Permit (81) l v II
CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2016-00254
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9569 SW WASHINGTON SQUARE RD B04
Project: Godiva Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Electrical TI with low voltage for fire alarm
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 03/31/2016 $100.70
Specifics: amps or less
10 crt Branch Circuits wo/Purchase 03/31/2016 $122.96
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Signal circuit or Limited 03/31/2016 $75.00
Energy Panel
Type of Const: 1 ea 12%State Surcharge- 03/31/2016 $35.84
Occupancy Grp: Electrical
Total $334.50
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ccorda = with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TTENTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 01-0010 through OAR 95 et -r0•• You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332 344.
Is ued By: 1 /„ �J,_ _ .. .' Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' n� Date: T�ip
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applicatio11R ECFIV,� 1.0R 0111( 1 I SI ONI.'t
City of Tigard1 Received
D Date/B : , C)4, Permit#: et,C.�D j(o_,tD a 5 V
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
'PI ■ Phone: 503.718.2439 Fax: 503.598.19(10 ,i t' 1 C Date/B : Related Permit#: fiApoix to g7 i
Inspection Line: 503.639.4175 1 U Ready Date/By: Juris: ® See Page 2 for
I 1(, 1R1) Internet: www.tigard-or.gov . , 0}_ Notified/Method: Supplemental Information
x TYPE OF+� s ,1 �1�\� I� PLAN REVIEW
❑New construction [$Addition/an I PILAU IS1O t' Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION' exceeds 10.000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling RI Commercial/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 ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMAT)( 1 t LOCATION Emergency system. larger separately derived
f-.3,• ❑Addition of new motor load of system.
Job#: Job site address: / ',I Q ❑ A", `E", 1 2 I-s"-
��6 (2 I `moi 7� W9 �� A • IOOHPormore.
City/State/ZIP: ���/� / / ��Z� ❑Six or more residential units.
❑Health-care facilities. 0occupancy.
Recreational vehicle parks.
Suite/bldg./apt.#: 04 f Project name: i_eb j/'4 .,./ 574 0 Hazardous locations. 0 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 1 Qty. I Each I Total
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]500 sqftor portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00
Fit_G//e�rk l- 4•"/ �G //e/fea
(with above sq.ft.)
Limited
energy,multi-family 75.00 2
residential(with above sq.ft.) .
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less i 100.70 1 0D,7
b 2
201 amps to 400 amps 133.56 2
Address:
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
0 APPLICANTI' 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel___
A.Fee for branch circuits with
Business name: above service or feeder fee, 10
each branch circuit 7.42 _
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56 18 o
Address: branch circuit
City/State/ZIP: Each add]branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: , b✓A-�fc8) ,e/#i�, �ji fec `� , Sign or outline lighting 67.84 2
x �� SignalIter circuit(s)or limited-energyxextension.
See Page 2 2
Address: �O _panel,alteration,or extension.
City/State/ZIP: C .G�
n`AC41'S# DP' '770`5 Each additional inspection over towable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(...cp?) .iia_- s 5 Fax:(503 ) 4927- 69y7 / Investigation(1 hr min) 90.00/hr
Email: S�pJ,/(�Gid'�',Alf 7 Industrial plant(1 hr min) 78.18/hr
l/ Inspections for which no fee is 90.00/hr
CCB Lie.: is4,Z69/ Electrical Lic.: rv. ic.: ,1 - specifically listed(1/4 hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name: Ste► Lu1J TDate:
)r�-ro�v o 201 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: /3 34.50
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 1 l.C_PermitApp ELR ERE.dor Rex 06 17 2015 440-4615T(11 05 COM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
I E r. Q .K.O L : fE .:'
Description I Qts Each I Total *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70
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* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n 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 I
Inspections for which no fee is
specifically listed(1/2hr min) 90.00/hr
C{)MMERCIAL.WORK ONLY: ELECTRICAL PERMITFEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
Clock Systems
❑ Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
TI Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:Building Pei inns Ft.0 PermitApp ELR ERE.dot: Rea 06 I?2015
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
9569 SW WASHINGTON SQUARE RD B04,
TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00254
Herb Stabenow
Violation Summary:
Inspector Contractor