Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
e • ' COMMUNITY DEVELOPMENT Permit #: ELR2010 00181
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/10/2010
Parcel: 1 S135BA00100
Jurisdiction: Tigard
Site address: 10205 SW WASHINGTON SQUARE RD
Subdivision: WASHINGTON SQUARE TOO Lot: 0
Project: Thirsty Lion
Project Description: Fire alarm and security systems.
FEES
Owner:
PPR SQUARE TOO LLC Description Date Amount
BY THOMSON PROPERTY TAX SERVICES, Restricted Energy Permit 09/10/2010 $150.00
2235 FARADAY AVE STE #0 12% State Surcharge - Electrical 09/10/2010 $18.00
PHONE:
Contractor:
GUARDIAN SYSTEMS
13500 SW PACIFIC HWY, STE 245
PORTLAND, OR 97223
PHONE: 503 - 639 -3723
FAX: 503 - 624 -8258
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: Y
HVAC: N Instrumentation: N Total $168.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: 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 0 • 952- 001 -0100. You may obtai - • • • the rules • ' -ct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: � i s i�� 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.
Sent By: GSNW; 5036248258; Sep -9 -10 10:41AM; Page 2/3
Electrical Permit Application
i oft of.F'ir.:F, I;ti}_ OL1'
City of Tigard 1 r iv.
_ a 13125 SW Hall Blvd., Tigard, OR 97223 Q G� D./By: ;.1 � l Nr,
Phone: 503.639.4171 Fax: 503.5911,1960 l f I a Revrow t �!(� 'UO I
T I t; A R :, tnspecuan Lino; 503439.4175 �`- may: Other Permit: .
Interned. www.tigsrd�or.gov L 0 O '� • r r to Wendy /uy huh, �U �� O Q ( 7 3 . -
11 S ‘---k No .z Wiwi. � S ee na n e I for
7; , . l i�, ? 1
1[1 I m II , Il:n ;l l 1I•: fi r s ; , .\ .. I Supplemental taformarion
�I': 11ILa :l;1.'.;i11:fi :j)•:I , "- ,'x,�+. 1•; `r;�.��r • " •�,r7 8 � y ��+� I .� I'7 �. r � '' ll il p � 111 I I �'r,n"Rr g , A' 11 1x; $; pFyp ' 1• tttg, , rF t ,I - • .,� w .-1
❑ ... CDtIti ' �5 sn:�¢ fir' it{'�aicakfL'r 'i!3XSNN II` i�. ll!n ; I � �: �. I INih' f. l 1 x l ilt FI pl Zl ��• 11 P:'11 ,�4 ' : :'T
New lructitm r i I . lace 1' ,, ` ' y I t „
Addilion/ahc 1 �tq �14,bf , . :`'''ui1..' rkr � it :;; �;:�:'
p 1� Reese ,;b e lf that apply � a " �-•�' --- �-- ��-- �• -r'•J
tl 1�t lY (Bmb,nit 9 e1� of pleas w /I.tCtLS chcCkCti below). Den Jn lion Other: . v L ❑ Service or feeder 400 amps or more
' ^ • "1�i ': °" "':h. h) �'.' ° .� j ( �r, 0 1 . f v I"l � t o big[ t qF . S ti s l 1;: . I , where the available fault c ❑ Building over d bodes d ories.
'' .. 1 . 15, , I':' i l i {A kt•U,..' , ' .t.111214' r ' - iiiii ' il : i II F S ` 51. I; l h _ 1 ' I� � current ❑ Marinas and b°alyards.
Jraa,1 Irs e ii '.I li �� ' 11 ' 111 ; } }I. t i excccds 10,000 amps u 150 vow: m ❑ Floating buildings.
❑ 1- and 2 - family dwelling Cominercial/industrial lees to ground, cxweds 14,000 p comwen at_uae
❑ Multi- familyM ❑ Accessory building .sr;cuiw,;,k
❑ aster builder
amps Ew ail other installations. In buildings. almio
I • �I i �. ; ,, 1 ... 1 , 0 ❑ u
nl r�� � ': ;)ui:lli:�..'. g ' �', �4? y '! � l?�� ', ' s 9t ; r c•: , g p F;rep pump: ❑ lmstallarinnof75KV
. It� ii<a 1. ; ; Rlil . ''''•i:11';'" L . d f10ag `10�IA!t Y ' , I 1 t;�1 LE oir fi ar bl� �� 1 �•�i':: r �' 1 . ❑E- xystemt. A ur
.. i in Islala = ;" �unsdl, ik:- . uJ:n0aoko. fill I ' 1 :' { I iK Y knvcd � tent.
. 1��. �lh' Itl�r: t l arger srp aratc t , y ,•
�'+L•: >s, �',`::• �IN ti(` � �Ii ❑ Addition of now motor lend of ❑ ••M "P.", '1 -2>' "1-3",
Job no.: . Job site address: 1 oao5 5 „ w , t 1 100HP or more. i,u;npancy
Li ty /State /ZIl': 7� n '�'/Jt ❑ SIX of Inure residential unit :. ❑ Recccarional vehicle panes
c'4t 3 ❑ Health-care facilities. ❑ Supply voltage for more 11011
S uitc/b[dg.7apl. no.: ❑ Nee clydoua lucatioriv 600 volts nominee!
Project name:
t ❑ Service or feeder 600 amps ur more
(31'08sstreet/directiot i!ii ;iili$jjie . I' y ; u 9 l g lc , v ¢ul q
'4.
1s to job site: 11i ! 11 I' J 7 ' 'Ir TF' j4 '
—, I _ ,,:� i, w ,' a„ n : y 1„ . ... g!i u: ?.n lr; il
DachiNigo
t Fee 'road •
New residential single. or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less
168.54 4
I'itx m /arced no.
P fa. add'I 5U0 sq. A. or pOnlon
l ;j'1 " I''',':',: tl) q +p ' q -' ;1 )''' ' + ,i:9,1 IIuIg� 8•, t ; •��t,uWl r J Limited en 39 �2 ..
ni )( A .`. -.1'!, ,..,. fll Zifilt A I I 1 li II energy, rC$identlal
P ppa,iw its 1R:1 :15�u ,; 'tpsli''I IIi:� fii "lyt Wilhahove sq. ft� 75.00
.
� (�. ' r v C1 � f � r Limited energy, muJiriomily
—.. ` Q �` % Pai\t'Ll , residential (with above sq. ft) 75.00 2
Services or !'ceders instalt alien and/or relocation
I I ;. ;ui � Ul " "i X 11 + i( wal p 'h5 ;' '11 '4. ' I)il�s��,atl} I ''. t f r m: 11r t�, WORM 200 arnp or ICSS 100
0 % 1)..In10 : mi 1 �' ' �'' li ' I I Iki eu+i. s, � I i I ��� 20 2
I ����,, ? � gr � ;� 1 .! '.Jt11111 1 amps to 4uo stri 133.56 2
Name; 4U I amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26;
Temporary services or feeders installation, alteration, and /ur
City/Slate/ZIP;
relocation
Phone: ( ) I Pox: ( ) 200 amps or less _
59.36 1
Owner installation: This installation is being made on property that I own which is not 20I amps l0 400 amp 125.08 2
intended for sale, [case, rent, or exchange, according to ORS 447, 449, 670, and 701. 406 amps u, 599 amps 168.54 Owner signature: Branch circuits — n 2
Date: new alteration or .extension, Cr cued
9q���� Li k l 1': � I' grill S101 ' enbr. . . D a t e : _ . -.- • - A. Fed fur [ranch circuits with
..
.i:P..11'iz'lli:. I.'.:; �'t k Jr I rt
I,. lt'( I ���, r.1:g:asl narclo; ur .
'" ��i�`+11 "��� � t'i 1 r'�C{7�,1��1 ,,� 1al„•, t • L I�.' � �I''�,5 Magda t' mbnru service or feeder fee, ,�
: ISro tcs ;al�lhrii ;ili:xGtrn4�t:t' u}1 each branch circuit 7 . 4 ► 2
Business name; II. Fee fur branch circuits wirhnu,
Contitct Warne: service or feeder fcc, First
branch circuit
56.1$
Address; Pun add'111rmnch circuit 7.42 2
• Miscellaneous (service or feeder not included) -
Cily /S411c /LI P; C4,ch manufactured or modular -
j Pax:
dwell in service anci/orfeedrr 67.84 7.
hunc: ( :) I aul :: ( ) Reconnect only •
E-mail;
f 67.84 2
g�pr Pomp or im do c
11 p ; ;r ( is I I ; 1 J �. vt�a w, s , I t f , 3?t1i�I Sisrt�r out • gn n circle 67.84 .2
. : P r n'NYd�G.raB,ia's�tid'f:�kitii0 tit 11 outline lighting
�,:at3'' 1`.�i�P.i?! ;i'I , ;i1Ii�l, 1 67.x4 2
ness 1larntl: Si cikevit(s) irr limi � �
(\�> and alteration, or extension l 2 ..1_,.7.A„,_._2
Busi
��.q� ?0,,C.,;, Each additional inspection over a in an of the above
Address:
\ - St3 S Lt l�{ pQ Additionalinspection(1 hr min) 66.25/ hr
City/Stoic/7.1P: n.�� �{� Q `a� Investigati (1 hr min) 66,25/ hr
h Industrial plant (I hr min) 78.18/ ltr
Phone: 633 �\ � 443q , Lic.: S a x; )
1 F+3 . � 2 inspections for which no fee i s -
CC :B $ r F s • ciftCall listed '/ ht min 90.00/ hr
Electrical Lie.: G f � 3 u prv, LitLic. {'
[;[seta L'G l ;S�E!�'l��r'll •tii.:'ii I a''�, rl !', YY��''c°; tr 3
Suprv, Electrician i stoic, t i,.,i,h: _I , iit,l,_ ? :,,4Ty +w ;.ti >. ":MJ.: Ijt
required: Subtotal: Y
Print nalnc ;,�� �j , Plan review (25% of permit fee); -
I Dale: • State surcharge (12% of permit fee): �
Authorized signature: TOTAL. PERMIT I EE: /11/L
r / �, this permit app p°n expires it a permit is oat obiai dbio IRO •'-
Print nine:
11)atx: permit after it has been accepted as complete.
! ' Number of inspections allowed per pit. .
: iaa4dinalpenn dr\aLc- 14,1nitApp.d MN i 140.411 5
1 TO la ticOMArfa
Sent By: GSNW; 5036248258; Sep -9 -10 10:42AM; Page 3/3
Electrical permit Application - City of Tigard
Page 2:- Supplemental Information
LIMITED ENERGY PERMIT FEES:
f
Pee for � �`�'��s���;i,�i:�� ° <if n� , l�ir�;�u�iE��.i� >'ii�;sl���� >s
residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Steteo Systems*
❑ Burglar Alarm
❑ Garage. Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other: ^`
Fee for e
each commercial $75.00
System •
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Cluck Systems
❑ Data' Installation
Rr Fire..A farm Installation
❑
•
HVAc;
❑ Instrumentation
El Intercom and Paging Systems
❑
•
Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
I ' Prt:,tcctivc Signaling
❑ Other. •
r�
Total number of cotrunercial sys tems: G•.
*No licenses are required. Licenses are required
•
for all other installations
t:U,i„dJi.o.i al.c :pen, ilApp.doc 07/11110