Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -26004
I DEVELOPMENT SERVICES DATE ISSUED: 9/30/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1512600-01107
SITE ADDRESS: 09645 SW WASHINGTON SQUARE RD
SUBDIVISION: FC-8 ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (4) branch circuits to relocate equipment for commercial TI.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PPR WASHINGTON SQUARE LLC WILLAMETTE ELECTRIC INC
P.O.BOX 21545 PO BOX 230547
SEATTLE, WA 98111 TIGARD, OR 97281
Phone: Phone: 624 - 2938 FAX
Reg #: 160 1-3631 34 -283C
FEES
Description Date Amount
Required Inspections
[TAX] 8% State Tax 9/27/02 $5.34
[ELPRMT] ELC Permit 9/27/02 $66.80 Rough -in
Elect'I Final
Total $72.14
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: Permit 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'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Igo* • ' �=ilectrical Permit Application
ii,,v • .� ,� ti
'
Date received: 9/2 S/0 Permit no.; 7ezela2 ze my
:..1 1 City of Tigard 1 \ L L : Projecdappl. no.: Expire date:
_ l a
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: Byj/ Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 SEP 2 2002 Case file no.: Payment type:
Vo,P .
Land use approval: ° ��� `� 4�
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family 6I Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
V\ Job address; SW w ( , i N
`,, S S"?,_ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
( �y Lot: Block: , I Subdivision:
"\ Project name: S C 0.0 2 r 1 nescription and location of work on premises: (t (nr (4.71/4. e Rit,p r
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Fee Max
Job no: 3 y Description Qty. (ea.) Total no. insp
Business name: W, it e.in, tie Et f # c Jn. c.
New residential - single or multi- family per
Address: Pd / jai 2 zC1 ct( }- dwelling unit. Includes attached garage.
City: r,, via IState:0& I ZIP: 9 - z k/ ' Service included:
l 1000 sq ft. or less 4
Phone: /D zy - 363 t Fax: 424 - 29;91 E - mail:
t - e R' Jb/03 I Elec. bus. lie. no: 3 y - Z.&? Each ed energy, residential sq. ft. or portion thereof
CCB no.: 7 ra
Limited energy, residential 2
s Q x City /m c. no.: / 'q4 Limited energy, non-residential 2
P q. L y - O L Each manufactured home or modular dwelling
Service and/or feeder 2
Signature of superv' " g electrician (required) Date
A^ , r' Sup. elect. name (print): , ,,, _ License no: 94 -S Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary servicesorfeeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
. ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase ` yt:� y` &C 2
of service or feeder fee, first branch circuit: 1
Phone: Fax: E -mail: 3 645 y s f
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension" 2
❑ Building over three stories ❑ Feeders, 400 amps or more sDescnpuon:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Egress/lightingplan ❑ Other. Per inspection I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other // ' 1
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ to , �t/
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ S, 1
Expires accepted as complete. TOTAL $ 2 • / '/
Name of cardholder as shown on credit card
Cardholder signature Amount 440-4615 (6/00/COM)
s
ELECTRICAL PERMIT FEES: LIMITED ENERGY PER?!!TFEES;"
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑ ,
201 amps to 400 amps $106.85 2 Vacuum Systems'
401 amps to 600 amps $160.60 2 .
601 amps to 1000 amps $240.60 2 n Other
Over 1000 amps or volts $454.65 2 " = .... ' i `
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits ❑
New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous . ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting'
Fees: ._ ❑ Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required Licenses are required for all other installations
front of application.
Fees:,
Total Balance Due $
. • - - . Enter total,of above fees . , $
- . .
' ❑ Trust Account #' 8% State Surcharge $
- Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts\forms \elc -fees doc 08/30/01
Y TIGARD • 24 -Hour
BUILDINp Inspection Line: (503) 639 - 4175
ECTION p1VISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /0 — 3 / AM PM BUP
Location -Sw Lti ) - S 5 c 00 Suite MEC
Contact Person l� n Ph ( ) 2 ' 36 3 / PLM
Contractor [..c)iffewir f f � elFci71 C Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC Z - G
Y
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: /SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
_ _ Rain Drains
Catch Basin / Manhole /
, Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers •
Final
P PART FAIL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
4 ) Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
(Al. PART FAIL
D Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA D ate (- 3/ O Inspector ) � ector Ext P
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL