW GREENBURG RD 1 ea 12% State Surcharge - 04/30/2009 $21.03
TIGARD, OR 97223 Electrical
PHONE: 503 - 639 -4627
FAX: 503 - 639 -4673
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $196.28
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 rf 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 - 0010th ugh AR 952 -0011 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 246 6899 or 1 800.332.2344.
e � �
Issued By: G \ //Z� O `'( L - Permittee Signature: &ZS _ . 'Pp ki eakkrk
OWNER INSTALLATION ONLY 1
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.
Electrical Permit Application � P VI. :
F roll ()uric r. I isr ONL,V
City of Tigard APR 2 9 200' 'veil, Permit blo..
13125 SW Hall Blvd., Tigard, OR 97223 y Plan Review �� , � �` , �`�
C Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIGARD 1, noway Other Permit
- lc; A I , I) Inspection Line: 503.639.4175 ReadyBy: 0 See Page 2 for
Internet: www.tigard- or.gov BUILDIIIG DIVISI NO-tined/method: u C Supplemental Information
.. _ . _ -. , - , . _.TYPE= OF ;WQRIC':` .. _ - - _ _- .._ ... ?pi iAIVsREViEW• -5 ....::::::.? ''
0 New construction ® Addition/alteration/replacement Please check all that apply (submit a sets of plans whtems checked below)
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stones
where the available fault current ❑ Marinas and boatyards
. -. _ , CATEGORY. OF' •'•CONSTRUCI'ION ; .. : - exceeds 10,000 as at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agncultural
❑ 1- and 2- family dwelling IN Commercial/industrial ❑ Accessory building
amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system.
. • . -JOB SITE ANFORMATION . AND •LOCATION - • ❑ Addition of new motor load of ❑ "A", "E ", "1 -2 ", "1 -3 ",
] 00HP or more. occupancy
Job no.: 66615 Job site address: 9585 SW WASHINGTON SQUARE RD ❑ six or more residential units ❑ Recreational vehicle parks.
City /State/ZIP: TIGARD, OR 97223 ❑ Health -care facilities ❑ Supply voltage for more than
['Hazardous locations 600 volts nominal
Suite/bldg. /apt no.: Project name: AUNTIE ANNE KIOSK ❑ Service or feeder 600 amps or more
Cross street/directions to job site: FEE SCHEDULE
Dinlir+pt100 I Qh• I Fee I Total
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 1
_ . ;:= i. •:; ., •. Limited energy, residential 75.00
;F.5 :;'.F.^' . ?DESCRIPI'ION'rOF ?WORK -, .;; "• -:�-..,: t,_R ... s: >,_ ~z ) _ 2
.,..., -. . ..::�::� •. - . : .- : ._ ...�... _i.,: -, ..-. ;._� (with above a4 R.
f f . , Limited energy, multi - family 75.00 2
NEW TENANT SUBPANEL IN D BLOCK ELECTRIC ROOM AND residential (with above sq. ft.)
POWER AND DATA TO NEW KIOSK IN FRONT OF J —CREW
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30
'-.Z''!.: " »,f''• V °'• : • ❑'P.ROPERTY `W
ONER:.: , s '/ •. - . ❑ • ;TENANT;-- •` ' 201 amps to 400 amps 106.85 2
Z`
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: ( ) 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
Branch circuits — new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
:''' -'.JD �APPLJCANT ; ; �' ., . , :'I : " ❑ •CONTACT :PERSON!. - .: ' : . above service or feeder fee,
each branch circuit 3 6.65 19.95 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
4..A 1........1..w.....:.
Address: Each add'l branch circuit I I 6.65 I 1 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 66.85 2
E - mail: Pump or irrigation gation circle 53.40 2
:CONTWACTOR " - - . ,. , . , • , , Sign or outline lighting 53.40 2
Business name: FRAHLER ELECTRIC COMPANY signal panel, or limited -
energy panel, aheration, or
Address: 11860 SW GREENBURG ROAD ext DAT escribe: 1 Page 2 75.00 2
City/State/ZIP: TIGARD, OR 97223, Each additional inspection over allowable in any of the above
Per inspection
Phone: ( 503) 639 -4627 Fax: ( 503 639 -4673 ti 62.50
•
Investigation per hour (1 hr min) 62.50
CCB Lic.: 37410 Electrical Lic.: 34 -13C Suprv. Lic.: 1816S Industrial plant per hour 73.75
-
ELEC.FRICAL:PERNIITFEES
Suprv. Electrician signature, rd: Subtotal:
175.
Print name: R . W. FRAHLER Date: 04/28/09 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 21 .0 3
Authorized signature' TOTAL PERMIT FEE: 196.28 _
Print name: Date- This permit application expires If a permit is not obtained within 180
days after it has been accepted as complete.