Permit •
CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2009 -00256
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/02/2009
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9585 SW WASHINGTON SQUARE RD MGMT OFF
Subdivision: c_ - -__ _: _ = tot: 0
Project: T Mobile Kiosk
Project Description: Install (2) branch circuits.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES,
2235 FARADAY AVE STE #0 2 crt Branch Circuits 06 /02/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/02/2009 $6.42
Electrical
Contractor:
CHRISTENSON ELECTRIC INC
111 SW COLUMBIA ST, STE 480
PORTLAND, OR 97201
PHONE: 503 - 419 -3300
FAX: 503 -419 -3695
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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 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: d-(1\9I Alt 9 "Vki J 4 Permittee Signature: %AA— .4V
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.
•
MAY -29 -2009 FRI 07:00 AM CHR I STENSON E�.,ECMI C, INC FAX NO. 95034193695 P. 01/02
rf', c\ Cl :1.
E lect r ical Permit Applicati '',-.' �, - ' -
, � FOR OFFICE IIS1i ONLY
City of Tigard um 29 2009 : •' \ �, Permit No • C iii GG is(
n 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
• 0 Phont: 503.639 4171 Fax: 503.598.19(IU r rN. • 1 * :• 1 RD Date/B : Oii or Permit,
Inspection Line. 503,639.4175 a l � �+ •' "' Date Ready /By: funs. See Page 2 for
•I' 1 G A R U
Intemet: www.tigard-or.gov i VI F%.t,t,, ii All•_In �° � fa � Noufied/Methad: Supplemental information
,' in.
.. TYP',0F;''1 ti� i . ... . ,.. . .'..T , I:° : '..', , • , .,;',TI:ANI' ,.: '.,.... •.
"'' ' Please check all that apply (submit 2 sots of plans w /itoms checked below):
El New constructionddition /alteration /replacement ❑ Service or feeder 400 amps or more 0 Building aver three stories.
❑ Demolition Other: where Ilse available fault current ❑ Marinas and boatyards
?CgNSyC :
eacccds 000 a
' ... , :....,!:!••..::;'!•;
0,mps at 150 vn or Floating
• • .. .. :•.: ATL'GORY OF : :' ' :. ...•.: l t Its o S buildings. ue a
ON " "'' ' less to ground, or exceeds 14,000 ❑ Commercial - agricultural
❑ I- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installatimts. buildings.
❑ Fire pump. ❑ lnslullation of 75 KVA or
❑ Multi ❑ Master builder ❑ Other: ❑ Emergency system, larger separately derived System
.10 B', Sl f , 1PFFORMA'!!'�OPi;' Al11lQ, :,){�,OCATJIQ ❑ Addition of new motor load of ❑ "A" "E" "1 - ", "1.3"
• :.'.4: :....,: , . ..... ,., . .
I nOFlr or more, occupancy,
lob no.:Cfaaal Job site address: �,6 � a� t [J Six or more remdcatiol unitb 0 Recreational vehicle parks.
❑ Health - care facilitie<. ❑ Supply voltage fur more then
City/Statc/ZIP: • • • , aa3 0 Hazardous locations. 600 volts nominal.
Y dun C ❑Service or feeder 600 arts or more. rot • "
D 1 Suite/bldg. /apt. no.: ;, • Projec n am e : l J ; ' . • .,•.; ,,.;.,
.
A. .i. • • ' ' FTE•'SCIiEDIZ:Ii: E :. ,
Cross street/directions to job site: aeierlprlan 14rv. I rec. l T�—
IP New residential Single or smultl- family dwelling unit.
Ii b 6) . ' i . —• -- t- 1 1 / , • Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less _ 145.15 4 -
-- Ea. add'I 500 sq ft or portion 33.40 1
Tax map /pat'cel no.; Limited energy. residential 75.00
:
:.:•.' ;DESCRV
II'ON;, I ,.::WQR *; . . , .. , , (with above sq. A-)
Limited energy, multi - family 75 00 2
. r1 ` lit) .7C- r y \ _ 5 O \ ( residential (widt above sq- It
.AD 111 ! lL lIG `1 S ervices or feeders installation. alteration, and/or relocation
y 200 amps or less I-1780.30 2 •
' 3.'PROFERTY '; .. • :[;!TEII? NT , , --- 201 amps to 400 amps • ' 17' 106.85 2 •
401 amps Iii 600 amps 160.60 1 -
Name: - _ - -- 601 amps to 1,000 amps 24r% 60 2
Over 1,000 amps or volts 454 65 L ' 2 -
City / State/ZIP: - -- Temporary services or feeder. installation, alts: radon, and/or
relocation ....
Phone: ( ) Fax: ( ) 200 amps or Ices .' . 06,85 1
201 amps to 400 amps 10,0,30 2 ,
Owner installation: This installation is being made on property that I own which is not 401 amp to 599 amps 133.75 2 • •
intended for sale, lease, rent, or exchange, according to ORS•447, 449. 670, and 701 Branch circuits — new, alteration, or extension per panel
(?caner signature: O ° -- — A. Fee for branch circuits with - —i •
+ above servic or f ee d er f ie,
• 0 , ' A 1tPI F ANT , . � .. ..... '`; ; CONR'iAC'.P. ORSON';, I, .., - 6,65 2
each branch circuit
Business name: B. Fcc for branch circuits )
- — , without service ur feeder fee, '
46.85 Lk/ ,t5 tl5 2
Contact name: _ first branch circuit
Address: • . Euch add'I branch circuit 1 6 15 (j),(0,5: 2
- Miscellaneous fservicc or feeder not Included)
City /State/ZIP: . Each manufactured or modular 90 90 2
- _ dwelling, service and /nr feeder
Phone. ( ) Fax ' ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2 • ' 1 . • CONTRACTOR , ..!;i Sign or outline lighting _ 5340 2 • Signal cir.:uit(s) nr limited.
Business name: �. ,, Ak 1 ►1 ' energy panel, alteration, or
Address' , t t ' N \) Nb ICU- , L ) — extension. Descnhe: Page 2 2
City/State /ZIP: Q v pat, up._ • "g..0 ( Each additional In .Pcction over allowable in arty of the above
Per inspection 62.50
Phone: ("'t l - ID Fax: "� ,,, -- investigation per hour (I hr min) 62 50
ISSII Su ry Lie. G Industrial steal plant per hour 73.75 _
I=IITa d� . •. 1 p £LECT7tICAi.'•1!•fit IT 1tlC1iS'
r up r v. , lectrician signature, required /' O� I Subtotal: ,
O
IV V . ^/ti I Plan review (25% fee). f j
Print name: ' ! .L (.\ � d o(" L i4 r ot
Authorized signature: State surcharge (12 "/a of permit fee TOTAL PERMIT FEE.
This permit application expires If is permit Is not nbtalnct within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspection•: allowed per permit.
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