Permit (130) IIIIICITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2017 00579
ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/02/2017
T t " 9 Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9632 SW WASHINGTON SQUARE RD G09
Project: Bath&Body Works Subdivision: None Lot: None
Project Description: (60)branch circuits for TI.
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
60 crt Branch Circuits wo/Purchase 08/02/2017 $493.96
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/02/2017 $59.28
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $553.24
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 t forth in OAR
952-001-0010 through 0 _00.0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 1.8 ./34
Issued By: 11 ✓- 6 % Permittee Signaxura:—
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 �11,4(� IV + 120 R O F F I C 1: t SI. 0 y 1.1
City of Tigard ReceivDate/Bea �� rL 4,7;
Permit#: EL C c20/7 ads?
III13125 SW Hall Blvd.,Tigard,OR 97223 ��pp Plan Review
g Phone: 503.718.2439 Fax: 503.598.1960 di C Q Date/B : Related Permit t j'7--150/42,,
Inspection Line: 503.639.4175 Ready Date/By: Juris: 0 See Page 2 for
1 I G A R D Internet: www.tigard-or.gov CIII OF FIGAR E) Notified/Method: Supplemental Information
TYPE OF NIMEDING DIVISIONPLAN REVIEW
ElNew construction X2 Addition/alteration/replacement Plea check all that apply(submit 2 sets of plans w/items checked):
Serv.ce or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 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 ° ]Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
1 0 Addition of new motor load of system.
Job#: 2D17i. Job site address: e11, 1./Kif e100HP or more. ❑"A","E","1-2","l-3",
City/State/ZIP: 17I✓J ! _ q 7h CISix or more residential units. occupancy.
�A C ( ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: 6,7.'1 Project name: ��T I ,&p0
❑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 I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: 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
.�^ (with above sq.ft.) 75.00 2
/ *.L
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amp r n Z 33.56 2
401 amps to-MO amps Z' 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 APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Feebfor branch feeds fee,
th
Business name: above service or feeder fee, 7 42 2
each branch circuit
Contact name: B.Fee for branch circuits without /4
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 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
CONTRACTOR / Pump or irrigation circle 67.84 2
Business name: ,,/ t, i�)1 a' i/lt e bIv .. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: PO SO2( 444 panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: �� `7C Each additional inspection over allowable in any of the above
L /��""" 7, Additional inspection(1 hr min) 66.25/hr
Phone:(sem-0t3) "310 -3,b�,6 Fax:(6,{,irj) ei . (p, O(el Investigation(1 hr min) 90.00/hr
,r - ,, , + b,44,32.@,
, i l , .�-J @, l AA Industrial plant(1 hr min) 78.18/hr
Email: t�}Ztir oci Tom/ !. f- ( a���
Inspections for which no fee is 90.00/hr
CCB Lic.: (/ ,6 l r Electrical Lic.: C7 Suprv.Lic.: 4615& specifically listed('/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: w y., ?j
Print name: (.-. 14u AiT ijt_ Al Date: B I ) 1 0 Plan Review Required(25%of pennit fee): �y
State surcharge(12%of permit fee): s•7, 5S"?6
Authorized signature: TOTAL PERMIT FEE: 5 3:..27
This permit application expires if a permit is not obtained within 1 0
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(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
I *
Fee for all residential s stems combined: $75.00 De Qty. Each Total
3' Renstems
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n 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
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n 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('/z hr min)
'COMMERCIAL WORK ONLY:
ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9632 SW WASHINGTON SQUARE RD G09, September 29, 2017 at
TIGARD, OR, 97223 9:37:11 AM
Record Type: Record ID:
Commercial - Electrical ELC2017-00579
Inspection Type: Inspector:
199 Electrical final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor