Permit ' 1
a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
o COMMUNITY DEVELOPMENT Permit #: ELR2009-00361
,TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/16/2009
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 (1) thermostat.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 12/16/2009 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 12/16/2009 $8.14
PHONE:
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062
PHONE: 503 - 692 -1565
FAX: 503 - 691 -1879
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: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $75.98
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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 OAR 952 - 001 - ( 0100 x .. You (matey\ obtain �a�copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: gcancZ-I " ` �'�l Permittee Signatur . • •
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.
4
Electrical Permit Application RECE 1_ FOR OFFiC :E USE ONLY
City of Tigard . eccwcct 1111
13125 SW Hall Blvd., Tigard, OR 97223
' ' O 6 2� I �ate/B a Phone: 503.639.4171 Fax: 503.598.1960 Milli
other Permit: MM,� •
1,_ r� Page 2 for
00
T I G A R D Inspection Line: 503.639.4175 CITY OF TIG •
n See
Internet: www.tigard BUILDING DIVI' II�DIR'ed'Method S ental I
Supplemental Information
'. ` , t ,,.: ' . , ' fYpz 4* 'iRK sz: Gwi
r :
❑ New construction ® Addition/altelation/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 M
.:.; i x e :, A ;^ �, e S n +,. r �. y Marinas a boatyards.
,r 1>y:K'Pl s..F] tY ll fd '• - s ° a% exceeds 10,000 amps at 150 volts or ❑ Floating hui ngs a
r, 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: 0 Fire pump. ❑ Installation of 75 KVA or
Emergency system. larger separately derived system.
.,;:,.? : '::' 0 .r .,:,' ....7 ,...s.,,.. . -- ' .., ,,, ?r.. ...: ,,, .. s... .$ ,. .,...r ❑ Addition nf new motor load of ❑ .. A .... E ., .. 2 ,. , .. 1 _ 3 .. ,
Job no.: I Job site address: ?5' AM S i ll" 5W/R 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIf': 7 /Gokitiab o , , Lz 3 ❑ Health -care facilities. ❑ Suppl voltage tar more than
/ Q / / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. n0.: 4] � Z 1 Project name: n ", 7� 22L) G f ❑ Service or feeder 600 amps or more
Cross street/directions to job site:
Description I • I fee. I Twat ` I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. tl. or Tess 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
' j u , t ; » iP1,� ` wQ `lam, - t .s;... / , . •s:. ,,i ;; , r (with above sq. R.) 67.84 2
C ,u 0 ,1 5 -q
Limited residential ntial energy, ( th ab sq
>) ft ) 67.84 2
tz-w n�rcNt
v residential with above sq R
Services or feeders installation, alteration, and /or relocation
x } ,�` .�. r .. � . � , , ti ,� i , 200 amps or less 100.70 2
:; . . Pl ` � i T '4Vir1!11Lfi.. i :� > 1 : . A �:, ... . 201 amps to 400 amps 133.56 2
�rl'
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 552.26 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 installation is being made on property that I own which is not 201 amps to 400 arnps 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
Owner signature: Date: Branch circidts — new alteration, or extension, per panel
A. Fee for branch circuits with
1 4- 4i ti YA:I`±T'f F t t , ' 1',pl, I $O above service or feeder fee,
each branch circuit 7.42 2
Business name: 4-12- ..J MiL -",.J) C>4L /J7i74c7lJ/b / B. Fee for branch circuits
without service or feeder fee, 56.18 2
Contact name: first branch circuit
Address: /O3 5ti 7-_) g� Each add'1 branch circuit 7.42 i 2
Miscellaneous (service or feeder not included)
City /State/ZIP: 7004?-40417/L) � f 796 'Z Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: (5)3 ) 0 2 - 15-6 5 Fax: : ( 4,03 ) ££/ - /8 7y Reconnect only 67.84 2
E -mail: /) I / c2.* a- L"€ t Z ,J. o 'Ir Pump or irrigation circle 67.84 2
„ G'CirN*iA02,* _ , ,4 , , , .,.. Sign or outline lighting 67.84 2
Business name: �l � � ��u�_ `) e /s)C Signal circuit(s) er or limited -
/T T' 7� energy panel, alteration, or
Address: /v33 0 7-v 9 „ w \
City /State/ZiP: extension. Describe: Page 2 2
'� � b2 � g 766 R�") c
+ 'Z /`s �� Y Each additional inspection over allowable in any of the above
/ -- Per inspection 66.25
Phone: (,50 3) G / 6 t, co/% /' /8 71
9� ' Fax: ( 5 3 ) Investigation per hour (1 hr min) 66.25
CCB Lic.: 5/93 Electrical Lic.: 9.0 L158 Suprv. Lic.: industrial plant per hour 78.18
" t ;E
Suprv. Electrician signature required: ."t' .M. P 11 " .• '. -
Subtotal:
Plan review (25% of permit fee):
Print name R OBP.52 T c, I-4 SFl LL e Date: / 2 _, /. p
07 Slate surcharge (12% of permit fee):
Authorized signature
}�
e/ _ C TOTAL PERMIT FEE: C�i
G This permit application expires if a permit is not obtained within 180
Print name: Dale: days after it has been accepted as complete.