Permit ELECTRICAL RESTRICTED ENERGY PERMIT
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CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00331
s C *? Date Issued: 10/22/2009
sTi GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S 126CC00100
Jurisdiction: TIGARD
Site address: 9700 SW WASHINGTON SQUARE RD
Subdivision: Lot: 0
Project: Nordstrom
Project Description: Restricted energy for protective signaling.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
C/O NORDSTROM, ATTN: TAX DEPT, PO BOX Restricted Energy Permit 10/22/2009 $67.84
2229 12% State Surcharge - Electrical 10/22/2009 $8.14
PHONE:
Contractor:
STANLEY SECURITY
15495 SW SEQUOIA PKWY #100
PORTLAND, OR 97224
PHONE: 503 - 968 -3353
FAX: 503 - 968 -3398
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
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: y
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 0 R 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6 99 or 1.800 332.2344.
RAA,i) Issued By: �l�A Y1 . �i1 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' 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.
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'Electrical Permit Application . OFFICE, ONLY
A
City of Tigard and Received Pennit No.: c i ( • `�
g 7l' : pate/By: /
Vr
e 13125 SW Hall Blvd., Tigard, OR 97223 U OCT 'Ian Review `
114 0 , ' Phone: 503.639.4171 Fax: 503.598.1960 ateBy: Other Perntit:
TiGARD Inspection Line: 503.639.4175 CITY OF 1 IGA' Ready /By: Juris: ^ ® See Page 2 for
Internet: www.tigard - or.gov D G DIVIii,pdpNfed/Method: W ( (4 Supplemental Information
TYPE OF WORK 17 tJ V VViI�V 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
❑ I- and 2-family dwelling ®Commercial /industrial 0 Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: 3554163 Job site address: 9700 SW WASH SQ RD 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: NORDSTROM ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qtv. I Fee. 1 Total 1 *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
ADD TO INTRUSION SYSTEM, TRUCK TRAILER CONNECT Limited energy, multi - family 67.84 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 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 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'! branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
Business name: STANLEY SECURITY ,PM
energy panel, alteration, or
Address: 15495 SW SEQUOIA PKWY #100 extension. Describe: I Page 2 2
City /State /ZIP: PORTLAND OR 97224 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 968 -3353 Fax: (503) 968 - 3398 Investigation per hour (I hr min) 66.25
CCB Lic.: 161567 Electrical Lic.: 37 I054C Suprv. Lic.: Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 67 5cU
Print name: STEVE MOREHOUSE Date: 10 -22 -09 Plan review (25 %ofpermit fee):
State surcharge (12% of permit fee):
Authorized signature: = t ` yA LLV\ TOTAL PERMIT FEE: S 9 g
Print name: STEVEN SNYDER Date: 10 -22 -09 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
I' \ Building \ Permits \ETC-Permit App doe 10/01/09 440- 4615T( I 1/05/CC/NI/WEB