Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00028
"1-1G ARE) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 01/19/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9451 SW WASHINGTON SQUARE DR A16
Subdivision: Lot: 0
Project: Vans
Project Description: Add /alter (13) branch circuits.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 13 crt Branch Circuits 01/19/2010 $145.22
wo /Purchase Service or
PHONE: Feeder •
1 ea 12% State Surcharge - 01/19/2010 $17.43
Electrical
Contractor:
MATES ELECTRIC
11124 NE- HALSEY
PORTLAND, OR 97220
PHONE: 503 - 516 -4142
FAX: 503 - 695 -6263 •
•
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
•
Total $162.65
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 set forth in OAR
952 -001 -0010 through OAR 952 -001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: \ 01 I _ _. . '£ 1 1 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:
C NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' -1 0ve-C t Date:
LICENSE NO.
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.
. '
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''''"Eledrical Permit Ap_ 14_: L._fica
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Received
City of Tigard . w .
• 13125 SW Hall Blvd., Tigard, OR 97223
71 dAN 1 9 2010 Date/B :
Plan Review Permit No. , 1 ik A • ima:,
6 2. ' Phone: 503.639.4171 FaX Other Permit: : 503.598.196 Date/B :
Inspection Line: 503.639.4175 Date Ready/By: 04See Page 2 for
I G A RI) CITY OF TIGARD
• . • Internet: www.tigard-or.gov Notified/Method: Supplemental Information
13LPIDINC,DIV,g310t4 - - - . . .- - - .. . - , -
- - - - - - .• • .-:: -- - . •
TYPE OF 'wOKK. -- - ,'' -, - - , ' ' ' ,PLAN r REVIEW
111 New construction CI Addition/alteration/replacement Please check alfthat app1S (Submit 2 sets:ofplans:w/itenis checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition III Other: : where the nvaifable' fault current 0 Marinas and boatyards.
- '• ''' - ' '''
• , y : ,, . • , , - ,:. . .„: CATEGORY;, 0E-:. 'CPNSTR , ucraii:r- • - --- • -, . . exceeds 10,000 amps at 150 volts or 0 Floating buildings.
.. _. ,. _, , • . .,-, • , • ,.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
111 1- and 2-family dwelling [11 Commercial/industrial 0 Accessory building - amps for all otherinstallations. buifdings.
• Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
larger separately derived system.
'':-. ' i : : • ' ' ' -
JOB rititIT!IFPiRSIATIOSI ...AND,LOC-ATION - _ ; -_.,. ; -''' 0 Addition of new motor load of 0 -‘..‘A',', "E","1 "1-3",
Job no.: Job site address: 'it( 5 l Was\rIrs 100HP br more.
' k.riint C) 0 Six or more residential units. .occupancy.
0 Recreational vehicle parks.
City/State/ZIP: 0 Health-care facilities. 0 Suliply voltage:for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: A \ jc , Project name: VCth 0 Service or feeder 600 amps rnore.
Cross street/directions to job site: ' Deiiiipfiofi 1 Qty. 1 Fee.. 1 Total 1 .
New residential single- or multi-family dWellftigunit.
. Includes attached garage. '
Subdivision: • Lot no.: 1,000 sq. ft. or less 168.54 - 4
Ea; add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Liniited energy, residential
67.84
DESCRLPTION OF WORK
(With above sq. ft.)
Limited energy, multi-family
R e ez......,d ,( f ( 1 V4 residential (with above sq. ft.) . 67.84 2
(1,4, ..c G). . Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
' ,,..g','PROPERTV.OWSIER .. :" • . • -, .... :„,:'D .tkisii+10-, -- • . : . 201 ampsto-400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax-::( ) 200 amps or less 59.36 1
Owner installation: Thi 201 amps to 400 amps 125.08 2 s is being made that 1 own which is not _
intended for sale; lease; rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to,599 amps 168.54 2
Branch Circuits - new, alteration, or extension, per panel
Owner signature: _ _ _ . Date: A. Fee for branch circuits with
EL.APPEJCANT- .: - - 4 - - : - • P CONTACT PERSON f..-='„-4 above service or feeder. fee, / 6
7.42 ' 2
each branch circuit
Business name: M 67 fe 5 t C-7,--t'c- B. Fee for branch circuits
without service or feeder fee, i
Contact name: - ..6.4 - 41 '09 , el-f - --5 first branch circuit / 56.18 2
Address: 9 /2- 5_ cifit-sfrridlic. ,a,, - Each addl branch circuit 7.42 2
• /1( Miscellaneous (serviceor feeder not included)
City/State/ZIP: TiC:p/bg_u 0._ q .5" ,4 At/a Each manufactured or modular
67.84 2
( 5 ,
57C - i t/42. Fax: : ( 5 ‘ f' -c' 6 dwelling, service and/orfeeder
• Phone:
Reconnect only 67.84 2
E-mail: hi ca. I5/e_cle-,L to ye, it ,..-- , ,...z,i-e--( Purnp or irrigation circle 67.84 2
leolNiTkpiC1 ',. :, if i: ' ,, , .''''.., 4: : .., :' 1-: , ,,: SI Sign or outline lighting 67.84 2
Signal circuit(s) or limited-
Business name: /k 4 9—f - :(-: - : .$ 4-leC 4 --- /c-- energy panel, alteration, or
Address: / / '7 Z. h /v /-7 /Dn.( 6 67? extension. Describe: Page 2 2
City/State/ZIP: • Y 0 Z eft 2 2-C7 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (9" "76 --' 41 zi z,... • Fax: ( 77.. C. Y5 Czc 3 Investigation per hour (1 hr min) 66.25
CCB Lic.: / 5 37( Electrical Lic.: 2.-.‘ - B2e7c , Suprv. Lic.: 3q2, Industrial plant perhour 78.18_
:LEECTRItALIPERM17,"-FEES.':.;.
Suprv. Electrician signature, required: ./; /-'f /(.../(-e--e-- Subtotal:
Print name: 4 4 , v / 1 4 4---77- , Date: / 0 Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: /44't`c / TOTAL PERMIT FEE: ji G
This permit application expires if a permit is not obta rthin I 0
Print name: 6 /dm., ,19/4-- f- 5 Date: '' / 0 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1 \Building \Permits \ELC-PermitApp.doc 10/01/09 • 440-4615T(1 I /05/COM/WEB
Electrical Permit Application - City of Tigard
Page,2 •- :Supplemental Information
LIMITED ENERGY PERMIT FEES:
l ;RESI'DENTIAL WORK ;ONLI' _ 71
Fee for all residential systems combined .. $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm •
❑ Garage Door Opener*
•
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COM1∎10 'WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 9.18-309-0000) •
Check Type of Work Involved: •
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data 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
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09