Permit CITY OF TIGARD ELECTRICAL PERMIT
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• COMMUNITY DEVELOPMENT Permit #: ELC2013 -00332
T I G ARO 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/17/2013
Parcel: 1 S126CD00300
Jurisdiction: Tigard
Site address: 9500 SW WASHINGTON SQUARE RD
Project: JC Penney Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (20) branch circuits remodel of lighting, power circuits and fixtures.
Contractor: ERTELL ELECTRIC LLC Owner: PPR WASHINGTON SQUARE, LLC
PO BOX 279 BY J C PENNEY 0288 -1
FOREST GROVE, OR 97116 TAX SERVICES
PO BOX 10001
DALLAS, TX 75301
PHONE: 503 - 841 -4511 PHONE:
FAX: 503 - 359 -5652
FEES
Quantity Description Date Amount
20 crt Branch Circuits wo /Purchase 06/17/2013 $197.16
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 06/17/2013 $23.66
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $220.82
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 al • her applicable law. AIvork will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Th se rules are set forth in OAR
952 - 001 -0010 through O 952- 90. You may obtain a copy of the rules or direct questions to OUNC by 32.1987 • 0-11)0.3 00.3 . 44.
Issued By: 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:
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.
Electrical Permit Application RECE
VE FOR OFFICE USE ONLY
Received
City of Tigard Date/By: / 7//7 i ?& , A .. "tNo.: <<0 _20,3 - )633.2
13 125 SW Hall Blvd., Tigard,OR 97223 JUN 17 201 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard or.gov Notified/Method: 7/6--- Supplemental Information
Dl ILDING DIVISION PLAN REVIEW
❑ New construction it Addition / alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: 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 ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. c
['Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 1 Job site address: 9.'n^ A/,ts-,r( /,vj� 100HP or more. occupancy.
tJt'J ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: se-U ❑ Health -care facilities. ❑ Supply voltage for more than R
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. '
:57,. �` FEE SCHEDULE
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Cross street/directions to job site: ( 94 4 d C Description
New residential single - or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK • (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
ZW a1t1 OAF L� l�,ri� 1 ` +� � t � residential (with above sq. ft.)
/ Renewable Energy I ❑ See Page 2
►y ,� . Services or feeders installation, alteration, and/or relocation _
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT 'PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B. Fee for branch circuits without �`//
Contact name: service or feeder fee, first 56.18 C7(p •ig 2
branch circuit
Address: Each add'I branch circuit Iq 7.42 HO l j 2
City/State /ZIP:
Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: ( ) I Fax: : ( ) dwelling, service and/or feeder
Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
•CONTRACTOR Sign or outline lighting 67.84 2
Business name: / g'T' �L - a Signal circuit(s) or limited- energy See
panel, alteration, or extension. Page 2 2
Address: ? 0, � 7,7 g Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) -■
City/State /ZIP: , - 7 -- t , 49 7 !/G Investigation (1 hr min) 66.25/ hr
Phone: (6b3) $i.1r' �S ( Fax: (�3) 3� _ s----6,s- Industrial plant (I hr min) 78.18 / hr
Inspections for which no fee is 90.00 / hr
III
CCB Lic.: /80 b I Electrical Lic.:* "3'b Su . : 5q Z
' . jj S specifically listed (%: hr min) II
Suprv. Electrician signature, required: ELECTRICAL ,PERMIT FEES
�, ` Subtotal: /47 to • lltirrrnt
�� 1 _ t � Plan review (25% of permit fee): •
( (� State surcharge (12% of permit fee): 2.3.44, ✓
Authorized sig ature: ` TOTAL PERMIT FEE:
. ,
Print name: Date: �_ Thi permit application expires if a permit is not obtained within 180
__ _` — ! / days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Building\Pennits\ELC_ ermitApp_ELR_ERE.doc Rev 05 /21/2013 440- 4615T(11/05 /COM/WEB
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description [ Qty. 1 Fee I Total I *
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
El Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552.26 2
12 Heating, Ventilation and Air Conditioning OAR 918- 309 -0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over25 7.42 3
❑ Vacuum Systems* >100 kva— no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is
charged at an hourly (1 hr min) 66.25/ hr
Inspections for which no fee is 90.00/ hr
specifically listed (% hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building\ Permi ts\ELC_PermitApp_ELR_ERE.doc Rev 05 /21/2013
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9500 SW WASHINGTON SQUARE RD, TIGARD,
OR, 97223
Commercial - Electrical
199 Electrical final
2014-03-05 (null)
ELC2013-00332
PASS - No C of O
Violation Summary:
Inspector Contractor