Permit
l i
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2010-00008
. * 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/20/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9595 SW WASHINGTON SQUARE DR B12
Subdivision: Lot: 0
Project: True Religion Blue Jeans
Project Description: Install restricted energy for voice/data.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #0 Restricted Energy Permit 01/20/2010 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 01/20/2010 $8.14
PHONE:
Contractor:
SAFE TECHNOLOGY GROUP INC
6400 NE HWY 99 SUITE 375
VANCOUVER, WA 98665
PHONE: 360-699-2130
FAX: 360-719-1527
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom/Paging: N Landscape/Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 O 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 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' MQ4 AaQ Date:
VV
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Eiectrie:al Permit Application WED FOR OFFICE USE ONLY
City of Tigard Received Permit No.: Q
13125 SW Hall Blvd., Tigard, OR 97223 JAN 2 4 Date/By ~t 1 Plan Review Other Permit:
u:.
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 QF TIGARD Date Ready/By: s: H See Page 2 for
Notified/Method: Supplemental Information
Internet: www.tigard-or.gov
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
❑ 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.
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1- and 2-family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KV A or
❑ Emergency system. larger separately derived system.
JOB' SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E", "1-2", "1-3",
Job no.: I Job site address: 9595 SW Washington Square Road I OOHP or more. occupancy
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Portland, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: B12 Project name: True Religion ❑ Service or feeder 600 amps or more.
FEE.SCHEDULE
Cross street/directions to job site: Description Qty. Fee. Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'1 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK with above sq. ft.
Limited energy, multi-family 75.00 2
Voice/Data residential (with above sq. ft)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
40 Lamps to 600 amps 160.60 2
Name:
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
201 amps to 400 amps ET 100.30 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Safe Technology Group Inc B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: Jason Sweet first branch circuit
Address: 6400 NE Hwy 99 Suite G375 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included
City/State/ZIP: Vancouver WA 98665 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (360) 699-2130 Fax:: (360) 719-1527 Reconnect only 66.85 2
E-mail: sales@safetechnology.net Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: Safe Technology Group Inc. energy panel, alteration, or
Address: 6400 NE Hwy 99 Suite G375 extension. Describe: I page 2 75.00 2
City/State/ZIP: Vancouver WA 98665 Each additional inspection over allowable in anof the above
Per inspection 62.50
Phone: (360) 699-2130 Fax: (360) 719-1527 Investigation per hour (1 hr min) 62.50
CCB Lic.: 173731 Electrical Lic.: CLE79 Suprv. Lic.: 4272LEA Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 0
Plan review (25% of permit fee):
Print name: Jason Sweet Date: I - Z
State surcharge (12% of permit fee): 1-91ro
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Jason Sweet Date: j . Z U - r a days after it has been accepted as complete.
* Number of inspections allowed per permit. ~ ~ . -1
l:\Building\Perrnits\ELC-PermitApp.doe 05/23/06 440-4615T(11/05)COMMEB