Permit (133) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2019-00613
I[-;.1 l+'.f.7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/18/2019
T
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9595 SW WASHINGTON SQUARE RD B12
Project Aldo Subdivision: None Lot: None
Project Description: Adding(12)branch circuits for TI.
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 09/18/2019 $137.80
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/18/2019 $16.54
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $154.34
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 oth/r applicable law. All work will
be done in accordance with approved plans. Thi- permit will -xpire if work is not started within 180 days of issuance/r if w��-/is suspended for more the 180
days. ATTENTION: Oregon - requires you • follow a rule opted by the Oregon Utility Notification C er. fse rules are set forth in OAR
952-001-0010 through OA- • •:1-00 i ou m .btain opy of les or direct questions to OUNC by calling 503.23 987 or 1 0.332.2344.
Issued By: -' � I Permittee Signature: —.s�'�
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.
Electrical Permit Application v ' rt)rz 01 1 1( 1 l '..,1: t)y 11
City of Tigard E V E I V —"
Date/By / l�d // / � Perrt^f. /�0. ) GJ7 0
111 13125 SW Hall Blvd.,Tigard,OR 97223 8 20 Ilan Review
■ Phone: 503.718.2439 SEP 1 Date/By: Related Permit#:
Email: TigardBuildingPermits@Tigard-or.gov TIGA'Rady DJuds: ® See Page 2 for
116 A R D Inspection Line: 503.639.4175 Internet: www.
p Yp, v o i y Date/By:
at ethod: Supplemental Information
TYPE OF WORK BUILDI G DWI. 1
PLAN REVIEW
' New construction 0 Addition/alteration/replacement Please check all that apply(submit it sets of plans w/items checked):
Demolition ❑other: 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
l-and 2-familydwellingCommercial/industrial less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: q p n Job site address: Q /� 7 0 Addition of new motor load of system.
. 0 5-DZ � (/5.. .-f/ 4015.4) ��j /! 100HPormore. ❑ A» <E» <l_2> 'l_3„
City/State/ZIP: hCI '722 3 / / o Six or more residential units. occupancy.
����n ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: 6I2 Project name: f^�lpo 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
/�) B (with above sq.ft.) 75.00 2
/`�r� 7 % / r/�voin5 /2 `/Ret Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 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 301.04 2
Phone:( ) 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 I own which is not 200 amps or less 59.36 1
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
0 APPLICANT 1 0 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 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
Each add'l branch circuit 7.42 2
City/State/ZIP: `l
Phone: Miscellaneous(service or feeder not included)
( ) Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
C NTRAETOR Pump or irrigation circle 67.84 2
-_. __.. �1TSHIC551ia[irC' �#�� - —P-07/7/).— s -r-.
'j// 'Wel Sigtrar ounine ting 67.84 2
v Signal circuit(s)or limited-energy
Address: 0 / 0 f( 6'11 f panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: ej /�� �1 �f GJ Each additional inspection over allowable in any of the above
�� /���� Additional inspection(1 hr min) 66.25/hr
Phone:(9 3 ) ge3 3 -„ /go Investigation(1 hr min) 90.00/hr
Email: Y/ S'� o/)-r70 ,or f Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.:J6,25-1/ Electrical Lic.: Suprv.Lic.: 9‘25:5- specifically listed('A hr min)
! f - ELECTRICAL PERMIT FEES
Suprv.Electrician signature,requir Subtotal:
Print name: A flpj H / Date:lig/, El Plan Review Required(25%of permit fee):
Authorized signature:
/l 1 State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: •-•-/br, ^Ag days after it has been accepted as complete.
* Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
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 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >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* >100kva—noadditional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/hr min)
CO Ll CMLYWORKy. ELEc�r uc :tr>rRmrr FE s
Subtotal(Enter on Page 1):
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
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n 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
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