Permit II u r
CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2011 -00139
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/16/2011
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9640 SW WASHINGTON SQUARE RD G11
Project: Hanna Andersson Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Sign lighting for (1) interior wall sign.
Contractor: VANCOUVER SIGN COMPANY INC Owner: PPR WASHINGTON SQUARE LLC
2600 NE ANDERSEN RD #50 2235 FARADAY AVE STE #0
VANCOUVER, WA 98661 CARLSBAD, CA 92008
PHONE: 360 - 693 - 4773 PHONE:
FAX: 360 - 693 -2747
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 03/16/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 03/16/2011 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 i ccordance • • appr• -d 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. TENTION: Oregon = re• ires ou to follow the rules adopted by the Oregon Utility Notification Center. Tho - ru - -re set forth in OAR
952 -00 -0010 thro gh OAR 9 ' 0 •u ay obtain a copy of the rules or direct questions to OUNC by calling 503.232. or 1.80. 32 344.
�[4 Li
Iss d By: � - �• 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:
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 Applicati4ECEIVED FOR OFFICE USE ONLY
City of Tigard Received Permit No.: /' �/� 3 . Y g DateB : , eke t"l r' d
13125 SW Hall Blvd., Tigard, OR 971, R 1 Plan Review
' I Phone: 503.639.4171 Fax: 503.598.1960 Date /B : Other Permit:
T 1 G A R D Inspection Line: 503.639 CITY OF TIGARD Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
BI IILDING DIVISION
TYPE OF WORK PLAN REVIEW
jg 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 Commercial /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 Addition n ❑ Emergency system. larger separately derived system.
W[t!(J ❑ Addition of new w motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: 100 or more. occupancy.
l� 1 0. ILArtQ'tOVt St ID Six Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: J (� ❑ Health -care facilities. ID Supply voltage for more than
- O ' 7 Z Z ' ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. d Ojob Project • name: � ❑ S e rvice or feeder 600 amps or more.
FEE SCHEDULE
ti 0.✓l YLLi . / 4 YL P. f SO I
Cross street/dire" site:
Description I Qty. I Fee. I Total I •
/ q 0. ` New residential single- or multi - family dwelling unit.
W 1,1,1 alto G� t o 1t. C JV &c&. e- Includes attached garage.
Subdivision: J Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'1 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
f Limited energy, multi - family
lI u,vo,1 r1Gtre.ci i nt e, r t 0 r W all 51 y) residential (with above sq. ft.) 67.84 2
lJ Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I X TENANT 201 amps to 400 amps 133.56 2
Name: r1 YLOI A >�d,�rs �� 401 amps to 600 amps 200.34 2
rl \_ � 601 amps to 1,000 amps 301.04 2
Address: ¶ S $ S 51A3 1J . n S Act Over 1,000 amps or volts 552.26 2
City /State /ZIP: Tara, r * ZZ 7 Temporary services or feeders installation, alteration, and/or
` J relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 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 I Mt CONTACT PERSON above service or feeder fee,
7.42 2
`' each branch circuit
Business name:
V(. lelx ,C3 (AA) e, r S t G( B. Fee for branch circuits
1 without service or feeder fee,
Contact name:
R C� { {)/1 first branch circuit 56.18 2
Address: Z O V !!ll Al ` ,t r e seo Rel, Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: O l 1. 11 t°. r (�v A G �, Each manufactured or modula 67.84 2
{ I �� dwelling, service and/or feeder
Phone: ( (o �) t e 3 Li7 7 3 Fax:: ( 3 (00) (o t 3 "1,!ly 2 7 e{ 7 Reconnect only 67.84 2
E -mail: - ei (16 u!X VI S 11.C.0 , cd1 rn Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting (t 67.84 tpi. t L 2
Business name: Van C- Signal circuit(s) or limited -
V G O(A .tl ex. /0017 I tt energy panel, alteration, or
Address: 2.41) CJ Al r
G �} yl,l ire-s I // , ;{� ,7r S (:) extension. Describe: / 2
City /State/ZIP: V Gl Yl G O u u ex tN / . 1 A 9p & to ( Each additional inspection over allowable in any of the above
0 Per inspection 66.25
Phone: (3 6,C) (o q 3
a 21 7 7 3 Fax: ( ) Investigation per hour (1 hr min) 66.25
CCB Lic.: 6 , 3c f 5 I Electrical Lic.: L7 _ 166 LS Suprv. Lie.: 52 6 sz(p Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: t -7 A cl
Print name: SIL/ �� Date: / Plan review (25% of permit fee): --rte'
3�// f r State surcharge (12% of permit fee): $ • ( 4
Authorized signature: A ...- TOTAL PERMIT FEE: 75. 4 S
This permit application expires if a permit is not obtained within 180
Print name: R P 1 s r m Date: 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( l 1/05 /COM/WEB