Permit CITY OF TIGARD ELECTRICAL PERMIT
° • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00422
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD MGMT OFF
Project: Washington Square Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Electrical panel and transformer for car charging station in lower level of northwest parking structure near Cheese
Factory.
Contractor: JRA INC Owner: PPR WASHINGTON SQUARE LLC
11860 SW GREENBURG RD 9585 SW WASHINGTON SQUARE RD
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 200 07/17/2012 $201.40
Specifics: amps or less
1 ea 12% State Surcharge - 07/17/2012 $24.17
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $225.57
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 = w+• • . = 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. A' ENTION: Ore! •n law - quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 r 010 through OAR 9 . ; ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
4 �.
Issu d By: � �:��, Permittee Signature: / ae
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' A � � Date: 7 /(7// �--
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 ApplicatRECEIVED FOR OFFICE USE ONLY
City g Received ' r1 t y' N fi,�it:0 „A.) y.�A.
Cit of Tigard Permit No.:
q Date /B :
13125 SW Hall Blvd., Tigard, OR 974k 1 7 2012 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
1 - I C A It D Inspection Line: 503.639.4175 CITY OFTIGARD Date Ready /By: 1uris: ® See Page 2 for
Internet: www.tigard- or.gov � � Notified/Method: Supplemental Information
TYPE OF WORK LJt 7 1�1 PLAN REVIEW
❑ New constntction ® 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 ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
or more.
Job no.: 69488 Job site address: 9585 SW WASHINGTON SQUARE RD IOOH more rest 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: CHARGING STATION ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
ELECTRICAL PANEL AND TRANSFORMER FOR CAR CHARGING residential (with above sq. ft.) _
Services or feeders installation, alteration, and /or relocation
STATION IN PARKING GARAGE 200 amps or less 2 100.70 201.40 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
n relocation
Phone: ( ) 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, 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 ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: - Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State /ZIP: dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: FRAHLER ELECTRIC COMPANY panel, alteration, or extension. Page 2 I 2
Each additional inspection over allowable in any of the above
Address: 11860 SW GREENBURG ROAD Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: TIGARD, OR 97223 Investigation (I hr min) 66.25/ hr
Industrial plant (I hr min) 78.18 / hr
Phone: (503) 639 - 4627 Fax: (503) 639 - 4673 Inspections for which no fee is 90.00 / hr
specifically listed (%3 hr min)
CCB Lie.: 197172 Electrical Lie.: C861 Suprv. Lie.: 5110S ELECTRICAL PERMIT FEES
Subtotal:
Plan Suprv. Electrician signature, required : o
Plan review (25% of permit fee): 201.40
Print name: ADAM ETHERINGTON Date: 071712 State surcharge (12% of permit fee): 24.17
TOTAL PERMIT FEE: 225.57
Authorized signature: 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\Permits\ELC- PermitApp.doc 07/01/10 440- 46t5T(tt/05 /COM/WEB