Permit
i
a CITY OF TIGA►RD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2010-00012
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/2612010
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9451 SW WASHINGTON SQUARE DR A16
Subdivision: Lot: 0
Project: Vans
Project Description: Installation of low voltage for data.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 01/26/2010 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 01/26/2010 $8.14
PHONE:
Contractor:
CACHE VALLEY ELECTRIC COMPANY
6200 SW ARCTIC DR.
BEAVERTON, OR 97005
PHONE: 503-431-6600
FAX: 503-624-1436
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 is ct 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 cordance with roved plans. This permit will expire if work is not started within 180 days of issuance, or if work As` suspended for more the 180
days. AT NTION: Oregon I e ' es you to follow the rules adopted by the Oregon enter. Those rules are set forth in OAR
952-001- 10 thro gh OAR 9 -001 010. u ay obtain a copy f the rules or direct questions to UNC by alling 503. .6699 or 1.800.332.23 fit.
Issue By Permitt8 ignature:
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 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.
01/25/2010 15:30 FAX 425 424 9966 CACHE VALLEY ELECTRIC 10001
Electrical Permit Appheation FOR •
~CEI`, 1 ED Received
City of Tigard Date/By: IO PermitNo.:(((,
't 13125 SW Iltill Blvd., Tigard, OR 97223 Plan
Phone: 503.639.4171 Fax: 503.598.1960JAN 2 5 2010 DateB :Review Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: hurls: -Rise. Page 2 for
Internet: wwv.tigard-or.gov CITYOFTIGARD NotifiedMethod: Supplemental Information
TYPF. OF V PLAN .REVIEW
. : _ - - _
® New construction F1 Addition/alteratiott/reptacement Please check all that apply (submit 2 sets of plans wlitemS checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where die available fault current ❑ Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
ATEGOkI' OF CONSTRUCTION
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ ]-and 2-family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
TION ❑ Emergency system. larger separately derived system.
JOB SITE' INFORMAT]ON iAND LOCA
. Addition of now motor load of "A" "E" "1-2" "l-3°,
7 ob site address9412'SW Washington Sq Rd 100HP or more. occupancy.
Job no.: 43718-11 l
❑ Six or more residential units. ❑ Recreational vehicle pas.
City/State/ZIP: Tigard, OR 97223 S/ ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt, no.: A16 Project name: Vans 168 ❑ Service or feeder 600 amps or more
FEE- SCHEDULE
Cross street/directions to job site: Deseri tion ^Fee. Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fr. or less 168.54 4
Ea. add'1500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
SCRIPTION::OF VFORK (with above sq. ft.) 67 4 2
DE
low voltage structured cabling Limited energy, multi-family 67.84 2
g
Oct C'. - ck-y V` - residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
---7777777 PROPERTY t)VVNER ❑ T.EN 11T 201 amps to 400 amps 13156 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 55126 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: { ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This i:lstallation is being made on property 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
Branch circuits- new, alteration, or extension, er anel
Owner signature: Date: A. Fee for branch circuits with
®,APPI I( aN1 CONTACT PERSON above service or feeder fee, 7 42
each branch circuit
Business name: Cache Val ley Electric B. Fee for branch circuits
Contact name: Vanessa Martin without service or feeder fee, 56.18 2
first branch circuit
circuit 7.42 2
Address: 6200 SW Arctic Drive Each add ch circuit
Miscellaneous (service or feeder not included)
City/State/ZIP: Beaverton, OR 97005 Each manufactured or modular 67.84 2
Phone: 431-6600 Fax:: 624-1436 dwelling, service and/or feeder
(503) (503) Reconnect only 67.84 2
E-mail: vanessam a eve.coln Pump or irrigation circle 67.84 2
COYTRACTOR Sign or outline lighting 67.84 2
.
Business name: Same as atove Signal circuit(s) or limited-
energy panel, alteration, or
Address: extension. Describe: 1 Page 2 1 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone; ( ) Fax: ( ) Investigation per hour (1 hr min) 66.25
CCB Lie.: 148222 Electrical Lic.: A- 113 Suprv. Lic.: Industrial plant per hour 78.18
EL.ECTRIGAL;.PER.NIII FEES _
Suprv. Electrician signature; reggired: .-,.y~ Subtotal: 67.84
Print name: Brian IIamiltor. DT ate: /1 25!10 Plan review (25%ofpermit fee):
State surcharge (12% of permit fee): 8.14
Authorized signature: TOTAL PERMIT FEE: 75.98
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
a Number of inspections allowed per permit.
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