Permit N ter' ELECTRICAL RESTRICTED ENERGY PERMIT
CITY OF TIGARD
n
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00109
TiGARI? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/15/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9412 SW WASHINGTON SQUARE RD K10
Subdivision: Lot: 0
Project: Crazy 8
Project Description: Low voltage for HVAC
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 06/15/2010 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 06/15/2010 $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 sub'ect 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 -- •rdance with a•= •ved 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. A • NTION: Oregon law ire •u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OAR 95 $01 -01 �r ou may obtain a copy o the rules or direct questions to OUNC by callin• e . • 6.6699 or 1.800.332.2344.
•
Is - uedBy: • ' & PermitteeSignatfure:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application ,FO� -ei ,.E B ' �oNL J -x f - . - =_
City of Tigard } /jy y R ,d / b 1 tl Penrut No aG( O'� jD O/
13125 SW Hall Blvd., Tigard, O 97223 lluE E V E lan Review //
-' ._ Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
_4 - Inspection Line: 503.639.4175 1 . ,.., 4 . n Date Ready/By: iuris- 10 See Page 2 for
J U N
Internet: www.tigard or.gov i eJ ( i !U Notified/Method Supplemental Information
TY: E 0. 13OORK ` , ; ,-•'c ` obi tr D 1A :. :PLAN REOEW.
New construction ❑ Addition/altemtion/Fn n DIVISION Please check all that apply (submit 2 sets of pians w/items checked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current ❑ Marinas and boatyards.
GA1`EGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
. t ground, exceeds C I t
less to or excee 0 ❑ Commercial-use ag:icul oral
❑ 1- and 2- family dwelling 0 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: F ire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
` a10$ SITE 1N1 OI:Lt4IAT10N ND LOCATION 5 ❑ Addition of new motor load of ❑ "A" "E" "1 -2 "1-3
Job no.: L [[�� 6�J Job site address: qii Z J 100HP or more. occupancy.
ti / ,i s^P / 4 Q t>�D ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: `� A'20 0� 11 7 Z � ✓ ❑ Health -care facilities.
El Supply voltage for more than
L ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: K 10 Project name: 6.4 eA iy 0 ❑ Service or feeder 600 amps or more
.FEE SCUIEDIUL1 . r....,
Cross street/directions to job site: Description i Fee. i Total 1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. 11. 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
w } DFiftIPT1;ON OF WORK k (with above sq. ft.)
Limited energy, multi - family 67.84 2
L OW V& i %A) &' 1 / jl 1 V residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 PROPERTY -6ili R Y 4 T614 N 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 1
Owner installation: This installation is being made on property that I own which is not 201 amps to aoo 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 ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
VLti
.. ::. above service rc or feed fee, 7.42 2
_. ... ,, A '- °' each branch circuit
Business name: At( (ko v , ,& 1. 4_,HA, t j / B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
& V!N iize 6 z... %,, K. i first i ranch circuit
Address: lb 33 O €) ! V a`>, i A Tl nt lC d Each add'I branch circuit 7.42 2
' (service or feeder not included)
City /State/ZIP: TO A L 77 4 OR 6 70 6 2 Each manufactured or modular 67.84 2
/� dwelling, service and/or feeder
Imo
Phone: (6 ) / 2 -d 5-46- Fax: : ( 6-03) 6 % /- / $ 79, Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
_ w it -=. h_ w `; , " $ 1R . lki ...s t z> x. ,. ,.. ..
.� �-. ` �° .� Sign or outline li 67.84 2
Business name: A �de� / Signal circuit(s) or limited -
1/..Gt 1/4.,4 / (y -a4 / 1 . energy panel, alteration, or
Address: 1 �3 --r Ih AP
extension. Describe: Paget 6 7�`� 2
City/State/ZIP: 7 ` b �� q 7 ® 6 2 . Each additional inspection over allowable in any of the above
o Per inspection 66.25
Phone: ((.7:5) , 9z, - - j Fax: (67)3 ) 0 /..-/o 74 Investigation per hour (1 hr min) 66.25
CCB Lie.:5(g Electrical Lic.: 3 Li7C Suprv. Lic.: q 0 Lee Industrial plant per hour 78.18
Suprv. Electrician signature, required: J � e ,1 /° {' Subtotal: 67, g c/
R �t / Plan review (25% of permit fee):
Print name: 0 g 1 'SAL Date: 4 / %/�
r I `�
State surcharge (12% of permit fee):
Authorized signature� _ o TOTAL PERMIT FEE: ill5,q0
Print name: ry / Date: This permit application expires Ira permit is not obtained within 180
f✓L� vt�fLjG S jJ /`� days after it has been accepted as complete.