Permit " < ^, ���� OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00115
T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/15/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9524 SW WASHINGTON SQUARE RD H08
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Spec Space
Project Description: HVAC.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 07/15/2010 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 07/15/2010 $8.14
PHONE:
Contractor:
HVAC INC
5188 SE INTERNATIONAL WAY
MILWAUKIE, OR 97222
PHONE: 503 - 462 -4822
FAX: 503 - 462 -6555
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 a plicabie 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, if • ork is s ended for more the 180
days. ATTENTION: Oregon law requires you to follow the by the Oregon Utility Notification Center ose r s are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the • • :ct questions to OUNC by calling 503.246.66994'•r .801. 3 2
Issued By • ••••'" _ = 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.
Electrical Permit Application e , g I a r v a ' . I O R o F F I c 1: U S ON I
.„ ) 1 Received !! ..
City of Tigard ' e 10 Date/By: 3dl i 4 13 7T Pennit No.: E `1 0 uo i t5
13125 SW Hall Blvd., Tigard, OR 97 23 3 Q (- Plan Review
3 C Phone: 503.639.4171 Fax: 503.598.1960 \ e Date/By: Other Permit: P (O — 00 130
Inspection Line: 503.639.4175 \I °1b 0 Date Ready/By Juris: ® See 2 for •
fIGA..D; a: Internet: www.tigard-or.gov i Y, jw '` \"" S® N o ti fi ed/Method: /j5 ( p Supplemental Information
• T YPE OF W ORK'\ . \ \1/4 ",' f PLAN IAA/ w,
�� �' PAN 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 stones.
❑ 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
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ 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 ", "1 -3 ",
Job no.: 4426 Job site address: 9524 SW WASHINGTON SQUARE RD. 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: TIGARD OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
ty ' ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: .14V0 �� Pr oject name: H & M S \,(, 1 ") (.�9 D 1- W ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to j b site: Description 1 Qty. 1 F ee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
. . DESCRIPTION OF WORK • ' ,' .. (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
LOW VOLTAGE CONTROL WIRING residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
El , PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT 1 ®. CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: HVAC, INC. B. Fee for branch circuits
Contact name: JODY DEPEW fi t branch service or feeder fee, 46.85 2
first branch circuit
Address: 5188 SE INTERNATIONAL WAY Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: MILWAUKIE, OR 97222 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 462-4822 Fax: : (503) 462-6555 Reconnect only 66.85 2
E -mail: jodyd @hvacincorp.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
INC. Signal circuit(s) or limited -
Business name: HVAC, energy panel, alteration, or 3 'ail
Address: SAME AS ABOVE extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: 50897 Electrical Lic.: 26571CLE Suprv. Lic.: 3796LEB Industrial plant per hour 73.75
}, n 1Il ELECTRICAL PE FEES
Suprv. Electrician signature, required: /' / �/) 1j , V j Subtotal: 6 7 . f
Print name: MIKE SCHMI GALL r �' ��� Dare: 6/30/10 Plan review (25 %of permit fee):
State surcharge (12% of permit fee): K. 1
Authorized signature: TOTAL PERMIT FEE: 75 et le
Date: 6 /30/10
This permit application expires if a permit is not obtained within 180
Print name: JODY D EW days after it has been accepted as complete.
• Number of inspections allowed per permit.
I. 05/2 /06 440- 4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL,WORB ONLY: • , .
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
- COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
• HVAC
❑ Instrumentation
0 Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06