Permit CITY OF TIGARD ELECTRICAL PERMIT
II q
I; COMMUNITY DEVELOPMENT Permit#: ELC2016-00105
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2016
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9368 SW WASHINGTON SQUARE RD R03
Project: Papyrus Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: (13)branch circuits and(2)low voltage systems for audio and data telecommunications.
Contractor: A&A ELECTRICAL CONTRACTORS INC Owner: PPR WASHINGTON SQUARE LLC
1588 SKY TERRACE PO BOX 847
SALEM, OR 97306 CARLSBAD, CA 92018
PHONE: 503-949-3193 PHONE.
FAX: 503-378-9085
FEES
Quantity Description Date Amount
2 ea Limited Energy 02/11/2016 $150.00
Specifics:
13 crt Branch Circuits wo/Purchase 02/11/2016 $145.22
Service or Feeder
Type of Use: COM 1 ea 12%State Surcharge- 02/11/2016 $35.43
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $330.65
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialtydes 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 iss nce, I k is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio Cent Th se rules are set forth in OAR
952-001-0010 through O R 952-001-0090. You ma obtain a copy oft•1 •irect questions to OUNC by calling 503. 32.1987 r 1 00 32.2344.
Issued By: - - Permittee Signature:
--cc
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent. V
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 �\ 1,(w OFFI( U. l SE O\I.)
City of Tigard ���\ 1R Received ? // ((_ Permit#:
III13125 SW Hall Blvd.,Tigard,OR 97223 V Date/By: /' /Yl � ' �(p�'U(9l
I
Phone: 503.718.2439 Fax: 503.598.19 VI 6 Plan Review Related Permit#:
V Date/By: 614102(' 1035
Inspection Line: 503.639.4175 �� 1(Q1 Ready Date/By: luris: RI See Page 2 for
11 t 1 r I) Internet: www.tigard-or.gov '. eito Notified/Method: Supplemental Information
T E OF WORT E F �Os PIP PLAN REVIEW
0 New construction ddition/alteration/ e >i �V�" Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Other: �t ❑Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
GATE `A OF CO '.' s ,t exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ I-and 2-family dwelling ommercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder,, i 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
'JOB SITE INFOR.MT '*A t , ATION 0 Emergency system. larger separately derived
Job#: I Job site address: (4)1.44/2.,f ❑Addition of new motor load of system.
.����� �`� LL.E�(,C I OOHP or more. ❑,.A„ „E„ ..l_2„ ..l_3„
d
0 Six or more residential units. occupancy.
City/State/ZIP: (Aju S SFr S cU -e- 0 Health-care facilities. Recreational
)� 0 vehicle parks.
Suite/bldg./apt.#: (J 3 I Vroject name: 190 el f S ❑Hazardous locations. ❑Supply voltage for more than
'` 0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description l Qtp. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
03) ��. r v (with above sq.ft.)
6 11 r-ceArt3 (4 401A ✓tat` Limited energy,multi-family 75.00 2
4-1..6 S 440is f 44 J 4a O residentialbl (with ybove sq.ft.)
lRenewable Energy ❑ See Page 2
PROPERTY' OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 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: ( ) I 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 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, '
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
service or feeder fee,first /
Address: branch circuit 56.18 -may 2
City/State/ZIP: Each add'l branch circuit b a 7.42 0y 2
Miscellaneous(service or feeder not included)
Phone: ( ) I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder _
Email: Reconnect only 67.84 2
CONTRACOR Pump or irrigation circle 67.84 2
Business name: 1 (-_,`"--k - S Th
Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: �l se 8 S� � ICC S panel,alteration,or extension. ee Page 1� Oy2 r 2
City/State/ZIP: (env I1 e 7 3 a Each additional inspection over allowable in any of the above
CJ Additional inspection(1 hr min) 66.25/hr
Phone:(�3) if 9,3/9 3 I Fax:(S-63 ) s 7 b - ?d 8� investigation(1 hr min) 90.00/hr
industrial plant(1 hr min) 78.18/hr
Email: 376 5 Inspections for which no fee is
CCB Lie.:( s3 7 (( I Electrical Lie.: 3 (, 3?c 1 Suprv.Lic.:0, specifically listed(/hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: ! _-- Subtotal: a2.fig- 4.-
Print name: ,_11/67ri Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of pennit fee): , 3/' II
Authorized signature: TOTAL PERMIT FEE ,P kl
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:Building Permits ELC_PermitApp_ELR_ERE.doc Rev 06 17 2015 440-4615T(1105:COMA WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WOK Y' ,.. P > EDUI _,
Fee for all residential systems combined: $75.00
Description I Qty. I Each I Total 1
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
W, A• • • .nd eo . - * 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* >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 over 25 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(%hr mm)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
\jeData Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ 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
t Building Permits ELC_PermitApp ELR_ERE.doc Res 06172015
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9368 SW WASHINGTON SQUARE RD R03,
TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00105
Jeff Grove
Violation Summary:
Inspector Contractor