Permit y n CITY OF TIGA ® \® ELECTRICAL PERMIT
` �" COMMUNITY DEVELOPMENT Permit #: ELC2013 -00095
„,_,_,
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/11/2013
_ ___r_ Parcel: 1 51260000300
Jurisdiction: Tigard
Site address: 9699 SW WASHINGTON SQUARE RD C10
Project: Portland Seafood Co Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: (1) branch circuit for ice maker
Contractor: WEST SIDE ELECTRIC CO INC Owner: PPR WASHINGTON SQUARE LLC
1834 SE 8TH AVE PO BOX 847
PORTLAND, OR 97214 CARLSBAD, CA 92018
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
• FEES
Quantity Description .: Date Amount
. 1 crt- Branch Circuits wo /Purchase 02/11/2013 $56.18
Specifics: Service' or' Feeder
1 ea 12% State Surcharge - 02/11/2013 $6.74
Type of Use: COM Electrical •
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 OA 2-001-0090. You may obtain � a copy of the rules or direct questions to OUNC by calling 503.232.1 or 0
1.800.332.2344.
/l
Issued By: I JJ AI/ t-�-�C�t Permittee Signature: 611, � r Lre ` ' V ld
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 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.
2013-02-07 22:13 WEST SIDE 15037360677 5035981960 P 2/2
Electrical Permit AvolicatiVt
I » > VED i.oft I )1.1.10E I. MA/NI.)
City of Tigard P' 1 1 2013 Received
Darc./13 : ,D--• ii k3 ----- peing.N..:ezt_001 3 .0€2.
.114 ,---.. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• _ • Phone: 503.7182439 Fax: 503 .t9rtiobF TIGARD Ds : : Other Permit:
Inspection Line: 503.639.4175 Dare Ready/By: Jut El See Page 2 for
Internet: www.tigard BUILDING DIVISION Notified/me/hod: I ( N..- Supplemental Information
. .
'. . . . . ''' - i" 4* fY...i - i -;' ..:::. I - : 0 '? . ;i ''s.•':-': •
0 New construction 0 Addition/alteration/replacement Maw chock all that apply (submit a sets of plans writems checked below):
['Service or feeder 400 amps or more 0 Building over three stories.
C I Demolition 0 Other where the available fault current El Marinas and boatyards.
. ,
. ' ...- . • .......:.:;'••;;.•':;.:;,4ce.V.r.liGORY'OPALSTAIT4(.}tici;., . . :,,- . -.‘...: -....• • ,. ;. • : :•/..;, 7 ,.. i, i,... exceeds 10,000 amps at i50 volts ar 0 Floating buildings. I
less to ground, or exceeds 14.000 0 Commercial-use agricultural I
El 1- and 2-family dwelling fla Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: , 0 Fire pump. 0 Installation of 75 KvA or
, , .,, .. -, ..,, 0 Emergency system, larger separatel derived system.
... 4 - '.:. 7 • :r . : '' . ..• ' ''.."•• •:. '•-....i0BM* ibitOPMATI6N419). .....•.: . -:::. • - --'' . ''..•• 0 Addition of new motor load of 0 "A", "E", "1-2", "1-3",
.„. •• , , • ._,•• • - • •••• ..• • • . • ii ..
.. . . . ..
Job no.: 1 7g6 Job site address: 9'9q !Dm, it') Ai., 100HP or mine,
• - .' -(; ID Six or more residential units. occupancy.
0 Recreation& vehicle perks.
/
City/State/ZIP: / 6..,.., 72 2,3 0 Health-care facilities. 0 Supply voltage for more dum
CI Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: Project name: 1 , 6 /6 ) 0 Service or feeder 600 amps or more.
• .• •'.... ...-• : - • ! .•,tatt-SCIRMA0E . • .
Cross street/directions to job site: Datorlotioo 1 011'. i no. 1 TOW 1 .
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fL or less 168.54 4
_
Ea. add'l 500 sq, ft, or portion 33.92 1
Tax map/parcel no.: Limited energy. residential -
75.00 2
:- :''''....;•••- .......: ' •-• • : ••• • ; 1 .:!. -c, .. .„.PkSggit,V,10, (with above sc l• ft.) ...
Limited energy, multi
75.00 2 1
C/re oil 7c I ic.e 74a,fr: residential (with above Sq. ft.) _
Services or feeders lustalladmkalteration, and/or relocation
200 amps or lesS 100.70 2
1 ••• • ••• , -0 .eltekitittC.OAtit'Alt4I3C"74• 4 7 =' tY•:' 201 amps to 400 amps 133.56 2 i
.• , ,.......„.... .,
. 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
Temporary services or feeders installs alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) , 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner Installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with fe 7A2 2
• • • , - '. . 0. ... . .....;••••':•:'•:••• ::I la. -01.0 :1. • ;". . , '':' ••: each branch circuit
B. Fee for branch circuits without
Business name: !I,
service or feeder fee, first
branch circuit / 56.18 s 2
Contact name:
Each add/I branch circuit 7.42 _ 2
Address: Miscellaneous (service or feeder not Included) - -
Each manufactured or modular • 67.84 2 I
City/State/ZIP: dwelling, service and/or feeder
Reconnect only 67.84 2
,
• .
Phone:
• ) Fax: ; ( ) —
Pump or irrigation circle 67.84 - 2
E-mail:
Sign or outline lighting 67.84 2
. -. : . .. •
•• • •
" .' • , • ..' ......, erfilaNt kt: ; Signal divulge) or limited
•
panel, alteration, or extension. Poge 2 2
Business name: West Side Electric Co., Inc.
Each additional inspection over allowable in any of the above
Address: 1834 SE 8th Ave. Additional inspection (I hr mM) 6625/ hr
Investigation (1 hr min) 66.25/ hr , I
City/State/ZIP: Portiand/OR/97214
. Industrial plant (I hr min) 78.18/ hr
—
Phone: (503) 231 I Fax: (503) 736 inspections for which no fee 1S 90.00/ hr
specifically listed (hr min) I 1
CCB Lic.: 13306 Electrical Lic.: 26-135C Suprv. L,ic.: 4654-S '::
•
Subtotal: S --
Suprv. Electrician signature, requi ...oe , • • ..:... ,_ .
Plan review (25% of permit fee):
Print name: Randall F Roberts Date: 2/ 6 State surcharge (12% of permit fee): 6
/
TOTAL PERMIT FEE: 6 .,..—
Authorized Signature: _ This permit application expires If a permit is not obtained within 180
days after it has bete accepted an complete. I
Print name: i Date: • Number of inspections allowed per permit.
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mBuildingwarmirnaLC-PermirApp.em 07,0140