Permit 111111 CITY OF TIGARD ELECTRICAL PERMIT
: COMMUNITY DEVELOPMENT Permit#: ELC2014-00647
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/02/2015
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9620 SW WASHINGTON SQUARE RD G06
Project: Michael Kors Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Electrical for TI of existing space for new tenant.
Contractor: ADVANCED WIRING SERVICES INC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 644 PO BOX 847
CLACKAMAS,OR 97015 CARLSBAD,CA 92018
PHONE: 503-310-3655 PHONE:
FAX: 503-698-6372
FEES
Quantity Description Date Amount
36 crt Branch Circuits wo/Purchase 02/02/2015 $315.88
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/02/2015 $37.91
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $353.79
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy oft direct questions to OUNC by calling 503.232.1987QQor11..800.332.2344.
t(Y-4 -A--
Issued By: _ _�.� i��_ Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
QECEIVED
EIeCti•iCal PertllTtit Annli A tot1. FOR 01,11(4;l!!..ii!'.c):•;IA
City Tf and JAN 2 9 2015 PmuiiNa.
13123/5tY Hail Tigard
Tigard,OR 47223
Data Received +, it .4f.. tt f7/� 0�7
111'1' t=hane: 503.718.2439 Fax: Fine TIGARD1e alrerPrtntit:1,94.09. 7e),/l.../..-03,157''
•tl.;Alit) Inspection Lint: 503.639.41.1 ILDING DIVISION ,,,� ,�,.,, : , rasccPa>jc2far
Internet: www.tigard-or.goUnilUU MindeNMethod' Supldenwrtal information
l�(�rvri Of WORK _ PLAN REVIEW
0 New construction ;r_3 f�ddlli{11UgItCrati011Jreplacemcnt Pkare cheek all that apply(svbntA$sets of plans afiuma checked below)
❑i)clnolltion ❑Qddili ❑Sen+ceorfeeder-100 amps or mom 0Buildingoverthreestories ,
.there nor mailable Emelt concur 0 Marinas and boatyards.
CATEGORY OP CONSTRUCTION excetist0,000ampsatl50+drsor i]Flcetingbuiidiags.
1-and 2-fan111 dwelling less to ground,or exceeds 14,000 ❑Commercial-use agricultural
Y S �(allillCYClnlfi11diistrlmi 0 building amps for all other installations. buildings
❑Multi•fhlnlly ❑Master builder 0 Other: ❑Fire pump. ❑instalhaion of 15014 VA or
- 1�•j• _�_ Emergency system. ❑`tarter`
I1.3e7 derived
ived system.JOIL 511 INFORMATION AND LOCATION 0 Addition of new motor load of
occupancy.
Job no.: 7l+ 2(% Job YIC nddrS•:jYY kl/L'f,01.rj 1A)(` gl• J SI om n re sidmtul ums ❑ICsce:tion al vehicle parks.
/C.'lty/State/ZIP: "7-/qR Y • 1 2 ❑Heah4-Cara facilities. 0 Suppir. rage for more than
f ❑Hazardous localtour. 600 vain nominal
SOilefbfd$.IOpt.na: Pro eel tunnte: D Sen;ea or feeder 600 a�,s or mom
G�t,iy l'l /�f%YS FEE so SCIIEDUIE
Cross street/directions to;job she: au.+u.a I Oa. I new I Tonal I • ,
New residential siugir-or multi-Family dwelling unit.
Includes attached garage.
Subdivision:f Lje ,l/ e Eel r V Sfi.i.,,,,7i Y,. .z I Lot no.: 1,0go sn n or teas { 168.5
'Pax mop/parcel Fa°dd.!590 sq.P or portion I 33 42 I
p/parccl no.: •1 Dinned cr.erp_residontat
TS 00 2
DESCRIPTION OF WORK } ! (with above sq.n.)
■ limited energy,mu!i-famtty
frt• //R.s�l ti s'- -i G7,U. art e(-7:_....t".ct /CTmLCr/ ' i icsidentiai(with above sq.It.) 7500 2
/;— 1 Renewable Energy C)Sec Paine 2
S/./eite -- Alf/.. rlon.; Kr f ;, ?-> +.t Seri let,or feeders iusllliarion,alteration,and/or relocation.____
V— . ,,,,(c or lc /00.70 2}or PROP:ct l' OWNER ❑ TENANT _J
i 2Gl amps to 4CO amps 133.55 2
/t,
Name: fr-7 /
,,C A c C r.t.r tot sni s to cam mops 20034 2
Address: r --1
y{/ /•t!/'s D(...t,,4 1 L'L7` tr,+ •' ,/C L S • h0;antp,r to;•000 ampe 301.04 2 t
N.i 1Cr00'mfg or volts 552.26 1 2
City/State/ZIP: „5-'�.r-f�, /� ,-;. :r i ' rot notary services or feeders installation alteration,
r ---�...... __. on,and/or
Phone:(•j(U) C qq- f4 C c J ' ;tux:( ) relocation
30 t ps or Less ! 59.36 i l
Owner insanitation:This installation is tiling loath oa property that •,t hit 1 to RCA 'i amps to maps
intended for sole,tense.rent,or exchange.according to ORS 347,449..'tt...resat?C, s _. ''s ..._._ { t25.o5 { 2
:sij 1 anus:0 599 amps 1 I 16854 I 2
Owner sigrtgturc: Date' I Branch circuits-new,atteration,or extension,per panel
\ rec rot brrnnccirsuits with 1 r APPLi(ANT 0 CU!i ACT 1?tk1(t
_l above 3fnlee or feeder k.,,
Buttine*a nave: ,,, each Mulch circuit 7.42 2
B fee for branch circuits 1r:tfaat t
Contact name: e 01-1-f L -e j' • 'Th or/eater fee.fns: ` 5
6 I S � 2
.—........-.`.__.------ i irr:n ch crctrt !
Address:
-----..._.._.... / G S. L a.bc. /�•'^L. ¢r 32-7,....
€ Each add.ihuuKRWilli( 3.5 7.42 ?j5- 2
cltyrstatc/zir: PA•. . .4 in.CL. `T p '7//i./ Miscellaneous(strike or feeder not included)
Each manufactured or modular I 2
Plane:(yZte) '�.�' S -2°/3/ •Fun:(&244 7/2 S-1-1.7 duelling.=mice antvor feeder a7 34
Reconnect old) 67.14 2
I',-moil: p e.,,,_,,:-/-5-74� ,.. - 't.41,/ . e..#,•.L. Arms or irr:lyuion circle
f CON liCTOR 67.54 2
Sign or outline lighting 67 gd 2
fiusillcYS ttantc; / r n r�/ �, Signal circuit/0 or limilcct crurg)' $�
f1 L i,1�L!"i°/ Cl�f��/H� T /L /tl C' panel,alteration,a c.x tension. P� 2
Address: 2
y 5 s i' Each additional inspection over allowable in any of the above
City/State/VP:P: , / ,• /�i7 Gy 7a/C Additional inspection(1 hr min) 6625/hr
�j 1 -/Jx�S r /V(✓ investigation(I hr min) 66.25fM_
Phone-( )3) r3 33- 9c2 Fax:93) g��j_. a' industrial plant(I lu nun) 7s.tutu
t (� laspeciions for++11ieh no fee is
CCB Lit.; / Electrical Lk.. P — i
/ / Slt ra.Lie.: specifically listed(:S hr min) MOO/hr
Sliprv'.Elcelrioiatt sty/• l 1, � l� I ELECTRICAL PERlffi FEES
� � ' subtotal;
Print nettle: e , Zliggillt: Date: i Plan review(23%of permit fee):
Authorized signature.. �'"•' -r' State surcharge(12%ofpennil fee):
TOTAL Pl;RMIT lrEE:
Print name: C a�4 1, ,e1.- Dote: 1N- 1 Z-- 1 This perwtr application a spires it a permit is ml obiaincd wierta it/
days alter it has heta steepled as samples.,
Humber of inspections akatt per Mnnq.I'Ua84isgrt.ati.0 r roltAOpJLk Of duc Yea 05121/j01) 440.461]7(1 r,WercoNuwaa
I✓,coo "et:r//V 72,6vic-A1-Asml y ro i5"fu e
Electrical Permit A ;'lication EIVE FOR Orl•R:V I;SF t),,I.
nl '+ l
City of'Iigaltl N0V 1 'L '.• R"ei.'ed �r
rean;t xa
Dateifi : /�Od'W.r tLC_ �1 —�i,
Ilier 13125 S1V Hall Blvd.,Tigard,OR 97223 Y4tn Review
. C Phone: 503.718.2439 Fay 503.598.19 '�'�/(� aim Datenity: Other Per liteuP2e/ -et)�59
T I G A K n Inspection Line 503.639.4175 �I 1 1 �+' I'`^'"' Date Ready/By: tuns. 0 See Page 2 for
Internet: www.tigard-or.gov RI 11)�mpn+ivio (*`olilled/Method: Supplemental information
'TYPE OF WORK 1 PLAN REVIEW
❑New construction 1gAddition/alteration/replacement Please cheek all that apply(submit j acts of plans sr/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: sslurc the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Harting buildings.
less to ground,or exceeds 14,000 ❑Comftmenl•use agricultural
❑ I-and 2-family dwelling XCo)mncrciaUtndustrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑tirc pump. ❑Installation of 150 KVA or
❑limergeney system. larger separately derived system.
.1013 SITE INFORMATION AND)LOCATION 1 ❑Addition of new motor load of ❑"A""F""I 2""1-3
lob no.: 9(y 2-0 I Job site address: 't) wptSLt t l a7C �. P� Six or or mare. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: -77yilvd O g. q^7 Z 73 ❑Health-care facilities. El Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.Ito.: 6.0(p Project name: it, -LP A y f 0 StMve or feeder 600 amps 01 ItsOrC.
FEE SCHEDULE
Cross street/directions to job site: lercrimion j Qty. I ree. I Toted i •
New residential single-or mufti-family dwelling unit.
Includes attached garage.
Subdivision: `)4' s�/p,cl� J ly/kd1-vrt. Sy. Lot no.: 1,000 sq R.or less 168.54 4
Tax map/parcel no.: f J
Ea.add'I 500 sq.ft.or portion 33.92 1
P/P Limited energy,residential
DESCRIPTION OF WORK (with above sq.R.) 75.00 2
L Limited energy,multi-Ranily 7500 2
7 L• Ate!t)v. - r Gt.*-1.- tjC6 "L-9 re- Fl.c/ residential(with above sq.R.)
` /' J Renewable Energy ❑ See Page 2
S/j4ee M!G ii.e2 L_/ ,y s .� r.e_ Services or feeders installation,alteration,and/or relocation
/ J°r PROPERTY OWNER I ❑ TENANT 200 maps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: Met cep-e Ci .. / 401 amps to 600 amps 200.34 2
Address: - p/ r,(),,eck v,L e/v s'�t 70C) 601 amps to 1,000 amps 301.04 2
L r
Over 1,000 amps or volts 552.26 12--
City/State/ZIP: s 4.ri-T�- /1Ofrt.t e-e,_ (>¢ 9,0 'Jo/ ` Temporary services or feeders installation,alteration,author
relocation
Phone:(,j(0) egg- ta(e 56 Fax:( ) 200 amps or less 59.36 1
Owner installation:This installation is being made on properly that i own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701,
401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,Leer panel
,14 APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: r'-- each branch circuit
�Gt'N�t�S I U O� / — D.Fee for branch circuits trtihout
Contact name: s c 07,--i-- _f / service or feeder fee,first i 56.18 Q 2
branch circuit
Address: ii-/1p S• G Q_ -s,..L #32.._ Eaehadtl'l branch circuit 35 7.42 Qj5 2
Miscellaneous nneous(service feeder not included)cd}City/State/ZIP: T jGs t K et_ 6 4- 17/p Each m anufacmred or modu la►
67.84 2
dwelling.service and/or feeder
Phone:((yZ(e) ��- S -2 3/ Fax::( �•z!o/} 7/Z -S./-1-Z Reconnect only 67.84 2
E-mail: 0 e -a ...-t -f l y A,e / . co�+'L. Pump or irrigation circle 67.84 2
/ CONTRACf01t Sign or outline lighting 67.84 2
t>`;' Business name: Signal circuit(s)or limited-energy Sec
e panel,alteration,or extension. Page 2 2
./". ' Address: Each additional Inspection over allowable In acv of the above_
Additional inspection(1 hr min) 66.25/hr
City/Stale/ZIP:
Investigation(I hr mini) 66.25/hr
Phone:( ) Fax:( ) industrial plant(I hr min) 78.18/hr
inspections for which no fee is 90.00/fir
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(%,hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 3/.S 44%
Print name: Date: Plan review(25%of permit fee):
State surcharge(12%of permit fee): 37,9/
Authorized signature: . TOTAI.PERMIT FEE: 353 r `�9
This permit application expires if a permit is not obtained within 180
Print name: S�-� -. I Date: \\- 1-7._.... %,l) - days after It has been accepted as complete.
• ' Number of inspections allowed per penult.
1t DaitMn$Wermin'!LC_Pmnriapp_IILR_HREdos Rev 05/21/201) 4.10.461SiQI/051CO.wEa