Permit CITY OF TIGARD ELECTRICAL PERMIT
Permit #: ELC2011 -00640
COMMUNITY DEVELOPMENT
TIIGAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/15/2011
R
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9473 SW WASHINGTON SQUARE RD A08
Project: Jamba Juice Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (2) branch circuits and (1) limited- energy for data telecommunications.
Contractor: RK ELECTRIC INC Owner: PPR WASHINGTON SQUARE LLC
24495 NW OAK DR BY THOMSON PROPERTY TAX SERVICES
HILLSBORO, OR 97124 2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 640 -1344 PHONE:
FAX: 503 - 356 -0513
FEES
Quantity Description Date Amount
1 ea Limited Energy 11/15/2011 $75.00
Specifics:
2 crt Branch Circuits wo /Purchase 11/15/2011 $63.60
Service or Feeder
Type of Use: COM 1 ea 12% State Surcharge - 11/15/2011 $16.63
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $155.23
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 0' • : 2 -00 0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
, ��
Issued By: / � � Permittee Signa d� G � � 70
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.
Nov 14 2011 11: 031:1M HP LASERJET FAX 5033560513 p.1
Electrical Permit Application volt 01, I• is .i,: t itii': ( 041 .1
City of Tigard RECEIV lie p erm i t
.4r . Plan Review
13125 SW Nall Blvd,, Tigard, OR 97223 Aar ' '
t+'
t+ Phone; 503.718:2439 Fax: 503,598,1960 �I twBy: Other Permit:
'r t t: P. u), Inspection Linc: 503:639,4175 IN 0 V .I 4 2 ' Va le Ready /9y; Has: Id See Page 2 for
Internet: www.tiaard- or.gov Notified /Molhod: *' Supplemental Information
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1:1 New construction ® Addition /alteration /r- 't' Please bask alt that apply *Moll a rah of pious w /rtoms checked below).
❑ Ser><Ice �r feeder 400 amps or more ❑ Building over three colitis.
❑ Demolition ❑ Other:
whore the available fault current ❑ 1!Aorllrat and boatyards,
1p+ It,, , . , 4 :: •,i s ,r,.r.',r � �� 1 -�p"t l' ii0P tj� , ', } , ^,? oxoaeda 10,000 amps at 150 volte or El Floating buildings,
P, .:. i,. - -r ..... i 'cx_,.,�..'r rk ,�,,...,.,,. less to
ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1- and 2- family dwelling is Commercial /industrial ❑ Accessory building amps far ail other installations, building:.
❑ Multi -family 0 Master builder ❑ Other: ❑Fire pump. 0 Installationof75KVAor
,• " :,` .; r ,,..1, :,v ,; a.,.,. ....._..r .........._...... - r,. ,.r �, : ,. ❑Borer enc e
- .g., g . .._.. :g ._ .: x......,:.,,._-..._„t...., g larger derived amain,
...... -... .._....... :,: ∎4-i ° 'g 4 : ; - S 11T I w :_ �4 , . J s 4Yy 'f .. : :r;,.7, ! d , , : ,. . •. ... ' Y system, at
:'fkt�`^�, :4kit S•1i',.'� C :: ':1 -rt � ':.._ _. °ti ,,, r .. n.,.r , i • ..,:. n. . 1C.l.::.:..., .. ! , ' ,.m ❑ Addition of new mo load of ❑ ,. ., „ ., ,
Job no -: 4232 1 Job site address: 9473 Washington Square Road 100HP or more occupancy.
❑ Six or more reridontial units, ❑ Recreational vehicle pe.rka.
City/State /ZIP: Tigard, OR 97223 ❑ Health -ogre facilities. ❑ Supply voltage for more then
- ❑ Hazardous locations. 600 volts nominal.
Suitc /bldg. /e;pt no.: J ❑Servtosor&eder600atrrpso
Pro tCtnam Jambe Juice or more.
Cross street/directions to job site: 11W ::-. t ;tk' 3 „ ' s .; 4
D.crlMtlon M Qa 1 rm I T4tet C " !W
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no,. 1,000 sq. ft. or less 168.34 4
Be, add'l 500 sq. it or portion 33,92 1
Tax mop/parcel no,:
_...,,,,., xw ............._._..._.. Limited aneray, residential . .......... .. I�'a- ,:.r...:...:_, � - y . rr .. c.:� K - ':. �tt9l rr�y; : r,,: a :.y :, .r�, :,.,.,..,, : • J r:.
,
........................... r>.:.: � ............ :;F;fs, „',:.1 i' r, "- ..,� ) 1 with above sq, ft,) 75
7 '.:' , ' , :.::::: , : i'. 4 ..:. �W�{ ^: hA'' �1 : : :'., .' : ................ .._...._...._.. .....e l: f . J :. "i �_., " r Y :
:..................... _.,,.., :.....,..... : :� ...,,., Limited energy, multi - family
(2) isolated ground circuits, data 75,00 2
1
{) residential (with above sq, ft)
Service§ or feeders Inscallatian, alteration, and /or relocation
- 200 amps or less 100,70 2
"A1Rt04itit i J ' °? *, ? y p r 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 I 2
City/State /ZIP:
Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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, 67D, and 701. 401 amps to 399 amps 168 2
Branch circuits— new, alteration, or extension, per panel
Owner signature: - Date; A. Fee ibr branch circuits with
:....: , :.AkPLJCiANT f ,' r 4 r �, z �, above service er feeder fee
7 42
... �` .. :: � -� i�� a .,, v rr °�}, _�[:? l�r�!4/�!�' � ^
t , , ,
.tl .... ...... ... � , 2
Business name: 13, Fee fbr branch circuits without
service or feeder fee. first 1 56 18 56.16 2
Contact name: branch_ circuit
- -- Each add branch circuit 1 7.42 7,42 2
Address: ' Miscellaneous (aervlet or feeder not included)
City /State /ZIP; Each manufactured Or modular 67,84 2
dwelling, service and/or ibeder _
-
Phone: ( ) Fax: : ( ) Reconnect only T 67.84 2
• E -mail:
- Pump or irrigation circle 67,64 2
;...., .............. . ... ",, , Sign or outline lighting
...........
? i r: � . tro-fuA.. /irq: IG '��lii; :7. ?.�",`r"t ., r r . - ..: . ::,ti tiirc F.,, �!'�:: , rve ^: rr,. _
r:..• :r t +vr ;.,�kA 7?' :' :I4kr'';i . ".+Ni.R'i'Ri :; ::t \w' tlmHhe��� r,�+A,�i :r., :: _ lr 1 y r J i r
_ :� .. Si ci[uuit(s) or limited- ener
Business name: RK Electric, Inc. panel, thermion, or extension, _ 1 Page 2 73.00 ion,
Each additional Inspection over allowable in any of the above
Address: 24495 NW Oak Drive Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Hillsboro, OR 97124 lrivegtigatian (] hr min) 66.25/ hr -
Industrial plant (1 hr min) 76,18/ hr
Phone: (503) 640.1344 Fax: (503) 356.0513 Inspections for which no fee is 90,00 / hr
s e -.n-. harm
: 34 -375 j � Suprv. Lic.; 4734 -6 � /;,5 f d JCallta GE1C14�'• :r t °;' "' CCB Lic.: 94275 t Electrical Lic. Ty .� ;A .,.,�� ;;^ , ,,' , .,,,, .. �h_,�..
Suprv. Electrician signature, required:! °" Subtotal: ]38,60
L �( plan review (25% of permit fee):
Print name: Ron L. Kurtz Dat 1/11/11 State surcharge (12% of permit fee): 16,63 /
' lid/. TOTAL PERMIT FEE: - t.
/ 155.23 9
Authorized signature: / f permit ermit a cation expires if a permit le not obtained - Within t$0
tL �` y , days after It has been accepted as complete.
Print name: Ron L. Kurtz Date: 11/11/11 • Number of Inspections allowed per permit
l'1Bul1dlo Peraltaer-c- rerreltApp.doc 07 /ii/lo 400.0615:'0 1 I05/COMMBB
Nov 14 2011 11:03AM HP LASERJET FAX 5033560513 p. 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMTTED ENERGY PERMIT FEES:
Fee for All 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:
mow. R,. ; ., ...;;.< ,
Fee for e Ch commercial $75.00
system
(SEE OAR 918- 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
I:1 Buildin ; ■Permita■me- PermltA n01 /lo