Permit r , CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT P ermit #: ELC2013 -00334
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2013
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9520 SW WASHINGTON SQUARE RD H06
Project: L'Occitane Subdlvision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: (15) branch circuits for interior alterations to existing retail store.
Contractor: DYNALECTRIC Owner: PPR WASHINGTON SQUARE LLC
5711 SW HOOD AVE PO BOX 847
PORTLAND, OR 97239 CARLSBAD, :CA •92018'
PHONE: 503 - 226 -6771 PHONE:
FAX: 503 - 226 -7720
FEES
Quantity Description Date Amount
15 crt Branch Circuits wo /Purchase 06/18/2013 $160.06
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/18/2013 $19.21
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $179.27
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 OA 5 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. - /
Issued By: Permittee Signature: L A/ /9 /eV - TON
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 503.639.4176 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.
Jun. 14. 2013 7:50AM ( L No.1393 P. 2
•
Electrical Permit Applic FOR OFFICE USE ONLY
City of Tig�► d 3>)N 1 1 20 Recaived
N - +r SW �9�j1 6 DateN : � /3 / 7 Permit Noz /3 ea3
. 13125 SH Hall Blvd., Tigard, OR 97223 CC aD Plan Review
Phone; 503.718.2439 Fax; 503� Dntem : Other Per �Q/3 -490/43 TIGARD Inspection Line: 503.6394175 ��� ► "a�- 1 �G DINISI O DoteRendyltly: 1u /� ® See Page 2for
Internet: Rhvw.tignrd- or.gov BUILDI Notified/Method: /�(T Supplemental Information •
.; ,. N, . .TYPE'.;Or■VoRlc .. .PLAN f0 - ': .
❑ New construction ` [Addition /alteration /replacement Please check all that apply (Submit 2 sets of plans w /items checked below):
❑ Service or feeder-100 amps or more ❑ Building over three stories,
❑ Demolition ❑ Other: _ where the nvailabte fault current ❑ Marinas and boatyards.
{;.. •:::::•:;..,:,:i!::',';,''; i:.. CA'I'I GO.It'Y' 0' CONSTItUCI'ION • exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
' '' ' less to ground, or exceeds 14,000 ❑ Commctcint•use agricultural
❑ I - and 2- faintly dwelling ❑.'Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
`,.4 . JOB SITE INrORM1s rlO1N AND LOCATION. 9-.5-A0 ❑ Addition anew motor load of ❑' A' °� ' I.2'"'I 2"
Job no.: / //p a& $lob site address LU!7j t � / )".."cL or more. occ re anoy,
/ ❑ Six or or more residential evils. ❑ Recreational vehicle parks.
C111' /Slate /ZIP: �
y/ PrU / a ❑ Health -care facilities.
❑ Heaardoar loaS. ❑ Supply voltage for more than
c 600 volts nominal.
Stile /bldg. /apt. no.; f � ,._ .. Project Rattle: l 4 /sn i� ['Service or feeder 600 amps or more.
� /[i rk . 1 : ; , i',' >
Cross street/directions to job site: yf ipuo° oty. I Fee. I Tout
New
ew residential single- or multi-family dwelling unit.
Includes punched garage.
SubdiviSlon: Lot no.: 1.000 sq. fl. or less 168.54 4
Ea. add'I 500 sq. fl. or portion 33.92 l
Tax map /parcel no.: Limited energy, residential
with a bove s (l. 75.00 2
ulscnu�T.ii�N• Qr t��oiu. , ; . ., ( �. )
/ 7~ Cie Limited energy, (with above multi-family
_4ektei. 41-6 C residcutinl 75.00 2
Renewable Energy ❑ Sec Page 2 -
___ _ Services or feeders iusinllatlon, alteration. and/or relocation
t' ?;. :PROPLRT1' OWNER r N 200 amps or less 100.70 • 2
201 amps to 400 amps 133.56 2
Nine 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 steps 301.04 2
-- - "-- Over 1.000 amps or volts 552.26 2
City /State /ZIP: 'rempornry services or feeders Installation, alteration, and /or
Phone: ( ) Fax: ( ) rcl0oiII it
200 amps or less 59.36 1
Owner installation: This install:uion 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: Brunch circuits - new, alteration, or extension, per panel
;` I ,'•;;'., M r;I'I'I.IC,1 \' I' . .. , CO ;PERSON A. Fee for branch circuits !via)
above service or feeder fee.
7.42 2
Business name: ,lO G each branch circuit
13. Fee for branch circuits without
Contact name: C. .fid � service or feeder fee, first 18 / 56.
branch circuit Jrlp, /gi: 2
A (I(lrCSS: _ Each edd•l branch circuit /9 7.42 / if 2
Ci11 /Slate /21p; lliSecllancOus (Service Or feeder not included)
__ Each mm�ufneturcd or madulnr 67.84 2
Placate: D ) c7� , r , .. `j1 Fax; : ( dwelling,servicCmlNorfeeder
Reconnect only 67.84 2
I: '0`111• Pump or irrigation circle 67.84 2
CONTRACTOR : '. Sign or outline lighting 67.84 2
l3uainess name: �G /��„_/. Signal circuil(s) or limited-energy ' d‘ct-U-. Nino, nitcralim+, or extension. Page 2 2
Address: ,67// s � Inch additional Inspection over allowable in any of the above
��ii "" Additional inspection (1 hr min) 66.25/ hr
' ('its• /Stale /ZIY: l// r 9701 y Investigation (I hr min) 66,25/hr
1 im:: (sue) a •� :2 , � F ax: ( , , 77 e7 Indusuinl plant (1 hr min) 78,18/ hr -
�SLlL Inspections for which no fee is 90.00 / hr
407 CB Lie.: 6x793 L• leetrical lie : -s` tprv_ Lic.: spectiieally listed (G hr min) ELECTRICAL PERT 1rI`..•FEES' ; .'
ti,ip . Electrician signature, require( gi. W�� ,1_ Subtotal: Q, en& ,
Prim name: , �� Plan rcvic (25% of permit fcc):
- State surcharge (12% of pen» it fee): /7.
:Ihurized signature ./1 1,. � TOTAL PERMIT PEE: /7 4 7 /
��� This permit nit'linuiou expires if n permit it not obtained within IBf! �/
I name:
0aC: 4 � • da s:trier it has been accepted as complete.
' Number of inspections allowed per permit,
1:H•. .hmn \Permits\tLC.Pcrmio+pp i l5'tI1,,toe 450.4615T(II /OS /COMAVF.a
Jun. 14. 2013 7:50AM No. 1393 P. 1
Dynalectric Company
Dynalectric 5711 SW Hood Avenue
Portland, OR 97239
An EMCOR Company Phone: 503.226.6771
Fax: 503.226.7618
ccb: 66793
Faxsimile
Number of pages including this cover sheet: 3
Date: 6/14/13
To: Electrical Permit Dept Tel:
Company: City of Tigard Fax: 503 - 598 -1960
From: Lynne McEachem
Message:
Following is an Electrical Permit Application and Credit Card Form to be processed.
Thank you.
Dy18-019 Rev. 02/17/04