Permit a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
f: : >. COMMUNITY DEVELOPMENT Permit #: ELR2009 -00359
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/15/2009
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9595 SW WASHINGTON SQUARE DR B12
Subdivision: Lot: 0
Project: True Religion
Project Description: Install restricted energy for CCTV.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 12/15/2009 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 12/15/2009 $8.14
PHONE:
Contractor:
3 GUYS ELECTRIC LLC
2062 NW 15TH CT
GRESHAM, OR 97030
PHONE: 503- 729 -1522
FAX: 503 - 661 -7378
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: Y Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N 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 - 000 01 . X 00. You may obtain a co y ` oof the rules or direct questions to OUNC by calling 50 .246.6699 or 1.800.332.2344.
�Y L�
Issued By: i A ( 1 X Permittee Signature: j'CVV
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.
CaII 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.
• ' Dec 14 09 10:O1a mult, county attorney (5031988 -3377 p.1
Electrical Permit A licat CEIVED I'on OFFICE USE ONO'
Cl Of Tigard Received
`J Ulu� ; , Permit No.: 9 l p . 2 _ 009. . da 2 , �Q
'! 13125 SW hall 131vd.,1'igard,012 97— 1 4 2009 Plan R,,,,,,,, \ 1
Phone: 503.639.4171 Fax: 503.598. Date /By: 0th Pe
TIGARD Inspection Line: 503.639.4175 Datc Ready /13y: El See Page I fur
Internet: www.tigatd- or.gov CITY OF TIGARD Notified/Method: supplemental Information
,..: •, :,A,x:ie,1011....G1.i. lv RE VLEW , I'I "
>p �,
p New construction ❑ Addition/alteration/replacement
Please check all That apply (submit a sets of peons w /items checked below)
❑ Service or feeder 400 nntps or mute ID Building over three slu
E Demolition ❑ Other: whole the available fault current ❑ Marinas mud boatyards.
A •,: '' , + a r - t exceed:+ 10,000 Limps al 1)0 rolls or ❑ Fleatiup buildings.
.. C Ott LGOIZY• O1• CONS 1, , L,b\
' .,•„•.• ! ' • less W ground, or exceeds 14,000 ❑ Commercial -use at;ncultural
ID I- and 2- family dwelling E Commercial /industrial ❑ Accessory building amps for all other installations. buildlntix,
y builder ❑ Other ❑ Fire El ' pump, ❑ Imlallatton of 75 ICVA or
Rine honey system. larger separately derived system.
Multi-family 301I: SITE i r0fMATION AND; LOCATION •. C ° ❑ Addition of new motor load of
C W Washington Sq. Rd, 1001112 ornwre. occupancy
Job no.: Job , itc address SS k q 0 Six or more residential units ❑ Recreational vehicle parks.
City /Stale/ZIP; Portlslld, OR 97223 / Sf J fl Health -care facilities. Supply voltage nu. more than
•• ❑ 1liwt:dmm'S locations. 000 Volt; :Mauna]
Suite /bldg./apt. no.: Project name: True Religion Brand Jesus 0 r feeder 600 amps or more. i
Service or !
• NE SCI 1 ".,. ,.'
Cross Slreot /UirecLiutts to JUL) Site: Dcu,,uui°u _ i Qe r -.. l T•r ++ ".
New residential single- of multi - family dwelling unit.
Includes attached garage.
Subdivision- 1.01 nn.: 1,000 sq. ft. or less l 168.54 I 4
- Ea. add'I 500 sq. it. or portion I 33.92 1
T ax map(parct l no.: Limited energy, residential
• DESCRIPTION OF .WORK ., . .; (with above sq. tl.) 67.84 2
- °.-- - Limited cnew, multi - family .M.
Install Camera System. residential (Anil above sq. !1.) o / s4
r Services or feeders installation, alteration, and/or rclocalio
200 amps or less 100.70 2
.
❑ PROPERTY ' OWNER' ' , I ,• ,0 :TENANT 201 amps t0 400 amps 133.50 2
401 amps to 000 amps 200.34 2
Name: ...
601 amps t0 1,000 amps '301.04 1 2
!Address: Over 1,000 amps or volts 532,26 2
Cit /Slalc /Zl1': - _
Temporary services or feeders installation. alteration, and /or
Y relocation __
__
Phone: t ) lax: ( ) 200 amp or hiss 59.36 I
Owner installation: This installation is bcing 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 L 168.54 I 2
Branch circuits- new, alteration. or extension, per panel
Owner signature: Date: .. . A. Fce for branch circuits with
t •APPLICAN 0 CONTACT' I'1lsRSQN, :,' : • above service or ftvder fee. 742
- each branch circuit
Business name: 3 Guys Ilrrtric, 1.1,C' R Fee for branch circuits
- - without service or feeder fee, 56.18 2
Contact name: Wade Hadley first branch circuit
Address: 2062 NW 15 Court Each add'1 branch circuit — I 7.42 12
— .-• miscellaneous (service or feeder not included)
City /State /ZIP: Gresham, OR 97030 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 729 -1522 Fax: : (503) 661 -7378 _ Reconnect only 67.84 2
E -mail: wade3267 @aol.com Pump or irrigation circle 67.84 2
_
Y CONTRAC1'011 : ;,; , . Sign or outline lighting _ 67.84 2
Rusincsn name. 3 Guys Electric, LLC Signal circuit(s) or limited-
,Ist.
energy panel, alteration, or
Address: 2062 NW 15 Court - extension, Dcscribyy�� , . f l Page 2 67.84 2
Camera System L L_( v _
City /State /ZIP; Gresham, OR 97030 Eat h additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 729 -1522 _tI Fax' (503) GG1 -7378 Investigation per hour (I 6i- min) ~ 66.25
CCI3 Lic.: 177242 Electrical l.ie.:CLEI20 1 l Suprv.Lic.: 516LEA industrial plant per hour i 78.18
\` - I (II ' ' ELI'.C1'KIISAl,`PLLRNIIT• FE) S ' iI 'I'
A. Suprv. Electrician signature, required / J L /) — '0 (— Subtotal: 67.84
Print rnnr11P• Mirk Hartley ll(V//��� �� ��� Date: 12/14/09 Tian review (25 / 01 perm it reel:
State surcharge (12't0 ufpcnuil fcc). 8.14
Authorized signature: J,, TOTAL PERMIT FEE•-. ! $75.98
Print name: June 41 idle This permit application expires if a permit is nut obtained within 180
> flare: 12/14/09
days after N l.aa boon arrrptrd 11X x com0lele_
�
• Number of inspections allowed per permit.
I 13ul 14ina \Pcru:itx \G:,C- PenuitA;al.6oC I;1 /4l /00 440.4615T(I 1 /05 /CONUWEI5
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