Permit (115) q CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00033
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/19/2016Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9469 SW WASHINGTON SQUARE RD A10
Project: Yankee Candle Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: (2)branch circuits for cash registers.
Contractor: ARON ELECTRICAL CONSTRUCTION LLC Owner: PPR WASHINGTON SQUARE LLC
15704 NE 70TH ST PO BOX 847
VANCOUVER,WA 98682 CARLSBAD, CA 92018
PHONE: 503-516-3139 PHONE:
FAX 360-882-7978
FEES
Quantity Description Date Amount
2 chi Branch Circuits wo/Purchase 01/19/2016 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/19/2016 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 of lher 01e71til questions to OUNC by calling 503,232 1987or 800.332.2344.
Issued By: ��l�G., Per lttea 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 SUER.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.
i
Electrical Permit Application ����
///'''```��� 1Rca7dyDate7/By:
City of Tigard (((��� � Pe mit k:13125 SW Hall Blvd.,Ti ard,OR 9722 } C/ jg tr Phone: 503.718.2439 Fax: 503.598.19 Q�U Related PermiUk Inspection Line: 503.639.4175 9 Iwia: See Page 2 foInternet: www.tigard-or.gov - ified/Method: Supplemental lnformadon
is
'
TYPEOFWORK PLAN REVIEW
❑New construction Addition/alteration/r I Please check all(lint apply(submit 2 sets ofplans w/items checked):
MOT
CS ❑Service or feeder 400 amps or more [I Building over three stories.
El Demolition El Other:
V where the available fault current ❑Marinas and boatyards.
CATE�`i�RY OF CONISTRU M ION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling &3Commercial/industrial ❑Accessory building less to ground.or exceeds 14.000 ❑Commercial-use agricultural
amps for all other installations. buildings.
E] Multi-family ❑Master builder ❑OtheC ❑Fire pump. ❑Installation of 150 RVA or
' IO$ SAI`E INI'OR(MtATION.AND LOCATION ❑Emergency system. larger separately derived
Job#: lOb Slte address: —t S W W�sLt q ❑Addition of new motor load of system
1 ' - I i.or or more. ❑occ "E','9-2',"I 3p
r ❑Sixormore facilities units. occupancy.
City/State/ZIP: f 'G A7�.QJ �I'- eeAT�''p��9 f ��n�^tZ,t 13f LLE
❑Health-care facilities. [I Recreational vehicle parks.
Suite/bldg./apt.#: A -' Project name. Rf )i` r 04N DL /P_nae ❑Hazardous locations. ❑supply voltage for more than
t� b Scrvlce or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: +S j-((NG TON S V•,T� l s A L, FEE SCHEDULE
Description I oil. I Each I Total
New residential single-or multi-family dwelling unit.
#: Includes attached garage.
Subdivision: Tbot
1,000 sq.fl.or less 168.54 4
Tax map/parcel#: Ea.add'1 500 sq.III.or portion 33.92 1
0ESC$IP,7TON OF WORK' - Limited energy,residential
/t {{.qq�r� 11 II (with above .ft.) 75.00 2
-6W0 20� y'N vol+ Cerct;t`(-5 yr CnS� y� 1 �1"fJ Limited energy,multi-family 75.00 2
residential(wish above sq.❑.)
Renewable Ener ❑ See Pa e 2
❑ PaorERTY QWNER 0 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 30104 2
Phone: ( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made On property that 1 own which is not 200 amps or less 59.36 l
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
401 ams to 599 am2
Owner Signature: Dale: P Ps 168.54
0 APPLICANT ❑ CONTACT PERSON Branch circuits-new alteration or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
T42 2
each branch circuit
Contact name: B.Fee for branch circuits m1hour
service or feeder fee,first
Address: branch circuit — 06'18tl 2
City/State/ZIP: Each add']branch circuit �, 7.42 a, 2
Miscellaneous service or feeder not included
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: N E LZC.1 RI(A-L CONSR_(.)CT(O/-( L L C- Signor outline lighting 67.84
5-7 0� u L 7 0� jkUC Signal circuit(s)
orlimited-energy
Address: anal,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: A-N V v L 2 �/ 6 Each additional inspection over allowable in an of the above
Q p Op Additional inspection(1 In min) 66.25/hr
Phone:(Sp3) - 3l FaO'
x:(j69j 2--19- Investigation(I In min) 90.00/hr
Inspection plant(I
Email: A-1ZnN_ E C- 41+D(3 , CCH min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: MZ-748 I Electrical Lic.: C g�� Suprv. Lic.: 5-7 s cificall�listed(i hrmin
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: - Subtotal:
Print Date: ( (O(j (b ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 6.3
Authorized signature: TOTAL PERMIT FEE:
This permit application expires Bit permit is not olfbained within 180
Print name: Date: ' ,9 ( b days after it has been accepted as complete.
* Number of inspections allowed per permit.
1'.'Building Permits ELCNrraitApO EREdoc Re,06IT7015 440-4615T(I I OS COM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit ,,F,,yyyyaaees: Renewable Energy Permit Fees:
Deicription 1rsystemsY,SSrz,. kk £ Renewable electrical e ;;.
Fee for all residential combined: $75.00 Qt. E.0r. 1
energy systems:
Check Type of Work Involved: 5 kva or less o0.7o z
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25A1 to 50 kva 301.04 2
F-1Garage Door Opener* 50.01 to (fee
kva 552.26 2
1100 kva(fee in accordance 552.26 -
�
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning solar generation systems in excess of 2e kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum .Systems* 1100 kva—no additional charge o.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an howl (I hr min)
Inspections for which no fee is 90.00/hr
s ificall listed('/:In min)
Ck14 M1FAiLBl1R03 Y " tx�razxr+t , e�ss
SubtotalEnteron Page I)
Fee for each commercial system: $75,00 :
• Number of inspections allowed per penin[.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I'.PuflJiny$Crm1,,,FLC Penni.Ape Ll R_FREdoc Ree 06112015