Permit „ ; , . "q CITY OF TIGARD
74
ELECTRICAL PERMIT
o :. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00636
T (G A R O! 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/01/2009
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9595 SW WASHINGTON SQUARE DR B12
Subdivision: Lot: 0
Project: True Religion Blue Jeans
Project Description: (16) branch circuits and low voltage for data.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 16 crt Branch Circuits 12/01/2009 $167.48
wo /Purchase Service or
PHONE: Feeder
1 ea Signal circuit or Limited 12/01/2009 $67.84
Energy Panel
Contractor: 1 ea 12% State Surcharge - 12/01/2009 $28.24
A & A ELECTRICAL CONTRACTORS INC Electrical
1588 SKY TERRACE
SALEM, OR 97306
PHONE: 503 - 949 -3193
FAX: 503 - 378 -9085
Type of Use: COM
I Class of Work: ALT Type of Const:
Occupancy Grp:
Total $263.56
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 ordance • 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. AT NTION: Oregon . requir> you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 010 through OAR 952 -00 0100. You m btain a copy of the rules or direct questions to OUNC by calling 503.24¢.66•9 .r 1.800.332.2344.
Issue By: I, / / , A/L(41_9 Permittee Signature: r � �
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:
f CONTRACTOR INSTALLATION ONLY /f
SIGNATURE OF SUPR. ELEC' 4 � i e�� ” V' , Date: a / C
LICENSE NO. 36 -3, 'L
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
ax ,,GGON r,OG
• 1- Electrical Permit Application Current Planning
^�� Washington County, 155 N. 1 AV, Suite 350, MS 12, Hillsboro, OR 97124, Approval
o Eton Phone: 503- 846 -3470, Fax: 503- 846 -3993, Project #
Inspection Requests: 503 - 846 -3699, www.co.washinEton.or.us
� � TYP ORK PLAN REVIEW
❑ New construction p /alteratio eplacement ❑Oth Please check all that apply:
❑ Service or feeder 400 amps ❑ Hazardous locations
. or more where the available ❑ Service or feeder 600 amps or more
CATEGORY OF CO STRUCTION fault current exceeds
❑ Building over three stories
❑ 1- and 2 family dwelling Commerci industrial ['Accessory building 10,000 amps at 150 volts or Marinas and boatyards
less to ground, or exceeds ❑ Floating buildings
❑ Multi family _ a udder ❑ Other: 14,000 amps for all other
JOB SITE INFORMATION AND LOCATION installations. ❑Commercial -use agricultural
buildings
❑ Fire pump
� u� ❑ Installation of 150 KVA or larger
Job no.: Job address:
6 J 5(,Z 44,eisA .- a-❑ Emergency system
t separately derived system
❑ Addition of new motor
City/State /ZIP: :=4Cu l^ ❑ "A;' "E " "1- 2,'`9 -3 "occupancy
lo ad of 100HP or more
Suite/bldg./apt. no.: Project name: ❑ Six or more residential units ❑ Recreational vehicle parks
2_ 41 D le 6 aim, i -`, C— ❑ Supply voltage for more than
/ '-�IJ Health -care facilities 600 volts nominal
Cross street/directions to job site: S k t S
•11 s ` s_ C . FEE SCHEDULE
=.�'� 1 ='- -•- Description Qty. 1 Fee Total
Subdivision: Lot no.: Residential single- or multi - family dwelling unit.
Includes attached garage.
Tax map /parcel no.: 1,000 sq. ft. or less 153.00 4
DESCRIPTION OF WORK Ea. add'I 500 sq. ft. or portion 43.00
L Limited energy, residential
, ki a . 2+ � --pre) 0-e-9 5 1ry - C. (with above sq. ft.) 61.00 2
' Limited energy, multi- family
67.00 2
residential (with above sq. ft.)
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation, alteration, and /or relocation
200 amps or less 92.00 2
Name:
201 amps to 400 amps 122.00 2
Address: 401 amps to 600 amps 184.00 2
City /State /ZIP: ... — — . - - - — - 601 amps to .1,000 amps 275.00
Over 1,000 amps or volts 514.00 2 2
Phone: ( ) Fax: ( ) Temporary services or feeders installation, alteration, and /or
relocation
Owner installation: This installation is being made on residential or farm property owned by me or a member of 200 amps or less 79.50 2
my immediate family. This property is not intended for sale, exchange or rent. (ORS 479.540(1) and 479.560(1).
201 amps to 400 amps 110.00 2
Owner signature: Date: 401 amps to 599 amps 153.00 2
❑ APPLICANT ❑CONTACT PERSON Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with � !!
Business name: above service or feeder fee, 1 1 1i . 7o
each branch circuit 2
Contact name: B. Fee for branch circuits /' )
•
without service or feeder / 6,k Z 0
Address: fee, first branch circuit v" 2
City /State /ZIP: Each add'I branch circuit 8.75
Miscellaneous (service or feeder not included)
Phone: ( ) Fax: ( ) Each manufactured or modular 104.00 2
E - mail: dwelling, service, and /or feeder
Reconnect only 79.50 1
CONTRACTOR Pump or irrigation circle 61.00 2
Business name: 'C- ' c ci.( ( , :�, . �C Sign or outline lighting 61.00 2
Si gnal circuit(s) or l -
Address: / S iX 6 y � e S' L ! energy panel, alteration, or f 42 g t /
City /State /ZIP: ? /7p 0�j � C. ' 6I6 extencin es
Phone: (?i3) 9 T 9 .-- 3 / 3 Fax: 6 3 7 3 — 9 d k s- 1 1 Each additional inspection over allowable in any of the above
h' / � , Per in spectio n 90.00
E -mail: Gr4•ekcir � P/" CCB lie. no.: / /7�/ ',�,�llt Investigation fee (See compliance)
Electrical lic. no.: - 3 / _ - c \ `c i t y or metro lic.:
Other:
Supervising electrician l� a ELECTRICAL PERMIT FEES 7 2
signature, required: % i 37Cn I Subtotal A �--- 2
Print name: T- 'er i� f C Date: Plan review ( 25% of permit fee)
• State surcharge (12% of permit fee) a �a
Authorized
/o TOTAL PERMIT FEE /„ 6
signature: - � l
� , i This permit application expires if a permit is not o tstified
Print name: within 180 days after it has been accepted as complete
" Number of inspections allowed per permit. Revision 6/08