Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00570
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718:2439 Date Issued: 10/01/2012
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD OFFICE
Project: Temporary Retail Kiosk Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (4) branch circuits for temporary retail kiosk located in courtyard area in front of Nordstroms.
Contractor: JRA INC Owner: PPR WASHINGTON SQUARE LLC
11860 SW GREENBURG RD PO BOX 847
TIGARD, OR 97223 CARLSBAD, CA 92018
PHONE: 503 -639 -4627 PHONE:
FAX: 503 - 639 -4673
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 10/01/2012 $78.44
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 10/01/2012 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 ac • .. = wit - • • •ved 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. ATT • ION: Oregon law -qu' -= you to follow the rules adopted by the Oregon Utility N• i cation enter. Those rules are set forth in OAR
952-001-4410 throu h OAR 952 - 0010. Yo - •btain a copy of the rules or direct questions to OUN • calling " . '87 or 1.800.332.2344.
Issue' By: Permittee Sig .ture: �, i oshr
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' ` • • I 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 Applicif l - =
� FOR OFFICE USE ONLY
1 '"' ' C 1 1�'
1 7 Received � n
City of Tigard ' Date/By: 66 ' < P-- ` ' ` , Permit No.: A
Etc ,/1P- a06
" 13125 SW Hall Blvd., Tigard, OR 2 y
�((�� Plan Review
- Phone: 503.718.2439 Fax: 503.59819'60P 1 ? Pl
Date/By: Other Permit: 4614*i2 -ad /7 9-
TIGARD Inspection Line: 503.639.4175 g` Date Ready/By: Juris: 11 See Page 2 for
Internet: www.tigard- or.gov 14I t�7._� t 1� R yu- . 1 Notified/Method: Supplemental Information
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1-1 1 ' IC t ,7
TYPEFL 1 it
OR .. � t ;,. �� PLAN REVIEW
❑ 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 ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "I - ",
Job no.: 69812 Job site address: 9585 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
El Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: MICROSOFT KIOSK ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I QIy. 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
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
WIRE INSIDE MICROSOFT KIOSK AT NORDSTROM COURT residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 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
y 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
El APPLICANT El 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 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 3 7.42 22.26 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
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: JRA dba FRAHLER ELECTRIC COMPANY panel, alteration, or extension. Page 2 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 (1 hr min) 66.25/ hr
-
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 639 - 4627 Fax: (503) 639 - 4673 Inspections for which no fee is 90.00/ hr
specifically listed (%2 hr min)
CCB Lic.: 197172 Electrical Lic.: C861 I Suprv. Lic.: 5110S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:"ft Subtotal: 78.44
Plan review (25% of permit fee):
Print name: ADAM ETHERINGTON Date: 09/26/2012 State surcharge (12% of permit fee): 9.41
TOTAL PERMIT FEE: 87.85
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.
:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I i /05 /COM /WEB