Permit 1CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit#: ELC2015-00799
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/05/2015
Parcel: 1S 1260000300
Jurisdiction: TIGARD
Site address: 9642 SW WASHINGTON SQUARE RD G12
Project: Lolli&Pops Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Modification of(12)branch circuits for TI. Low Voltage for fire alarm.
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
12 crt Branch Circuits wo/Purchase 10/05/2015 $137.80
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/05/2015 $16.54
Type of Use: COM Electrical
Class of Work: ALT 1 ea Signal circuit or Limited 10/05/2015 $75.00
Energy Panel
Type of Const: 9 12%State Surcharge- 10/05/2015 $9.00
Occupancy Grp: Electrical(manual)
Total $238.34
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 . - •.. e 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. • ENTION: Ore., law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 .01-0010 through OAR 9 ' 00 r r=r. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332,2344.
/
I sued By: .ei Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for-ale,lease or rent.
OWNER'S SIGNATURE Date:
/ CONTRACTOR INS • -
SIGNATURE OF SUPR.ELEC' X , � Date:
LICENSE NO.
C' .•39.4175 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.
Electrical Permit Applicatio FOR OFFICE I '.l ONLY
City of Tigard RECEIVED Received I'ennitN: f/•�'o'1G/5-O 79
`J f g Date/B•: �OMC C.��J
UPI 2 • 13125 SW Hall Blvd..Tigard.OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19tC T 5 2015 Date'B : Related Permit /1,96/6--- OO•25-c/
Inspection Line: 503.639.4175 Ready Date`By: Juris: ® See Page 2 for
I IGARD Internet: www.tigard-or.gov CITY OF TIGARD Notified-Method: Supplemental Information
TYPE oi344151DING DIVISION PLAN REVIEW
51 New construction ❑Addition/alteration/replacement Please check all that apply(submit a sets of plans w'items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling is Commercial/industrial ❑Accessory building less ground.or exceeds 14.000 ❑commercial-use agricultural
amps for all other installations. buildings.
❑ M ulti-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system, larger separately derived
Job#: //'' // I Job site address: /L / n ❑Addition of new motor load of system.
�v�s—�f? l �b �� ��/t�fj/ i !/��Z IOOHPormore. ❑"A.. ..F.. „i �.. „1_�..
❑Six or more residential units. occupancy.
City/State/ZIP: ❑Recreational vehicle parks.
//� ❑Health-care facilities. p
I
Suite/bldg./apt.#: Project name: //__ 6 /� ❑Hazardous locations. ❑Supply voltage for more than
h0��/ ` J CJ�
El Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description 1 Qty. 1 Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.(I.or less 168.54 4
Tax map/parcel#: Ea.add]500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00
Pay c.. 6,-- (with above sq.ft.)
/`���� ` � t>`�l{ _b '� Limited energy,multi-family 75.00 Q— residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone: ( ) Fax:( ) Over 1,000 amps or volts 55226 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale, lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I [] CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first / 56.18 J be /L 2
branch circuit
City/State/ZIP: Each add'I branch circuit /a 7.42 $'/,4Z 2
Miscellaneous(service or feeder not included)
Phone: ( ) Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR .. Pump or irrigation circle 67.84 2
Business name: /2/2yfrm Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy See Page 2 ,5
Address: ,p igD a'Y panel,alteration,or extension. 2
City/State/ZIP: �� �t9 9`!7 /� Each additional inspection over !towable in any of the above
/4lf�Ar r✓/? ` ,/. Additional inspection(1 hr min) 66.25/hr
Phone:ire 3' ) f3 3.-,2115,0 Fax:( ) Investigation(l hr min) 90.00/hr
Email: A4'� "1")-/4.,t ,r f Industrial plant(1 hr min) 78.18/hr
/" Inspections for which no fee is 90.00/hr
CCB Lie.:/ 2$ / Electrical Lic.: e uprv. Lic.: �7J( specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature required
7 Subtotal: /37. g D
Print name: Date: ❑Plan Review Required(25%of pennit fee):
���� /,,,, / Date:
State surcharge(12%of permit fee): / •S`7/
Authorized signature: TOTAL PERMIT FEE: Li. 3`J
This permit application expires if a permit is not o wined within ISO
Print name: S AC„/,///117 Date:/ js./ days after it has been accepted as complete.
J • Number of inspections allowed per permit.
t Huilding'Permits ELC_PermitApp ELR E.RE.doc Rem 06.17,2015 440-4615T(11'05'COM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description Qt). Each ."121 Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70
5.01 to 15 kva 133.56
Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
Burglar Alarm 25.01 to 50 kva 301.04 2
Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is
66.25/hr
charged at an hourh (I hr min)
Inspections for which no fee is
90.00 hr
speciticall■ listed('_hr mint
COMMERCIAL WORK ONLY _ `'` ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 11:
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
Clock Systems
Data Telecommunication Installation
I Fire Alarm Installation
n HVAC
Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control*
n Medical
❑ Nurse Calls
11 Outdoor Landscape Lighting*
Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:''Building Permits ELC_PermitApp_ELR ERE.doc Rev 06,17,2015
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9642 SW WASHINGTON SQUARE RD G12,
TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00799
Jeff Grove
Violation Summary:
Inspector Contractor