Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00009
T1GARf3 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/06/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9532 SW WASHINGTON SQUARE RD H11
Project: The Body Shop Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (19) branch circuits and (3) limited energy for TI.
Contractor: FRAHLER ELECTRIC CO Owner: PPR WASHINGTON SQUARE LLC
11860 SW GREENBURG RD BY THOMSON PROPERTY TAX SERVICES
TIGARD, OR 97223 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
19 crt Branch Circuits wo /Purchase 01/06/2012 $189.74
Specifics: Service or Feeder
3 ea Signal circuit or Limited 01/06/2012 $225.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12% State Surcharge - 01/06/2012 $49.77
Electrical
Type of Const:
Occupancy Grp:
Total $464.51
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 952- 001 -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 Signature: /JA/ �/ / C' /
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.
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Electrical Permit Application FOR OFFICE USE ONLY - _-
� Received i:1
C 125 Of Tigard DateBy: /manna",
Permit No. k`t C c20/2 --40‘,00 9
INIII 13125 SW Hall Blvd Ti O R 42r ` LQ�� Plan Review
Phone: 503 - 718 - 2439 Fax: 5�J60 '' O Date /B : OtherPerinj. 4 „,. p,' 6 ,
Inspection Line: 5 ns ecton ne: 03.639.4175 P \v Date
TIGARD p , �`''`o Y Y S See Paget for
Internet: www.tigard- or.gov r {� Notified/Method: Supplemental Information
�� ��v � Su le
s ; in ” r e ".tit ffi....: - TYPE OF WO 1` ?`. -. v t t, . - " -. ,
.,F ..� , _�.�:,.,������ �.,....a,� � ,- ��. <�.: .. �.�..,: � au � � ��,,PLA1V I2E�,I1W� � •� _ .. �_:
❑ New construction E Addition /alterati N aeement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or ❑ Building,overtliree stories.
❑ Demolition ❑ Other: where the available fault current'zi ❑'Marinas and boatyards.
, #A'E(;ORY OB CONSTRUCTION . `mot- exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
"'` .. ` less to [mound, 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 of75 KVA or
: ""- ❑ Emergency system. ' larger separately derived system.
_t ->. t MM,tM. £s �, ,. , OBrS1TE INFORMATION AND LOCA'IIION '
- 4 � w �-- ��t. � . _ ... ,� � ,_ .��._ � �� � ❑ Add ition of new motor load of ❑ "A "E "1.2 "1.3"
Job no.: 69093 Job site address: 9532 SW WASHINGTON SQUARE RD 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: THE BODY SHOP, SPACE H11 ❑ Service or feeder 600 amps or more.
sc
t' ., _ " g "" :. C:$01 -14.* " :. i
Cross street/directions �. �_J.:�,a ..,..z u . street/directions 10)06 site: Description I Qty. I Fee. . to � Total
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
��' �x r a ¢ ur ` 75.00 2
_...� � { . , .: �,.- ilif SGRIPT 0 O *0*- _ .i ,111- _ " ` " s .;_ (with above sq. ft.)
Limited energy, multi- family
• TENANT IMPROVEMENT residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
ITM 1 AO ili #15,4/10**,- ' << : v TOW., A , i- `201 amps to 400 amps _ 133:56' 2
Name: 1 401 amps to'600 amps 200.34 2
_._._ . _ . • - - -- 601, amps. to 1-,000:amps' .. .. , _ 2
Address: • ., • - a o
u
Over 1,00 mps,or v" Its 552.26 2
City /State /ZIP: :Temporary services or feeders installation,_ alteration,.and /or_.. '
. ...... . _ - _ .. ._ . .. - 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
1 :RO ,❑ APF)lICA:NT _ igit* CONS ACT P +,RSON �' above service or feeder fee, 7.42 2
., x", ..< _ .� s : - - ._ each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 18 7.42 133.56 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
" :' tfat "s :. € Af - - f GniV t' W.C.: 4R " ; "s C „ , : .. ` g - Si circuit(s) or limited- energy
Business name: FRAHLER ELECTRIC COMPANY panel, alteration, or extension. 3 Page 2 225.00 2
Each additional inspection over allowable in any of the above
Address: 11860 SW GREENBURG. ROAD' Additional,inspectlon (l hr min) 66.25/ hr
City /State /ZIP:' TIGARD, OR 97223 Investigation '(] hrminj 66.251 hr • • ,
' - - -- ' Wu plant (1 - hr min) 78.18/ hr
hone:, (503) 639 - Fax: (503) 639 - 4673 . Inspections for which no fee:is 1 ;• -`- '
- - - / speci
i listed (% hr min) ' 1- -. •
• 9 0 007 hr {
37410
CGB -
Electrical Llc. 34-13C v
Suprv. Llc.. 5110S r CAI P :t:,:
� __�,t; . <- �EIlEC <�?RI.a..,...- 1.EI�MI1',�EF=�� " ���.� I
�,, 4 41
Suprv: Electrician signature, required: G %���'�� I t i Subtotal: 414.74 � .
. . Plan • review (25% of permit fee): ;
Print name: ADAM ETHERINGTON - Date: 01/04/12 • State surcharge (12% of permit fee): 49.77
TOTAL PERMIT FEE: 464.51
Authorized signature: i
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: Number of inspections allowed per permit.
I:\ Building \PermiisiELC- PermitApp.doc 07/01/10 440- 46t5T(t t /05 /COM/WEB
•
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
VRESIDENtar tORK4OINTL`Y g '
Fee for residential s ste
. 1 „ .. all .. y ms combined $75.00
=Check Type of Work•I ._;.
nvol'ved: '
Audio and Stereo Systems*
• n Burglar Alarm •
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other: .
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work InvoIved:. •
•
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 nurriber of commercial-systems:
*No licenses are required. Licenses are required -
for all other installations
]:\Building \Permits\ELC - PermitApp doc 07/01/10 •