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Permit r CITY OF TIGARD ELECTRICAL PERMIT ; g COMMUNITY DEVELOPMENT Permit #: ELC2011 -00131 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/11/2011 Parcel: 151260000300 Jurisdiction: TIGARD Site address: 9640 SW WASHINGTON SQUARE RD Gil Project: Hanna Andersson Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project Description: Electrical for TI. Low voltage for data telecommunications system. Contractor: JC ELECTRIC INC Owner: PPR WASHINGTON SQUARE LLC 118 NW 184TH STREET 2235 FARADAY AVE STE #0 RIDGEFIELD, WA 98647 CARLSBAD, CA 92008 PHONE: 360- 887 -7889 PHONE: FAX: 360- 887 -5584 FEES Quantity Description Date Amount 23 crt Branch Circuits wo /Purchase 03/11/2011 $219.42 Specifics: Service or Feeder 1 ea Signal circuit or Limited 03/11/2011 $75.00 Type of Use: COM Energy Panel Class of Work: ALT 1 ea 12% State Surcharge - 03/11/2011 $35.33 Electrical Type of Const: Occupancy Grp: Total $329.75 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 throw . is - 001 -0090. You ay • - ..y o e n. questions to OUNC by calling 503. 1987 or 1.800.33 2344. IMP Issued By. i` /_/ ` / Permittee Signature: filb deb 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. 03/10/2011 08:49 3608875584 J.C. ELECTRIC, INC. PAGE 01/03 Electrical Permit Applicatio ° a v r' 1012 (11TIR I. l 'Sr c1Nl.v City of Tigard n ° -' ® ��� Permit No.: • L 2_0 ! N . ^ 13125 SW i 7 11 18.2439 13139. TF ' 03. 9 8.19 - ' R O 2 011 XIa efity ew Other Permit: & � 3 ���; -.,, . Phone: 503.7 F ax: 503.598.1960 Iyan I� OC1 r 1 i ,, _: n Inspection Line: 503.639,4175 r, Date Ready/By: rune. 1 See rage a for Internet: www.tigard- or.gov Notified/Method: EL' Supplemental Information ! I. i-(� 7{ � 313t arch I nqr [+ ; r aiic, itp" t +l?'li i' t l tl ! t; ; I 1 � +! n I i I I f i IPt 01=10 r f . ! Ai Eat I i 1 I t it � > t g idi liif bath 4 }r I�� , ie ltg , l' `.. , : �IE�� ; "I i' pl c; h 1 ,111,11. i cc , : i� e , i6� 1II4l iil El New construction 0 Addition/alteration /replacement Please check all that apply (submit a sets + t s o f plans w / items c h e clted below): ❑ Sec - vine or feeder 400 amps or more ❑ BuUdmg over three stories. ❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards, f ! I it• I N1; 1ii1� t>patn mi?etto ] •a i 1 Ill ,,�j tN @ 1t t' 1 'y in 1t 1 � : ! � It 7 i1 st 3 ' i (��I(f ` � � 1 t excceds 10,000 amps at 150 volts or Q Floating buildings. 111 it a i W EI 1 1 11 ' �lulllii�.il itN3=A11nt�f nf<$ 1 uti[[&[I1� 1g,', [nu;a +t+�t �i li oi ll1 11. ,, J l i less to g round, or a needs 14,000 ❑ Coaamercial -use agr;cultura] ❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations, buildings. ❑ Multi - family 0 Master builder ❑ Other: 0 Fire pump. El Installation of 75 KVA or l 1y1, w u�m "" mlfa nittttuu 1nln�tniti1111IR1m aggr][a 1afr f# i` (1 1j gI n ©Emergency stem. larger separately derived system. Ii f b„I � ? ■ 1 a 1 I " n riilti r tc [TUL t ''' , j r lai tGU i lafsr, l�{ hf il3 i }1�11I ill i j1 ❑ Addition of ne motor load of 0 ••A" .. E" . •1 -2 .. 1.3" Job no.: 2011029 Job site address: 9585 SW Washington Square Rd ut o r or more, occupancy, CI O Six or more residcntiol units. ❑ Recreational vehicle parks. City/ State/ZIP: Tigard, OR 97223 El Health-care facilities. 0 Supply voltage for more than _ ❑ l;lazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Gil Project name: HANNA ANDERSON [at�1 l S } e {{ rv fl i �a c [! e [{t o l o r feeder 600 amp {a more 1([A( {{r1+(i �1�[�{ { w..- -. ;11[Ir �Yl l!'II1tYtl11 lifi C lttlll tti 111fI[ IIS11nNA ililff:4)fN ;= 1�''� ilk 1 -I Cross street/directions to job site: Washington Square Mall Suite Gil Aeeerivt+oa , y Fee. Tars, , (near inside Nordstrom entrance) New residential single- or multi- family dwelling stoic. ( ) Includes attached garage. ^ Subdivision: 1 Lot no.: 1,000 sq. ft. or leas 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map/parcel no. �` }`p Limited energy, residential Dl[ 1 a ]" 1, 1 111 1 , Id i It f1111 i.11T tt,aa ' r�, l ;�dl e!rinl nl � 1N}1. l iii, li 111 i f ' [ wi above ft.) i fa 75.00 2 � '! 1 [ = 1 ` 1 ! i lE , S Limited th energy , multmiJ' 1 1 � L Q,-( , th • , residential (with above sq. f ,) 75.00 2 0 Services or feeders installation alteration, and/or relocation 200 amps or less 100.70 2 1' i i j 1 rt+ tgtut r iu m °i l 1 � ' P[�' . t } ,t y h ( 1 y ill r i ' I : i 1 3{d , ? �[, f !t (q i {{�( k1 amps amps 1 l�f r tffr[Nimesi ill 14/ 4�� 1i ifi 1 }lN ; � ` 1 , t� a mtr i rd w tllll {il Effk ill - 201 am to 400 am 133.56 2 4 01 amps 10 600 amps 200:34 2 Name: 6ol amps to 1,000 amps 301.04 2 Address: Over 1.000 amps or volts 552.26 2 City/State/ZIP: /State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Pax: ( ) 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 401 stops l0 599 amps 168.54 2 intended for sale, lease, rent, or . exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension ,per panel Owner si _ ature: Date: • A. Fee for branch circuits with r# ttl!�'�� I U +Iij j�I ((�� ) p� Ii f g+1 :9 [ Imtt Lt filer ;i: l above service or feeder fee, f BNIB.t #YT ifhT�n+ imhZ 1 liittQ i i,tr pt � l i P I 11 1 # . , i e szeiti st nikni v i nni i kk N tli4 �f� ea ch branch circuit 7.42 2 Business name: B. Fee for branch circuits without • service or feeder fee, first Contact name: branch circuit 56.18 S'1,,,,‘. 2 • Each add' l branch circuit ZZ 7.42 l -1LA 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular City / State/ZIP: dwelling, service and/or feeder 67.14 2 Phone: ( ) I Fax:: ( ) Kceonnect only 67.84 2 Pump or irrigation circle 67.84 2 E- mail: pelm j {tjI'rfJ��p!}� {igti { t��� {� �� g { f - nsigf III11FC8J AI�tm'fRVii bl'mM,ini if .ii>u {tAiiEf.iNtlllitEiilt+4 IIIIfCktf '{t lfiu !ii 71"Iill si o)orliw -energy 67.84 2 Business name: JC ELECTRIC, INC. panel, alteration, or extension. \ Page 2 'IS, 2 Each additional inspection over allowa in any Of thelitbov Address: 118 NW 184 ST Additional inspection (1 hr min) 66.25/ hr r. Investigation (1 hi min) 66.25/ hr City/State/ZIP: RIDGEFIELD WA 98642 Industrial plant (1 hr min) 78.18 / hr Phone: (360) 887.7889 Fax: (360) 887.5584 . Inspections for which no fee is 9000 / hr s. - cificall listed Khrmin CCI3 Lie.: 1.18452 Electrical Lic•: 37 -72' + f Sup, o_= 4289S ,1f�'c' ,(Pell €lit #i7:77,1777 iiii "d't ;i1 ,1 d1 "< , ? liri$''i '• Ii ]uni I . ,- Subtotal: ' Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: JON COULIMO • / � / i Date: 3/9/171 • State surcharge (12% of permit fee): _S ,.'...f.') Authorized si na ture: I " TOTAL PERMIT f FEE: aq g This permit application expires if a wain is not obtained ined wln 180 da after it has been accepted as complete. Print name: JO ! r IMORE Date: 3/9/11 +' Number of inspections allowed per permit. 1: 1Building ■Peamits PennitApp.doc 07/01/10 440 .4615T(11 /05 /COM/WEB 03/10/2011 08:49 3608875584 J.C. ELECTRIC, INC. PAGE 02/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for ,al! residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: fr Ml SI, a ,g I c< of } IIFilUt :PA Fee for gam commercial $75.00 system (SEE OAR 918 - 309 - 0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Cozxttols ❑ Clock Systems Eg 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 ate required for all other installations t 03uilding1Permits1ELC •ParmitApp.doc 07 /01/10