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Permit CITY OF TIGARD ELECTRICAL PERMIT 1 11 1 1 �' COMMUNITY DEVELOPMENT Permit #: ELC2010 -00719 T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/29/2010 Parcel: 1S1260000300 Jurisdiction: TIGARD Site address: 9524 SW WASHINGTON SQUARE RD H08 Project: H & M Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project Description: (2) 200 amp temporary service, plus investigation fee for work without permit. Contractor: FRAHLER ELECTRIC CO Owner: PPR WASHINGTON SQUARE LLC 11860 SW GREENBURG RD 2235 FARADAY AVE STE #0 TIGARD, OR 97223 CARLSBAD, CA 92008 PHONE: 503 - 639 -4627 PHONE: FAX: 503 - 639 -4673 FEES Quantity Description Date Amount Specifics: 2 ea Temp Services or Feeders - 12/29/2010 $118.72 200 amps or less 1 ea 12% State Surcharge - 12/29/2010 $14.25 Type of Use: COM Electrical Class of Work: ALT 119 Investigation Fee (equals 12/29/2010 $118.72 Electrical Permit) Type of Const: 14 Investigation Electrical 12% 12/29/2010 $14.24 Occupancy Grp: State Surcharge Total $265.93 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 R 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.287 or 1.802344. Issued By: Permittee Signature: Gli A //� � / G�•r•�x 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 Applicatior FOR OFFICE USE ONLY City of Tigard Received �/� �Q,(/ `, g DEC 2 9 2010 DateBy: /9/97 9//d /(`jF/-j` — Permit No.:C te r ge/0 . - 607/7 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review / Phone: 503.639.4171 Fax: 503.598 OF TIGARD Date/By: Other Permita4 /0 DO /S f t G A F D Inspection Line: 503.639 Date Ready/By: Juris: H See Page 2 for Internet: www.tigard or.gov BUILDING DIVISIO Notified/Method: 77 Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling XCommercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system `- I, � El Addition of new motor load of ❑ "A ", "E , "1 -2 ", "1 -3 ", Job no.: ( Job site address: q5, I.- 5N /40.561 n '�- 100HP or more occupancy. ❑ ❑ Six or more residential units. Recreational vehicle parks. ty / City/State/ZIP: T , ^ ••d, ❑ Health -care facilitie ❑ Supply voltage for more than 't ©� 7ZZ� 0P I ❑ Hazardous locations. 600 volts volts B lts nominal. Suite/bldg. /apt. no.: Project name: 14 s r n d ` " n s t � . ❑ Service or feeder 600 amps or more. `f� V FEE SCHEDULE Cross street/directions to job site: Description I Qrv. I Fee. I Total I 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 DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi - family 75.00 2 • 2- 0 0 ar , i _ • I,/ A . la , `. -. residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER _J ❑ TENANT 201 amps to 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 IfrANIETA 59.36 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 /,, 7,2- 2 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 ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee each branch circuit 7.42 2 Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E -mail: Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: !� I eth �r C fax+r G ( ` A/71 panel, alteration, or extension. Page 2 2 y Each additional inspection over allowable in any of the above Address: 11860 SI-4 Grzont�u /_ / Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: oe 97,--.5 (r/! Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: (5 13) ,3-4 7 Fax: 6 ) ‘ Inspections for which no fee is specifically listed (% hr min) 90.00 / hr CCB Lic.: 379 J) Electrical Lic.: 3 (,L/. � Suprrv. Lic.: /g/ fah ELECTRICAL PERMIT FEES �� " v Subtotal: r> Suprv. Electrician signature, red: Plan review (25% permit fee): //1 72 T Print name: , / • F ' 1 � / Date: A349.9/AO State surcharge (12% of permit fee): ' TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. /u AS Print name: Date: • Number of inspections allowed per permit. // - f I: �Building\Permits\E1 .C- PermitApp.doc 07/01/10 440- 4615T(t t /DS /COM/WEB e6 5 Y'3 /3 a ,9 6 Electrical Permit Application p lication City of Ti . ty Tigard �_- Page 2 Supplemental Information r } ql ' ' LIMITED ENERGY PERMIT FEES � r ti • =R ESIDENTIAI..WORgjONLY "F M 417.1 Fee for all residential` systems combined $75.00 •'''';' . F- • - ° Check Type of Work Involved: 419 ' Audio and Stereo Systems* °'` , } -, . El Burglar Alarm.: CI Garage Door Opener* t T } y } • ❑ Heating, Ventilation and Air Conditionin System*" • b: g Y 4 - 1 ❑ V acu um �Systems* 1 I ' / • DI Other: _ " . - e. ®MMERCL WORK `, t j i , • ONLY . e :,:.,.p _• Fee for each commercial $75.00" ' • • r. system`` ti .,0 : p. (SEE OAR 918- 309 - 0000); • Check Type of Work.Involvedc - - Y { • ❑ Audio and Stereo Systems El Controls-. _ ` M1 , J..- ❑ ' Clock Systems' ' ' • ❑ Data Telecommunication Installation ❑ Eire Alarm Installation - -. • HVAC ❑ Instrumentation; , ❑ Intercom and Paging Systems Landscape Irrigation Control* . . ❑ Medical _ ' Nur se .. 1 ` ' 1:1 Calls - El Outdoor Landsca e Lighting* , p • ❑ ' Protective Signaling : . • • ❑ Other I1 . Total number of commercial, systems: - : * No licenses are required , Licenses: are' required --• . ;, �•for 'all other installations •• I' • I:\ Building \Perm@s\ELC- PermitApp:doc 07/01/10 - _ `