Permit CITY OF TIGARD ELECTRICAL PERMIT
' � COMMUNITY DEVELOPMENT Permit #: ELC2012 -00102
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/16/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9459 SW WASHINGTON SQUARE RD A14
Project: Footlocker /House of Hoops Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Routing phone conduit and service conduit to Space A -15.
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
1 crt Branch Circuits wo /Purchase 02/16/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/16/2012 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
• Total $62.92
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 • : 952- 001 -0090. You may obtain a copy of direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
4
Issued 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 Application �, �`��'ti� ; ■
i FOR OFFICE USE ONLY'
City of Tigard � Received
IN a 13125 SW Hall Blvd., TigazO \97?�3' r`,0� Date/B : � Permit No.: ,_ �o
' Phone: 503.718.2439 Fax: S ! - I9 �� �® Plan Review
Date/B : Other Permit: i Pri// 00
TIGARD Inspection Line: 503.639.4175 CN 4 Date Ready/By:
Internet: www.tigard- or.gov �, J uris: See Pent 2 Information
�� Notified/Method: � supplemental See
TYPE OF WORK:, .
r .
❑ New construction ® Addition /alterdgii7ieplacement PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
CATEGORY OF CONSTRUCTION where the available fault current 0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2 family dwelling // Commercial /industrial ❑ Accessory building less to ground, or exceeds 14,000
❑ Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other:
❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMA ri D LOCATION ' ❑ Emergency system. larger separately derived system
Addition of new
Job no.: 69206 I Job site a d d r e s s . WASHINGTON SQUARE RD ❑ 100HP or more. motor load of ❑ occupancy.
••t_3
City/State /ZIP: TIGARD, OR 97223 0 Six or more residential units. 0 Recreational vehicle parks.
❑ Health -care facilities. ❑ Supply voltage for more than
Suite/bldg. /apt. no.: I Project name: FOOTLOCKER ❑ Hazardous locations. 600 volts nominal.
t ❑ Service or feeder 600 amps or more
Cross street/directions to job site: FEE SCHEDULE
Description _L - Q r y. I Fee. Total
New residential single- or multi- family dwelling unit.
Subdivision: Includes attached garage.
I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel n0.: Ea. add'I 500 sq. ft. or portion 33.92 1
DESCRIPTION OF WORK Limited energy, residential
(with above sq. ft.) 75.00 2
ROUTE NEW PHONE CONDUIT AND RELOCATE SERVICE CONDUIT TO Limited energy, multi - family
SPACE A - residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56
2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts - 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) . I 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
Owner signature: Date: Branch circuits — new, alteration, or ex tension, per panel
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without •
Contact name: service or feeder fee, first ] 56.18
branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: . Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited - energy
Business name: FRAHLER ELECTRIC COMPANY panel, alteration, or extension. Page 2 2
Address: 11860 SW GREENBURG ROAD . _ Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: TIGARD, OR 97223 Investigation (1 hr min) - 66.25/ hr
Phone: (503) 639 - 4627 Industrial plant (1 hr min) - - 78.18/ lir
Fax: ( 639 - 4673 Inspections for which no fee is
CCB Lic.: 37410 I Electrical Lic.: 34 -13C I Suprv. Lic.: 5 110S specifically listed (%: hr min) 90.00 / hr
ELECTRICAL PERMIT FEES
t
Suprv. Electrician signature, required: `a G
Subtotal: 56.18
Date: 021512 Plan review (25% of permit fee):
•
Print name: ADAM ETHERINGTON State surcharge (12% of permit fee): 6.74
Authorized signature: TOTAL PERMIT FEE: 62.92
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
* Number of inspections allowed per pennit.
I:\ Buildinglpermits \ELC- permitApp.doc 07/01/10 440 -4615T(I1 /05/COM/WEB