Permit CITY OF TIGARD ELECTRICAL PERMIT
74 xi
COMMUNITY DEVELOPMENT Permit#: ELC2015-00645
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/14/2015
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9451 SW WASHINGTON SQUARE RD A16
Project: Vans Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: 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
17 crt Branch Circuits wo/Purchase 10/13/2015 $174.90
Specifics: Service or Feeder
I ea Plan Review Electricial 10/13/2015 $43.73
Type of Use: COM 1 ea 12%State Surcharge- 10/13/2015 $20.99
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $239.62
Required Items and Reports(Conditions)
This per -s subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and other feeble law. All work will
b ne in accordance w approved plans. This permit will expire if work is not started within 180 days of issuance, or ork pended for more the 180
ays. ATTENTION: Oregon I requir you to follow the rules adopted by the Oregon Utility Notification Cente Th.-, res are set forth in OAR
952-001-0010 thr ugh OAR 952-00i- 0. Y u/may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 or 1.87•.23••
Issued By: e /. Permittee Signature: _oaf
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:
C RACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date: [i•—/r
, f
LICENSE NO. G75-5
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 Applic1 JeEr T 1) FOR OFFICE USE ONLY
Cityof Tigard Received
By: o f 5-, 5�
Illa 131 SW Hall Blvd.,Tigard,O�Q➢ 3� r� Date/By: S /5 ' ,- Permit No.:
Phone: 503.718.2439 Fax: 503.5g8199b0 J F'o)') Date/By:
Plan taw 5 ' r 14 Other Permit:
TIGARD Inspection Line: 503.639.417�viT"+'kFTI Date Ready/By:..f ^ * 7uris: El See Page 2 for
Internet: www.tigard-or.govv�Fr�ii,l1 I V (AcRD�}�I� Notified/Method: �[ I5 Supplemental Information
TII4U1 JM IS1ON r V' (1 .Vet°it.r-t PLAN REVIEW
Please check all that apply(submit 2 sets of plans w/items checked below):
❑ New construction ®Addition/alteration/replacement
0 Service or feeder 400 amps or more 0 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.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ® Commercial/industrial ❑Accessory building am
ps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
['Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address:9451 SW Washington RD 100HP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:A-16 Project name:VANS 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Q . I Fee. I Total 1
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
0 PROPERTY OWNER ® TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:VANS
401 amps to 600 amps 200.34 2
Address: 6550 Katella Ave 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Cypress,CA 90630 Temporary services or feeders installation,alteration,and/or
Phone: (714)889-3695 Fax:(714)889-6776 relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I 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 to 599 amps 168.54 2
Owner signature: Date: _ Branch circuits—new,alteration,or extension, r er panel
® APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name:RGLA each branch circuit
B.Fee for branch circuits without
Contact name: Kevin Keslin service or feeder fee,first I branch circuit v 56.18 '6, �2
Address: 5100 River Rd.Suite125 Each add'l branch circuit it) 7.42
7.42 / 7
2,2
City/State/ZIP:Schiller Park Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone: (847)916-2711 Fax: :(847)671-4200 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail kkeslin@rgla.COm Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:SI 11 J 11 N(t f-D I.A. I et (Zk j r C S Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: b - )4 (,41 4 Each additional inspection over allowable in any of the above
/ p Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: CLAevµ 4c)M Az OQ- I701S
z�� Investigation(1 hr min) 66.25/hr
(3 Phone: ) 3ia- -o J .S Fax:663 ) tP%$ _(o?�7 2-- Industrial plant(1 hr min) 78.18/hr
I Inspections for which no fee is
CCB Lie.: I tea 5' / Electrical Lic.: 0_-7 Suprv.Lie.:L/4,75 S specifically listed(%hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required:. Subtotal: ]�q,TO
Print name: Date: Plan review(25%of permit fee): 3;`]
State surcharge(12%of permit fee): 2 ,
Authorized signature: TOTAL PERMIT FEE: /u�_,
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.
1dBuilding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(1 l/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 j Qty. I Fee I Total
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
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating, Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
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 fec is 90.00/hr
COMMERCIAL WORK ONLY: `"" specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
I I 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
I:'Building'PermitssELC_PermitApp_ELR_ERE.doc Rev 05/21,2013