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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2013 -00392 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/11/2013 Parcel: 1 S126CD00300 Jurisdiction: Tigard Site address: 9500 SW WASHINGTON SQUARE RD Project: JC Penney Subdivision: FAIRVIEW PLACE CONDO Lot: 20 Project Description: Add (1) branch circuit to existing tracklighting in Joe Fresh children's clothing area. Contractor: GENESIS ELECTRIC NW Owner: PPR WASHINGTON SQUARE, LLC 3753 KIENTHORPE WAY BY J C PENNEY 0288 -1 WEST LINN, OR 97068 TAX SERVICES PO BOX 10001 DALLAS, TX 75301 PHONE: 503 - 303 -8056 PHONE: FAX: 503 - 303 -8605 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 07/11/2013 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 07/11/2013 $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 actor. - • 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. ATTE. ON: Oregon w requires you to follow the rules adopted by the Oregon Utility Notific -'•- - -nter. Those rules are set forth in OAR 952-001-01 0 through OAR 952 -0' - 009.. may obtain a copy of the rules or direct questions to OUNC by 4 t1FArA l z . 87 or 1.800.332. '44. • Issue. By: .. —` �L rL _ Permittee Signature. ifi , L�� 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. From: Keith Ciminski Fax: +1 (503) 303 -8605 c t Ei rie Fa x: +1 (503) 598 -19 Page 2 of 2 7/8/2013 10:10 Electrical Permit Applicat 1 1 • . . ' I llll (ll r1(i 1S1.: ON.1.1 ' • City of Tigard Received Qp , 24U 9 2 013 Date/Il : !i i Permit No.: O � / 3- • 13125 SW Hall Blvd., Tigard, OR 972 Plan Review i _ • Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit: 1' 1 i; A R n Inspection Line: 503.639.4175 CI TY OFTIGARD Date Ready /By: turtle ® See Page 2 for InternetInternet: www.tigard or,gov ROWING tfVISION Notified/Method: Supplemental Information TYPE OF WORK I PLAN REVIEW 0 New construction ® Addition/alteration/replacement I Please check all that apply (submit 2 sets of plans w-items checked below). E D 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. target separately derived system. ❑ Addition of new motor load of ❑ "A ". "E ". "1.2 ", "1 -3'_ Job no.: 30703 Job site address: 9500 SW Washington SQ Rd 10011P or more. occupancy, ❑ Six or more residential units. ❑ Recreational vehicle parr. City / State/ZIP: Tigard, OR 97223 0 Health-care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: JC Penney 0 Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Greenburg tion Descrip tv. Fee. .—......— �� Total r' New residential single- or multi - family dwelling unit. _ __ _ _ Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft or less 16834 Tax map/parcel no.: Ea. add'l 500 sq. ft or portion 33.92 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi- family 75. W 2 Add new track light (led) to existing track lighting circuit in the Joe Fresh residential (with above sq. ft) Renewable Energy ❑ See Page 2 childrens clothing area. Services or feeders installation, alteration, and/or relocation ❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: - •- -- 401 amps to 600 turps 200.34 2 Address: 601 amps to 1,000 amps 301.1)4 2 Over 1,000 amps or volts 552.26 2 City /State/ZIP: Temporary services or feeders installation, alteration, and/o Phone: ( ) Fax: ( ) relocation 200 amps or less ( 59.36 t Owner installation: This installation is being made on property that 1 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 u 599 p 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 I above service or feeder fee, 7.42 Business name: Genesis Electric NW each branch circuit " -- - t3. Fee for branch circuits without v Contact name: Keith Ciminski — �' - service or feeder fee, first t 56. 18 SG- 18 2 branch circuit Address: 3753 Kenthorpe Way Each add'l branch circuit 7.42 2 City /State /ZIP: West Linn Miscellaneous (service or feeder not included) Each manufactured or modular 67.84 2 Phone: (503) 303 - 8056 Fax: : (503) 303 -8605 dwelling, service and/or feeder Reconnect only 67.84 2 E - mail: GenesisElectricNW@Gmail.com T_ Pump or irrigation circle 67.84 2 CONTRACTOR _ — _ Sign or outline lighting 67.84 2 Business name: Genesis Electric NW Signal circuit(s) or limited - energy I See - panel, alteration, or extension. ) Page 2.__I 2 Address: 3753 Kenthorpe Way Each additional Inspection over allowable in any of the above City / State/ZIP: West Linn Additional inspection (1 hr nun) 66.25/ hr Investigation (I hr min) 66.25/ hr Phone: (503) 303 - 8056 Fax: (503) 303 - 8605 hldustrial plant (1 hr rein) 78.18/ hr l Inspections for which no fee is CCB Lie : 192658 1 1tH Electrical Lie.: C692 1 \l \l � Suprv. Lie.: 5255S ol specifically listed (V, hr min) 90.001 hr Suprv. Electrician signature, requiredl�� ELECTRICAL PERMIT FEES ter! _' Subtotal: 56.18 Print name: Keith Ciminski Dan:_ 7 A /3 Plan review (25 %ofpermit fee): 11 State surcharge (12% of permit fee): 6.74 Authorized signature: TO1'AI, PERMIT FEE: 62.92 ----' This permit application expires if a permit is not obtained within 18O Print name: Date: days after it has been accepted an complete. • Number of inspections allowed per permit. t∎truarheg''' u\ELC_Pcmti,App ..tiv ERE.dc Rev DS/21.2013 440 /0 51COM /WEa From: Keith Ciminski Fax: +1 (503) 303 -8605 To: City of Tigard Fax: +1 (603) 598 -1960 Page 1 of 2 7/8/2013 10:10 FAX Date: 7/8/2013 Pages including cover sheet: 2 To: City of Tigard From: Keith Ciminski Genesis Electric NW 3753 Kenthorpe Way West Linn OR 97068 Phone Phone (503) 303 -8056 Fax Number +1 (503) 598 -1960 Fax Number +1 (503) 303 -8605 NOTE: Please let me know if I can give you a credit card over the phone. I beleive my account is already set up in your system. Thank You, Keith cl 503 - 260 -7770 e City of Tigard II 13125 SW Hall Blvd. ill , Tigard, OR 97223 Phone: 503- 639 -4171 T I GARD FAX TRANSMITTAL Date July 9, 2013 Number of pages including cover sheet 3 To: Keith Ciminski From: Debbie Adamski Co: Genesis Electric NW Co: City of Tigard Fax #: 1 -503- 303 -8605 Fax #: 503 - 598 -1960 Ph #: 503 - 718 -2450 SUBJECT: Credit Card Form MESSAGE: Keith, We do not take credit card information over the phone and we do not keep credit card information on file. Please complete the attached Payment Authorization form and fax it back so we can process your permit submittal. Thanks! I:\ENGWAX.DOT From: Keith Ciminski Fax: +1 (503) 303 -8605 To: City of Tigard Fax: +1 (503) 598 -1960 Page 1 of 3 7/9/20134:19 DIED Ili_ 9 2 013 C FAX auto 1241146C* Date: 7/9/2013 Pages including cover sheet: 13 To: City of Tigard From: Keith Ciminski Electrical Permitting Genesis Electric NW 3753 Kenthorpe Way West Linn OR 97068 Phone Phone (503) 303 -8056 Fax Number +1 (503) 598 -1960 Fax Number +1 (503) 303 -8605 NOTE: Here is my payment authorization, thank you, Keith 503 - 260 -7770