Permit CITY OF TIGARD ELECTRICAL PERMIT
up
1111111 2 COMMUNITY DEVELOPMENT Permit#: ELC2015-00150
TWARD CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/12/2015
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9530 SW WASHINGTON SQUARE RD H10
Project: Athleta Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Tenant improvement for new retail store
Contractor: ADVANCED WIRING SERVICES INC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 644 PO BOX 847
CLACKAMAS, OR 97015 CARLSBAD, CA 92018
PHONE: 503-310-3655 PHONE:
FAX: 503-698-6372
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 03/12/2015 $100.70
Specifics: amps or less
48 crt Branch Circuits w/Purchase 03/12/2015 $356.16
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/12/2015 $54.82
Electrical
Type of Const:
Occupancy Grp:
Total $511.68
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 othe ap•icable 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 if wo is - spended for more the 180
days. ATTENTION: Oregon law requires you to follow I= rules adopted by the Oregon Utility Notification •Cr. J�se rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a ••• i� r direct questions to OUNC by calling 503.23 87 or 1:T.•2.2344.
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 w�� I Olt o f I It I 1 .I ()NI 1
City of Tigard REGG Received �s
Permit#:
DateB : i'AP LC.•t. •l Sa
71 • 13125 SW Hall Blvd.,Tigard,OR 97223 �Q��
• Phone: 503.718.2439 Fax: 503.598.1960 MAR 12 .. M-, ,
Inspection Line: 503.639.4175 `GP" i Date/By: ® See Page 2 for
I I'' \I:I g g j d/Method: CJ�' Supplemental Information
Internet: www.ti ard-0r. ov G1� r* Dw1•
TYPE OF WORK�%mgA PLAN REVIEW
Ig New construction ❑Addition/alteration/r acement Please check all that apply(submit 2 sets of plans w/items checked):
❑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.
❑ 1-and 2-family dwelling OCommercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMAT a, 1 LOCATION ❑Emergency system. larger separately derived
to ❑Addition of new motor load of system.
Job#:.261/f..-Li Job site address: - s'� iv/et c I00HP or more.
/ 9772 ❑Six or more residential units. occupancy.
City/State/ZIP:
Po/zflrse„ 0/7 ❑Health-care facilities. ❑Recreational vehicle parks.
❑Hazardous locations. ❑Supply voltage for more than
Suite/bldg./apt.#: �U Project name: f� �
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential .
(with above sq.ft.) 75.00 2
.74 eLbQ/ 014 c i✓ ,;(3 Limited energy,mufti-family •
75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less / 100.70 100 70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension, er panel
A.Fee for branch circuits with
Business name: c- above service or feeder fee, /��j
�� 41 �DL.J each branch circuit !0 7.42 35(:;1b 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 1 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
ONTRACTOR Pump or irrigation circle 67.84 2
Business name: QrIL17n/pr��//Z//f /t ij/lam Sign or outline lighting 67.84 2
,(//✓ Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: p0 gOx /JV panel,alteration,or extension.
City/State/ZIP: / ��- 7�f v�Z Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 3) �33.a1,� Fax:( -03 ),,,z -11,./7,7 y Investigation(I hr min) 66.25/hr
Email: „�y p /��/ / e-f Industrial plant(1 hr min) 78.18/hr
i� "° NA Inspections for which no fee is 90.00/hr
CCB Lic.:[d,! i1/ Electrical Lic.: C 7 Suprv.Lic.: 114 7r specifically listed(%hr min) _
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _, / Subtotal: 1.(5So. Fjl!p
Print name: SPilo G H 44Pr
/ Date: 1Z/!— ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): Si.fcl
Authorized signature:
TOTAL PERMIT FEE: S(/, Sp r
/ This permit application expires if a permit is not obtained within 180
Print name: c•�-� / ii, Date: 3-12—/5"—' days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:'Building/Permits\ELC_PermitApp_ELR_ERE.doc ev 04/21/2014 440-46151(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 I Qty. I Each I Total
3' 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
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener*
g p >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* 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 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr min) _
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
y " Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
H Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
H Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
fp I.1Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9530 SW WASHINGTON SQUARE RD H10,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical ELC2015-00150
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor