Permit CITY OF TIGARD ELECTRICAL PERMIT
e COMMUNITY DEVELOPMENT Permit #: ELC2009 -00285 i
T I GAR L) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/12/2009
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 958_ 5"SW_WASHENGTON_SQUARE -RD MGMT OFF
Subdivision: Lot: 0
Project: Activate Cellular
Project Description: Install /alter (1) branch circuit for kiosk.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES,
2235 FARADAY AVE STE #0 1 crt Branch Circuits 06 /12/2009 $46 85
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/12/2009 $5.62
Electrical
Contractor:
GEORGE & SONS ELECTRIC CORP
PO BOX 339
CLACKAMAS, OR 97015
PHONE: 503 - 654 -8634
FAX: 503 - 653 -6886
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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 throug OAR 952- 001 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1 800 332.2344.
Issued By: . leis_ tt . ` I - .. . , 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 an Inspection that business day.
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 P ermit Application
I OR (II I Ii I • . I ' I . I I\ 11
City of Tiga :� ; r ;i� E 4� Date Received
: - 13125 SW Hall Blvd.:" °r), d 97223 �� Permit No. ' co Q W
_. Phone: 503.639.4171 503 598 I Plan Review 1 �. 1`�
'
N 11 009 Date Other Permit; p •�• • 00 i
r ; , > inspection Line' 503,639.41 Ready/By:
: of Date R y
iB :
Internet: www,tigttrd�r.go Notified/Method: ® 9ce P age Z for
a. :3P1 Supplemenat Information
—
n ,,..
JAI ti' • : Rr ttC1r',1•,1 PLAN 1REVWW
New construction ❑ A :' replacement Please check all that apply (submit 2 rots of
YjLTr� - plans w /items checked below),
- El Demolition Q Other: CI Service or feeder 400 amps or more [] Building over three stories
where the available fault current ❑ Marina and boatyards
CATEGCtRY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ floating buildings
[] 1- and 2 family dwelling Commercial /industrial ❑Accessory building less to g round, or exceeds 14,000
❑ Commercial use agricultural
❑ Multi family ❑ Master builder amps for all other installations buildings.
❑ Other: D Fire pump ❑ Installation of 75 KVA or
0 system. larger separately des d system. SITE INFORMATION AND LOCATION
❑ Addmon of new motor load of ❑ "A", "E", •�1 -2" - 1 - r,
Job no.: Job site address: ' • t p f ICOHP or more occupancy
. r 5 1 a , .i t�! _ OM M ❑ Six or more residential units, ❑ Recreational vehicle parks
City/State/ZIP: Tigard Oregon p ❑ Health-care facilities ❑ Supply voltage for more than
❑ Hazardous locations, 600 volts nominal,
Suite/bldgJapt. no.: Project name: • A ' ❑ Service or finder 600 amps or nwre
FEE
Cross street/directions to job site: �/ SCHEME
• ` r . !1 , . y . . Descrim1 I Qty„ I Feb 1 Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less 145 15 _ 4
Tax map /parcel no.: M+ Es. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
• r t i/ • Limited energy, multi - family 75.00 2
• a . ; 1 a r 1 r .-•2 a. residential (with above sq 8 )
Services or feeders installadon,alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 _ 2
City /State/ZIP: Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
- each branch Circuit 6.65 2
Business name: B Fee for branch circuits
without service or feeder fee, ' 46.85 *6 ft, 2
Contact name: first branch circuit
Address: Each add'l brunch circuit . 6.65 f 2
Ci /$tate/ZIP Miscellaneous (service or feeder not included)
tY : Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: George & Son's Electric Corp. Signal circuit(s) or limited -
energy panel, alteration, or
Address: PO Box 339 extension Describe: Page 2 2
City/State/ZIP: Clackamas, Oregon 97015 Each additional inspection over allowable In an of the above
Per inspection 62.50
Phone: (503) 654 -8634 t ! I Fax: (503) 653-68116-1. Investigation per hour (I hr min) 62 50
CCD Lic.: 35600 I Electrical Lie.: 3 - 117C Suprv. Lic.: 31!5 - industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, trqu�tti - Subtotal - jt�', (/ 5
Print name: Craig Robison Date: 6/1!2009 Plan review (25 °0 of permit fix)' •
State surcharge (12% of permit fee)
Authorized signature. TOTAL PERMIT FEE. i permit ,5a, y1-
Print name: Th it application expires if a permit b not obtained within 180
Date: days after it has been accepted as complete.
• Number of inspections allowed per permit
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