Permit II CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
o • COMMUNITY DEVELOPMENT Permit #: ELR2010 00198
T 1 G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/28/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9477 SW WASHINGTON SQUARE DR A07
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Best Buy Mobile
Project Description: Data telecommunications system.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 09/28/2010 $75.00
CARLSBAD, CA 92008 12% State Surcharge - Electrical 09/28/2010 $9.00
PHONE:
Contractor:
PROGRESSIVE TELEPHONE SYSTEMS &
COMMUNICATIONS INC
PO BOX 190
PHONE: 503 - 665 -4900
FAX: 503 - 665 -4830
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: Y Fire Alarm: N
HVAC: N 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 rul s ado ted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0100. You may the rules or ct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: c j �.
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 503.539.4175 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.
09/23/2010 TflU 17:08 FAX 503661 ' II: WED 2002/003
SEP 2 3 tili0
Electrical Permit A.pplicati 1T1' OFTIGARD FUR OFFICE USE ONLY
ILDING DIVISION
- City of Tigard s / honikNo.: ^ • .. to__ I. VIZ 13125 SW Hall Blvd., Tigard, OR 97223 L.i
Phone: 503.639.4171 Fax: 503.598.1960 Other Pumtt 7_a r r t 0 - a.• Y (o
T I G A R D Inspection Linc: 503439.4175 Date Ready/By: hair L• Page 2 for
Internet: www.tigard- or.gov Notified/Method, (,,k Supplemental Information
.. "' :...
....•... 't'YPE:'Oi:: WORK'' _-
W ":
Plea. cheek all cut appl (submit 2. sets of plans widens checked below):
• ❑ Ncw construction �Addition/altcration/replaccment rlea0 Service or feeder400 amps or more ❑ Building Over three :dories,
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
• ' ` ' . `: exceeds 10,000 al 1 5 v olts or ❑ Floating buildings.
n+ps 8 tcu
:. ..... , CATEGORY OF CONSl'lt17CTION,. ... ......'
Icsa to ground. or exceeds 14,000 0 Commercial -use a ltural
❑ 1- and 2 -f imily dwelling ACommercial/industrial ❑ Accessory building arms for all other installations. buildings.
❑ Multi- family ❑ Mastcr builder 0 Other 0 Fire pump. ❑ Inst,alutinn of 75 KVA or
r
::JOB SITE'dNFORMATION. AND:I:OCATION' .. Addition anew larger E" "l separately derived system.
• C ❑ Addition of th;w motor load of (]
Job no.: l � 31 gS 1 Job Site address: c tQ 7 ` 1 5 6 11- t fr . , 9 1 I ix Or MOM occupancy.
• `+ 0 Six or te residential unit. ❑ ltcocrGunal vehwle parks.
City/State/Z1P: - TO (-‘ D. 61 /r .43 ' 4se 1 ❑ Heatth.carc facilities ❑ supply volerge for more than
1 ❑ Hazardous locations, 600 volts nominal.
Suitdbldg./apt. no.: Project name,' [fit RLt, y r 0 service or fader 600 amps or mote.
l .;.:...;?.11.t. 5 .: _
' ,:': :;
:,::::i:,,.� . ,. ,. x'J E SC1f1EDt1,Li&, -- ;...
Cross strcct/ditcctions to job site: _ rteaerinron n L yes A ram
New residential aia*• or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no,: 1,000 sq. ft. or less 168,54 4
Ea, add'l 500 sq. 0. or portion 33.92 1
Tax map /parcel no.: limited residential
75.00 2
.... : ;' r:; ;:DESCR�TPIQ(:OE :r?V,ORK; ;....'- '..:7,.. "::i:;�::a (withabovc
i ,.,�.�,,�� �n �a � ,, -�- �{ Limited energy, multi - family 75.00 2
`i'►'Vr� tall 0%J it ti 0 L e.g.) 4' d�e..� a. 1. o _iO residential (with above sq. R)
0 Services or feeders installationotheration, and/or relocation
UU 200 amps or less 100.70 2
400
'.: •. PROPERTY OWNER.: ( f ENANT
..; ,._ .. .'.::;. ` ` .:, . } s.�7 201 amps to amps 133.56 2
.... ......
Names 4 t, a I- i p b , 401 amps l0 600 amps 200,34 2
601 amps to 1,000 amps 301.04 2
Address: gam lkJ ('�,� jL s Rszi Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State/Z1P: Rst) it 4, D 2 q7a. -3 - 4g4cil relocation
Phone: ( ) Fax: ( ) 200 amps or less 5936 1
201 tunes to 400 amps , 2
Owner installation: This installation is being made on property that 1 own which is not 401 ramps to 599 amps I 168,5 12508 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, end 701. Branch circuits - new, alteration, or extension, ear panel
Owner signature: Date: • k Fee for branch circuits with
. . ;.,�. : aboveservice re &cdcr fee, 742 2
. N?lz�:iiciu!1z:'= ' `' : -:; .. �: ^ >.:`,�':4 ,3 coi!rcACr.: rz�sor�; - :;:
.'' � '.. ' :' : _ �," . cash branch circuit
Business name (1(L5Sl UZ L1.2 ► W)te st s 3 fj 86.yn NYL B. Pa fur branch circuits without
service or feeder fee, first 56.18 2
• Contact name: ° ( s all D r t 141 ]pbu branch circuit
M 1 4 Each add'l branch circuit l 7.42 ' 2
Address: go N { oparL ati Dr Miscellaneous (service or feeder not included)
u0 (� a -r Fach manufactwcd or modular
City/State/ZIP: 6
{ Q s � �ry , Dee C 1 dwelling, service and/or feeds 67.84 2
Phone: Q ' e � v b Fax:: (03) I , 3 a Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: 67 84 2
-,� . . , , . , .•_ .. •. - Si or outline l ipJftitlg
.• .: ..ir:........ ... • ._,...... •_.... . :..:. ... .
....... ... CONTRA(:TOR;':: : ::;;!: : I i?e.,�,:: _....: <..'.`� i:'■;Y` Signal preuit(s)orlimited-energy
• Business name: . • 0/ I VL �•�, I �-� � a ?ry • a panel, alteration, or extension. ) Pa) e 2 1- 2
Fach additional inspection over allowable in any of the above
Address: j( ( L 44 • / • D r - Additional inspection (l ltr min) 6625/ hr
• City /State/ZIP: Q.S �YYf 0 k qqi Q Invcsligation (1 hr min) 6625/ hr
1 Industrial plant (1 hr min) 78.18/ hr
Phone: co) (t9 S, 4 9 0 Fax: (SQ3) £ S _ _ e/ J 3 6 Inspections for which no tee is 90.00/ hr
specifically listed (fi hr thin)
CCB Lie.: $t ) lici/ Electrical 144.: 2 f , f) Suprv, Lie. 1 4 7Le & -.._.- <. , ", i _
Suprv. Electrician signature, required: j { __ " 4EA Subtotal; �$r O
Plan review (25% of permit fee):
Print name: J /y)j 5 � , S 0 3 13ata C 1 - o i . ` lb State surcharge (12% of permit fee
� , G TOTAL PERMIT FEE_ r
Authorized signature. / /y // ' �( I -
V
`Gt/ V/ T hin penult appGutlan expires If a permit is not obtained wlthtu 180
Print name: 4{a 11.41 . . /./ JUL / t � fC �J,� Date: Ci/ /�0/ ei • n sp'e Lio after It ow been accepted as complete.
Number of inspections allowed per permit.
1 nlee 57N1118 440 4615T(11/05ICOM.W D
-5,znn t . m o b tom, 4. It -1.3 C
09/23/2010 THU 17 :09 FAX 5036654830 PTSC gi003/003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK .ONLY :. • ;
Fee for ail residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other
: DRX:ONL : -
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 I
Data Telecommunication Installation — v D l Ge . �' b a t, Jo .
Fin- Alarm Installation U
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control'
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1_ .
*No licenses are required. Licenses are required
for all other installations
I: ilding \PamiaV?LC- PennitApp ire 09M1/10
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