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Permit ,, CITY OF TIGARD ELECTRICAL PERMIT ` ' - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00066 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2011 Parcel: 1S1260000300 Jurisdiction: TIGARD Site address: 9355 SW WASHINGTON SQUARE RD T19 Project: VERIZON WIRELESS Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project Description: TI. Includes low voltage for fire alarm. Contractor: KEC ELECTRIC INC Owner: PPR WASHINGTON SQUARE LLC 761 SW BAILEY AVE 2235 FARADAY AVE STE #0 HILLSBORO, OR 97123 CARLSBAD, CA 92008 PHONE: 503 - 439 -0904 PHONE: FAX: 503 - 640 -3838 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 01/27/2011 $100.70 Specifics: amps or less 42 crt Branch Circuits w /Purchase 01/27/2011 $311.64 Type of Use: COM Service or Feeder Class of Work: ALT 1 ea Signal circuit or Limited 01/27/2011 $75.00 Energy Panel Type of Const: 1 ea 12% State Surcharge - 01/27/2011 $58.48 Occupancy Grp: Electrical Total $545.82 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 O�01 -0090. You ray o. _ • - o. o • - rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: Aro — 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. Jan 27 11 10:33a CONWAY 503- 969 -7420 p.2 Electrical Permit Application RE CE NEC l'OROFF10E:1 SE ONLY City of Tigard Received 11, , J AN 27 Permit No.: ,,,,,,,,,„. 13125 SW Hall Blvd, Tigard, OR 97223 '� 2011 ° an Review f ig ;c:? it — Phone: 503.718.2439 Fax: 503.598.1960 Date/Ry: Other Pennie St 1,D....u0 *5- T I G A i1 I) Inspection Line: 503.639.4175 �/ ^ Date Ready /By: Janis: 13 Sec Page 2 for Internet: www.tigard or.gov CB 1 I O� �� � Notified/Method: 1'J j Suppleme,ntnt Information ril III � � —• .. TYPE OF WORK t1�6rrrv." PLAN REVIEW El 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. CI Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings, less to Bound, or exceeds 14,000 ❑ Commercial -use agricultural ' ❑ 1- and 2- family dwelling ® Commercial/industrial El Accessory building amps for all other installations. building_ ❑ Multi - family ❑ rvfaster builder ❑ Other: ❑ F pump. ❑ Installation of 75 K VA cr JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E °1 -2 ", "1 -3 ", Job no.: 11 -1005 Job site address: 9355 SW Washinton Square Rd. 10011Pormore. occupancy. El Six or more residential units. ❑ Recreational vehicle parks. CitylState/ZIP: Tigard, Or © Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt no.: T19 Project name: Verizon 0 Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qry. ( r•K I trawl f • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. R. 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 Tenant Improvement / Remodel /,R a t r residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or lei 1 100.70 100.70 2 © PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City /State/ZIP: relocation ' Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I 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 ❑ APPLICANT 0 CONTACT PERSON above service or feeder fee 42 7.42 42 311.64 2 each branch circuit - Business name: B. Fee for branch circuits without service or feeder fee, fast Contact name: branch circuit 56.18 2 Each add'l branch circuit 7.42 2 Address: Miscellaneous (service- or feeder not included) -------------- Each manufactured or modular City /State/ZIP: dwelling_ service and/or feeder 67.84 2 Phone: ( ) . Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited-energy Business name: KEC Electric, Inc panel, alteration, or extension. I Page 2 75 2 Each additional inspection over allowable in any of the above Address: 761 SW Bailey Ave Additional inspection (1 In min) 66.25! hr City /State/ZIP: Hillsboro, Or 97123 Investigation (1 hr min) 66.251 hr industrial plant (1 hr ruin) 78.18/ hr Phone: (503) 439 -0904 Fax: (503) 640 - 3838 Inspections for which no fee is 90.001 hr specifically listed ('h hr min) CCB Lie.: 99267 Electrical Lie.: 34 -426C Suprv, Lie.: 4489S ELECTRICAL PERMIT FEES Subtotal: 487.34 Suprv. Electrician signature, required: Plan review (25% of pe emit fee): Print name: Kenneth E. Co ay Date: l / State surcharge (12% of permit fee): i 58.48 - • TOTAL PERMIT FEE: 545.82 Authorized signature: ' -', 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. IAAuild \peroits'$t-C- Dc.mltApp. doe 07 /01:i 0 440 -461 5 T(11,05rCOMiwEB Jan 27 11 10:33a CONWAY 503 - 969 -7420 p.3 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined........ $75.00 Check Type of Work Involved: [ Audio and Stereo Systems* • Burglar Alarm E l Garage Door Opener* [71 Heating, Ventilation and Air Conditioning System* El Vacuum Systems* El Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: U Audio and Stereo Systems [ Boiler Controls [ Clock Systems [ Data Telecommunication Installation • Fire Alarm Installation [ HVAC [ In [ Intercom and Paging Systems [ Landscape Irrigation Control* EI Medical ❑ Nurse Calls [I Outdoor Landscape Lighting* ❑ Protective Signaling • Other Total number of commercial systems: _ • *No licenses are required. Licenses are required for all other installations I:\Buildineermiu \ELL- PrmicApp.doc 07 101/10