Permit v CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00100
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/13/2013
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD OFFICE
Project: Tesla Motors Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: (1) branch circuit to install receptacle for car charging station
Contractor: TICE ELECTRIC Owner: PPR WASHINGTON SQUARE LLC
5405 N. LAGOON AVE. PO BOX 847
PORTLAND, OR 97217 CARLSBAD, CA 92018
PHONE: 503 - 233 -8801 PHONE:
FAX: 503 - 872 -8290
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 02/13/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/13/2013 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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- 01 -009 . You � maa / y J obbtain a of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
l�-
Issued By: L v' a'` Permittee Signature: O PL( L 4n O
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 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
02112/2013 14:39 Tice Electric Company if 728275 P.0041005
Electrical Permit AppiicationRECEIVED i• tit t t o 1 1(r I .,, l 0\1 \
City of Tigard D •(,) ;+1 (), sr to mltT,ro: Ea_ ,gyp 13 - ye ( A
13126 SW lia11131vd., Turd, OR 97223 FEB 1 2 2013 Plan Review Miff Ott —
a Rhone: 503,718.2439 Fax: 503.598.1960 pmyg
Inspection Line: Internet e 75 CITY OF TIGARD 1 Supplemental lntormation
1
TYPE OF cDINC DIVISIO PLAN REVERT
t W
❑ New construction TO Addition/alteration/replacement Flews check ell that apply (submit 1 sea of plum w/herns chocked beto :
13 Setv(ee or Reds r 400 amps ammo 0 Building over dues modes,
❑ Demolition ❑ Other: Wiese ehe mm0abls earh wow 0 Merinos sad bomyards.
CA1'EQQItY OF CONSTRUCTION exceeds 10.000 amps at ISO volts er O manes buildings.
Ica to limed. or =soda 14,000 ❑ Comanee:Wanss eget:allure(
❑ I - and 2- family dwelling El Commercial/industrial ❑ Accessory building amps for oil awerttutallations, buildings.
❑ Multi -ihmily ❑ Master builder ❑ Other O Piro pump. CI Installation of 75 KVAor
JOB SITE INFORMATION AND LOCATION CI Addition lar�:epmately'daivedsystem.
❑ Addition of new motor load of 1=1"A". "B", °tom, 4.w,
Job no.: 80.8438 Job site address: 9595 SW Washington Square Rd 10 HP mom. Recreation.
❑ Six or more resideetial•udta D Recreational vehicle parka.
City/State/ZIP: TIOARD/OR157223 l:I Healthcare Smithies. 13 Supply voltagethr more than
❑ Rumbas loca 600 vela nominal.
Suite/bldg./apt. no.: l Project name: TESLA CAR CHARGER °Served or Roder 600 amps arc ate.
Cross street/directions to job site: F>(tiE SCHEDULE
aearromtom 1 the I Fes. I 7Lett I ,
New residential single- or multi Amity dwelling omit
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. fl, at less 16854 4
• - De. add'! 500 sq. R. or portion 33 92 I
Tax map /parcel no,: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (wieh_above se.. R)
Limited energy, mull family 75.00 2
INSTALL 1 RECEPTACLE FOR CAR CHARGING STATION . residential (viheh above sq. It)
' Services or feeders Inatallatlon and/or relocation
• 200 snips or less 100.70 2
0 PROPERTY OWNER I ❑ l°LNANT 201 ampsto 400 amps 133 .56 , 2
401 amps to 600 amps 200,34 2
Name: . 601 amps to 1,000 amps - 301.04 2
Address: Over 1,000 amps or volts 55226 2
City /StEtefZIP: - Temporary smites or feeders lnata11ation, alteration, and/o
relocation
Phone: ( ) I FOX: ( ) 200 tmsps or leas 59 .36 1
Owner Installation: This installation is being made on property that I own which is not 201 to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, end 701. 401 amps to 549 saps 168.54 2
Brunch drculta- new, alteration, or extension, per panel
Owner signature: Daate. A. Pee fbr branch circuits with
❑ APPLICANT I 43 CONTACT PERSON above service or feeder Re,
each branch clmuit 7 2
9usinc68 =Me: TICE ELECTRIC B. Rs for branch circuits wldtorrr - "—
=vice or feeder tire that 1 56.18 89.18 2
Contact name: THERESA HOL LAN brands circuit
• T Each'edd'Lbrmah circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
Each mnnulhetttred or modular '
City/State/ZIP: dwelling, service and/or heck 67.84 2
Phone: (503. ) 872 -8230 I Fax:: ( 971 ) 230-3330 Reconnect only 67,84 2
. Pump or Ird;adon circle 67.84 r • 2
E-mail: lhereesh lieeelec.com Sign or outline lighting 67.84 2
COP17'RAiv TOR Signal circuit(a) or limited -er er&
Business name: TICE ELEC FtIC COMPANY , panel, eltermfon, or«tension Paget 2
Each additional Inspection over allowable to any of the above
Address: 5405 N LAGOON AYE Additional inspection 0 hr min) 6625/ M
City/State/ZIP: PORTLAND/011/97217 ln `
Investigation (t hr min) • 66251 hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 8724230 I Fax: ( 971) 230-3330 Inspections tar which no fee is 00,00/ hr
apeeifcelly listed K hr nun)
CCB Lie.: 166 I Electrical Lie.: 26C I Suprv. Lie.: 33045 . 1E .ECi'piCAi. PERMIT MK
Suprv. Electrician signature, inquired: �'�
Subtotal: 58.1
nC • 7.c-n- � Plan review (25% of permit 54:
Print name: LO WELL ARNO I Date: 2/12/2013 - Stele surcharge (12% of permit fee): 8.74
TOTAL PERMIT PEE: 62.92
Authorized sigattl0lre: 11th permitapp0wtton oxplree'If a permit Is set obtained within 180
dare altar It has been accepted as complete.
Print name: I Date: • Number of Inspections allowed per permit.
02/12/2013 14:38 Tice Electric Company (FA)05038728275 P.001/005 • .
ELECTRIC COMPANY
5405 N Lagoon Ave Portland, Or 97217
Phone; 503/233/8801
Fax: 971/230/3330
Fax
To: City of Tktard From Theresa Hollan
?ax: 503 - 598-1960 PaeeS: 5
rh9 Date: 2/12/2013
Re: Electrical Permit Ar mlicatlon CC:
Urgent ❑ For Review 4 Please Comment Please Reply ❑ Please Recycle
2 electrical permits for two different locations,
Thanks
Theresa
503- 8724230