Permit , CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
,, Q '_ COMMUNITY DEVELOPMENT Permit #: ELR2010 -00124
T t G A ) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/21/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9785 SW WASHINGTON SQUARE DR D12
Subdivision: WASHINGTON SQUARE MALL Lot: 0
. Project: Radio Shack
Project Description: HVAC.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 07/21/2010 $75.00
CARLSBAD, CA 92008 12% State Surcharge - Electrical 07/21/2010 $9.00
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 $84.00
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- 001 -0100. Y• - - • • -. : • of the ru -s or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B - ---e-' 4 = � Permittee Signature: - �7,----- ---- -
LAP
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.
Electrical Permit Application ,� ---_ -> �--- e 6 Ma tri te E-13 I:
City Of Tigard ,..,,,\_,,,,,, � l � � � � �/ Received �__ � �: � _..�_� _ ems _� .. -�_ _.
�+ Date/By �11 � 1� � I Permit No.: "TT�J Q) to".uoi - �
13125 SW Hail Blvd., Tigard, OR 9722_ "� A � . � \\ ` Plan Review /
J Phone: 503.639.4171 Fax: 503.59
a 8.19 ��_ 1_ ; Q Date/R Other Permit: ��A n%\ y- (A PAlU- s1
a Inspection Line: 503.639.4175 ' 1� v Date Ready/By: .1 uris: H See Page 2 for
Internet: www.tigard ` \' -- ' 'Notihed/Method: r y Supplemental Information
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: . :.s ' ; i T 1t P . O F 1 [ / O R K ; t r '' } , i r 3., - " , ;. t ; r , , -, ' �. ; FLAI!f RPV Y ; , Y x 4 i0I
0 1 New construction egt Additiontalteratlon/fePih4ine �' d Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: ;,")\,;.' ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
gtge;0l: F x z . F o s amps at 150 volts or
s i O Cc)N>�'�ir�i`�s�r : :�. ,._,� `.. _ -'s t z "zee;= r' '� . exceeds 10,000 am P ❑Floating buildings.
less to Bound, or exceeds 14,000 ❑.Commercial -use agricultural.
❑ I - and 2- family dwelling gi Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
F t•: yY x F � ❑ E mer gency system . larger separately derived syste:
E 0" . ^ r , J011 SIT',E' Y4+ ORI!'t'AT!o s D
4` 400 `, - 4 7 .,'r*". ' i ❑ Addition of motor load of ❑ "A", "E ", "1 - 2 ", "1 - 3 ",
- r'- -: n'C . din.... . .. 3'P' - d }� : -
Job no.: 351$2 Job site address: g70S6 w4t.5 7 ikie 10011' or more. occupancy.
❑
f ❑Six or more residential units. Recreational vehicle parts.
City /State/ZIP: '" A Rv O � Y ',� ❑ Health -care facilities. 0 Supply voltage for more than
�/ A 1�.7jpA7 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: P-/ Z I Project name: 4 p 0 S G.4 ❑ Service or feeder 600 amps or more_
Cross street/directions to job site: Description `i3 . D� ` S ''��
I Qty. 1 Fee. 1 Total aI 1 *
New residential single- or multi - family dwelling writ.
Indndes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 1 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 , I
�c.r;5., a`x� F ``• -.6_ ;r3. r5' . i - {� *. V' r c "``r. A5-�r cv� -_„<, mired energy, residential 67.84 2
_.,. .�.......a . _ . - . :: .1�.DT.S a>;Olti , . .. fit§ alfik '.. „ i (with above sq. ft.) dethti
S % ��® , J Limited energy, multi-family 67.84 2
(Ow ✓ / rA LeA,] residential ,15 residential (with above sq. ft.)
- I Services or feeders installation, alteration, and/or relocation
. Pip. n a g t< ti
200 amps or Less 100.70 2
wpm : � _�.s�n ,..�_..- '��_� ��i�?�� t}?E"��`��ros :riaa 201 amps to 400 amps 133.56 2
Name: p
F4Gb ptzt 5 ,1 401 amps to 600 amps 200.34 2
L 7l 601 amps to 1,000 amps 301.04 2
Address: 479 5,.,,t of.AA�17 714 SQ ,4 _/ 4j.� t/� Over 1,000 amps or volts 552.26 2
City/State/ZIP: Tv ox Qt .23 I pa Temporary services or feeders bastailation alteration and/or
relocation
Phone: ( ' ) I. 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 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 ex tension, per panel
A. Fee for branch circuits with
. ' •':-:'
� S( `' i lf 4 °: ? , t' " `at e• -. above service or feeder fee,
srao° each branch circuit 7.42 2
Business name: A° t„,.., it ,4 / 13. Fee for branch circuits
aitllbut service or feeder fee, 56.18 2
Contact name: k.,„,,.., X. I1rst branch circuit
Address: 103SO S -rim A-7-7A, Each add'I bran cii suit 7.42 2
_ ' Miscellaneous(iircvice 6r feeder not included)
City/State/ZIP: T(r7t /, 7 t p 17 ,L Each manufactured or modular 67.84 2
) �9, dwelling, service and/or feeder
Phone:
{ '� 3) �9 -l5bs Fax : 003 )491.127q Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 ' 2
z:4:01,41.7---: s� 3$ c tom- r Y
�,e �.��„ w �' n sign or outlinelighting 67.84 2
Business name: pp��� Signal circuit(s) oriimited- '
A I.Ie.O Iw/ /i1(.j?" „,...A energy panel, alteration, or
Address: lo 3330 J �1 TNA /A�Ai extension Describe: ' Page 2 2
City/State/ZIP: fr (^ f n.I ` t9'e 1706 Z Each additional inspection over allowable In an of the above
' Per inspection 66.25
Phone: ( 603) 6e r - g _I Fax: (5 63 )p7/.-/6179'
Investigation per hour (1 hr min) 66.25
CCB Lic.: 6-1Q 3 Electrical Lic.:3 /0 1 Suprv. Lic.: q y Lei : Industrial plant per hots 78.18
Suprv. Electrician Signature, required: ��L i L t� 2c la �~ ` .•" ` r t
L' Subtotal: , l •e,
Plan review (25% of permit fee): .B.
Print name: R O B ley �. LA 5.4„6, Date: 7//01,/ G
State surcharge (12% of permit fee): ` q_ W"
Authorized signature J TOTAL PERMIT FEE: 7 4 g rt
tore. e . /� J/ This permit application expires if n a ccet is not • within 180
-
Print name' ..� 'may L. v Date: / � '�.�'1Gf�C 4n days otter It has been een acceppted as complete.