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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT o COMMUNITY DEVELOPMENT Permit #: ELR2010 -00065 k�x Date Issued: 04/22/2010 E G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S1260000300 Jurisdiction: TIGARD Site address: 9483 SW WASHINGTON SQUARE DR AO6B Subdivision: Lot: 0 Project: Pac Sun Project Description: Burglar Alarm FEES Owner: PPR WASHINGTON SQUARE LLC Description Date Amount 2235 FARADAY AVE STE #O Restricted Energy Permit 04/22/2010 $67.84 CARLSBAD, CA 92008 12% State Surcharge - Electrical 04/22/2010 $8.14 PHONE: Contractor: ADT SECURITY SERVICES INC 2815 SW 153RD DR BEAVERTON, OR 97006 PHONE: 503 - 469 -7212 FAX: 503- 469 -7114 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: 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: Y 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 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: �C�� / //� 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. Hall Electrical Permit Application _ ,', ° ` , +71 ....4..r..,„ FORtOFFICE USEO k � , il � 1 `c,��,, .' """ Receive City of Tigard y - ° � /� �d �! Permit No.: . / O '4Dd/ I •e . � � �7 :. _ 'Date /f) 9 l 1 3125 SW Blvd:, , "Tigard, OR 97 23 � ' flan Review a/0,200 / --00.020,2-.) . Other Penn i6 4 Phone: 503.639.4171 Fax 503.595.1960 Date/13y: 4414 l Inspection Line: 503.639.4175 oT1GAR Date Ready/By: Jeri+ 8 Sec Page 2 for a I ,�.5?�`J1t6716dy Internet: wwlr.ligarJ or.g01' Notified/Method: Supplemental information TYPE OF WORK PLAN REVIEW Please check all that apply (submit 2 sell or plans vile nls checked below): ❑ New construction ® Addition /alteration /replacement ❑ Service or feeder 4011 amps or more ❑ Building over three stories ❑ Demol 11ion ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds I0.000 0 al 150 volts or ❑ I-loafing buildings. less to ground. or exceeds 14.00(1 ❑ Commercial-use agricultural ❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps 101 all parer installations. buildings. ❑ IMulti- Ioinily ❑ Master builder ❑ Other: ❑ Fire pump. ❑ hlstallalion of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORIIATTON AND � L 1 6o OCATION ❑ Addition of new motor load of ❑ "A "li". "I I -3". (3 0 v �L p�y SW , c2Sd ,SU/ 9 �, 10011P or more. occupant+•. Job no.: p� 7 ,2- l Jo b site address: 673 D ❑ Six or more residential tuns. ❑ Recreational vehicle park,. City/State/ZIP: Q Q �� ©( � q (yy�3 ❑ health -care facilities. ❑ Supply voltage for more 110111 / B F- L'/ / CI Ilazarduus locations. 600 volts nominal, l � - � ❑ Service or feeder 600 amps or more. Suite/bldg./apt. no.� -p(p, I Project name: �f"&/?-iG UNGdE ,r -CLOV-1i FEE SCIIEDULE Cross street/directions to job site: /Cf',e2SS Ae0/77 2)/c (S 5/ ie7 >N7 uescription 1 411.1 I6-e. 1 moral j • l �,l ,t / New residential single- or multi- Luuilc dwelling unit. CJ 9 54 y6XT 76 e '0,e /d ?/'' /c/4 / 9 " A2 Includes attached garage. _ Subdivision: Lot no.: 1,000 sq. ft. or Tess 165 - 54 .1 Ea. add'I 500 sq. (1. or portion 33.92 I i Tax neap /pared nu.: Limited energy, residential l - (wit above s+ DESCRIPTION OF WORK 1 7 s 1 � Ii.) )° 414)a-64../M-1 Limited energy, multi - family d 1 residential (with above sq. fl.) b7.1 Services or feeders installation, alteration, and /ur relocation 200 amps of lus 91(1.7(1 J 2 ❑ PROPERTY OWNER ❑ TENANT 2 201 amps to -lot) amps 1 33.56 2 1 ' 4U I amps to 600 amps j 2)1)1.34 2 _ Name: i , 601 amps t.. 1,000 amps 3111 .04 1 Address: Over 1.000 amps or "DIES j 55 1 3 ° Temporary services or (ceders installation, alteration, :old /or City /Stale /ZIP: relocation I'honc: ( ) Fax: ( ) 200 amps or less 56.36 I 2 0 1 amps to 490 amps 1 125.05 I 2 Opt ner installation: This installation is being, made on property that I own which is not 401 amps to 599 amps 165.5.) I _� intended fur sale. lease. rent, or c.xchan le, according to ORS 447, 449, 670. and 701. Branch circuits - new, alteration, or extension, per panel _� Owner sipnalurc: - Date: :A. Pee t6r branch circuits with ❑ APPLICANT 1 X CONTACT PERSON above soviet or iccdcr fee. 42 each branch circuit l3USIness (((line: 11. Pee (in' branch circuits Irirhulr/ r '/ service or feeder 6 e. (iol 5(,.I 8 Colltact mime: ' ) /� /J�.0 ('" branch circuit __ �" 777°•• J 110th add I branch circuit 7.42 1 Address: Miscellaneous (service or (cede• not included) " Each manufactured or modular Clt)' /State /ZIP: dvvclling, service and /or (seder 67.54 - Phone: )5 ) A/69-7,247 Fax: : ( ) Reconnect only 1 67.84 2 Pump or 11risal circle I 1 67.54 1 2 11-m0i1: Sign or outline lighting 67.84 1 2 CONTRACTOR Signal eIreuit(s) or limited - energy 67.5-1 I3usincss name: : \1) "h SECURITY I panel, alteration, 01. extension. lase 2 Each additional inspection over allowable in any of the above Address: 2515 SW 153 I)R Additional inspection f I hr min) I I 66.25/ hr 1 Invesligation (1 Iii min) 1 I 66.25/ hr 1_� City /State /ZIP: B1".:AVERTON OR 97006 ' .---.- Industrial 910111 (1 hr min) I 75.1 5/ hr hone: (503) 969 - 7(i99 Fax:_ .503"i469 -7 - I-I4 1 Ins 101 which 00 tie is ( ) = 0.09 / hr specifically lisle, ('/ hr min) C CH L.ic.: 5 9944 Electrical Lic.: 262U9CLF Suprv. I_ic.: LE: \3ft9 EI,ECT'RICAI. PERMIT FEES I/7 r / Subtotal: 67.51 Suprv. E=lectrician sign fur ru ure: / �� f I ld Plan r evlcw(25 %of permit feel: Print name: KEN KRAUS I Date: State surcharge 112 °•'o olpernlit lea 5.14 H TOT;A1. PERMIT [120 1 75. Authorized signature: This permit application expires if a permit is not obtained within IRII /s / / days after it has been accepted as complete. Print name: Dale. o� !/ Number of inspecti a per permit. C Iiuddin,'.I'ermily l l.): -Per : ulApp -dos 10.01,19 15 - 0) 51)) 1.05 91101.1V(I(( Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: - RESIDENTIAL WORK ONLY: Fee for all residential systems combined S67.84 Check Type of Work Involved: Audio and Stereo Systems* 1 Burglar :Alarm 1 Garage Door Opener* 1 1- (eating, Ventilation and .Air Conditioning System* 1 Vacuum Systems* 1 Other: COMMERCIAL WORK ONLY: Fee for each commercial S67.84 system (SEE O_AR 9IS- 309 - (1000) Check Type of Work Involved: _Audio and Stereo Systems Boiler Controls (.loch Systems Data Telecommunication installation Fire .- \l:arin In tallation 1 1 I AC 1 Instrnmentatictn Intercom and paging Systems Landscape Irrigation Control* Medical Nurse Calls 1 1 Outdoor Landscape Lighting* L Protective Signaling 1 1 Other Total number of commercial systems: I *No licenses are required. Licenses are required for all other installations 1: ilsl l_c -I mi[App.doc 1001 09