Permit a CITY OF TIGA ELECTRICAL RESTRICTED ENERGY PERMIT
. COMMUNITY DEVELOPMENT Permit #: ELR2010 00203
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/08/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9669 SW WASHINGTON SQUARE DR CO3
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Express
Project Description: Low voltage for HVAC
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 10/08/2010 $75.00
CARLSBAD, CA 92008 12% State Surcharge - Electrical 10/08/2010 $9.00
PHONE:
Contractor:
PACE HEATING & AIR
1884 FESCUE ST SE
ALBANY, OR 97322
PHONE: 541 - 926 -4328
FAX: 541- 926 -4543
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. You may obtain a co• of the rules or direct questions to OUNC by calling 50
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.
09/29/2010 WED 11:54 FAX 5032667238 0003/009
Electrical Permit ApplicRiEtC EFVED FOR OFFICE USE ONLY
Mil of Tigard 9 Pert Nn.: ehki010 /Q -Odd°
III p A Reccice <I ,9 /o . %J Datcl3 •:
° Phone: SW Hall , Tigard, O 6'9232 9 r . C rp plan Review /4 `/ ` .
Phhone: 503.639.4171 .4171 fax: 503.598.19(10 Date /Hy: Other Permit: !G 'WV
T I G A R D Inspection Lino: 503.639.4 terry OF TI Dale Rwdy'13y: Milli ®St Pa «e 2 for
',He net: www.ugard- orBUILDI f BARD Nwilicdgntediod: Supplcmcnral Inform: tion
TYPE O1 . N'03 DIVISION PLAN .REVIEII'
�� (I(I i 11011 / ;dleralioll /I'e'I)laeClllent Please check all den apply (submit 2 sets or plans wlteins checked below):
❑ New construction e�,
❑ Service or (ceder 400 amps or more ❑ Building over Three smries.
(10.3..)e.0 . ❑ Other: where the available liwdt l.•UITCIII ❑ Marinas and boatyards.
('A EGORY .or CONS•CRUCTION, , ' e5eceds 10.000 amps al 150 rolls or ❑ Floating buildings.
less to ground. or exceeds 14.1)00 ❑ ('oalmen int -use agricultural
❑ 1- and 2-family dwelling 9ontntereial /industrial ❑ Accessory building amps tin all oilier installations. buildings.
❑ Multi - fancily ❑ Master builder El Olhcr: 13 Fire pump. ❑ Installation of75 KVA or
❑ Emergency system. larger separately derived system.
• • J013 SITE INIr01U1t1ION AND.LOCA'1ION ❑Additionol'nctvmotor load of ❑ A" li" I 1.3 .
I U(11IP or Inure. occupancy.
Job 00.: [ ,lob site address _`i L.) LOC/Ski1 Ibr �a(ia •
��� ❑ Sir; or mule residential units. ❑ Reerealtonal vehicle parks.
City /Stale /ZIP. -- - T 4 �} -• , i - ❑ Ilcahh•c:uc l'acililics. ❑ Supply voltage tin more than
❑ Hazardous locations. 01)0 volts nominal.
Suite /bldg. /apt. no.: ( . , Project name: •J)C:Ia LLI ; t, -4 { D 1) (j (*) ❑Seitieeor feeder 000 amps ormole. I FEE SCIIEDULE. • .
Cross street /directions to job sire: ne>rrilnion 1 ()h. 1 ere. 1 •rol:u 1 „
New residential single- or multi-family dwelling unit.
_ Includes attached garage.
Subdivision: Lot no.: 1,000 sq. II. or Tes 168.54 4
la add'I 5(1(1 al. 11 or portion 33.92 1
Tax map /parcel no.:
DESCRIPTION OF �'0RK Lin (a111 above s(f0(1)nlial 7x.00 _
Limited energy, mull i ly
75.0(1 2
� -1 V) 4q C_ residential (with above sq. 13.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY "OWNER " • ❑ TENANT' • %.* . •. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 2011.34 2
Name: 601 amps to 1,0(10 amps 3(11.04 2
Address: Over 1,0011 amps or volts 552.26 2
- -� -- Temporary services or feeders installation, alteration, and /or
City /Slate /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or Icss 59.36 1
201 amps to 400 amps 1 25.08 2
Owner installation: This installation is being made on properly that 1 own which is not
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 extension, per panel
Owner signature: Date: - ....__._.... -- --- A. Fee Ib• brunch circuits with
above service or feeder lee, •
API'1.1CANT• �: ❑ ' • : PER S O N: _ each branch circuit 7.42
• Business flame: r 1 ,....4 I 13. fee for branch circuits wAdoor
set vice or feeder lee, first
56.18 2
Contact mime: . branch circuit
� Each a(I(I'I brunch circuit 7.42
Address: `C I� -. cam; C,,,_-.(,, �;\ _.. Miscellaneous (service or feeder not included)
Each manufactured or modular
City /Stale /ZIP: d .1, „ O b' L„ C:>12- C _ 7.-2.> -
/ 7 j 1- .3Z " dwellin service and/.. reed. 07.84 2
`�` "c:)--',1. fax: : ( ) I - .1[.P -. t / S --1- 1 '3 Reconnect only
-
2
67.84
Phone: (Sit I) g 9-e..,-- LI3 "c:)--',1. - h(
' 1 Pump or irrigali0>1 circle 67.54 2
E 1 rr l 6 \i/1 kr) Cet) mac, .p, (1ate o'' I "" I 04,-),(y--) Sign or outline lighting 67.84 2
' . .. 'CONTRACTOR SIkO >1 01 uil(s) or limited- energy
13usiness name: • 1 14-f/e -7 p ? 4 (' Panel, alteration, or extension. Page 2 2
• Each additional inspection over allowable in any of the above
Address: ' 8s(. .., / ,,,te__. >- " s_ Addili0nal ins ion (I ht' min) 66.25/ hr •
Investigation, (1 hr min) 66.25/ lir
City /State /ZIP: • AL C�i2 9
- Y Industrial plant (1 lir min) 75.15/ hr
Phone i5q 1 -. 94G - (-(3,n I Fax: / - 9 -417 -- inspections lit which no rcc is c
specifically listed wt hr min)
9060/ lir
CCI3 Lie.: 77./ 3 Electrical Lie.: 76,d Suprv. I..ie.: ,533 ELECTRICAL -PERMIT FEES . • 1 . . . •
�/' /1/ /o' /-- // Subtotal: m`. , c Z.3
Sultry. Electrician signature, required: / o
Plan review (25% of permit Ice):
Print name: - J. 7, f
, Date: Slate surcharge (12% 01' permit fee): 0 ••
� Rp ( TOTAL. PL'Rh41T FEE: , ,?
Authorised signature �,.� -. ,_ F �C ..- N��_.,. (2_ ' rids permit application expires if a permit is not obtained within 180
I I IIII name: c D a I C: > days after tl has berm accepted as complete.
." L \ (-
(\ C �� 1t -t` �. e 7 ' . I Number of inspections allowed per permit.
r (..) •
1• nuilding Pern,is•aE. eottitApp.dor 07.01 10 •410. 4415'1(11 (ti OW 51'1:1)
09/29/2010 WED 11:55 FAX 5032667238 0004/009
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK.ONLY:. • •
Fee for all residential systems combined ...
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door ( cncr*
iat 1 'tiring, en tilation and Air Conditioning System*
Vac unt Systems
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(ST'.I. OAR 918 - 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ B oiler Controls
❑ (;lock Systems
❑ Data 7• ciccommunication Installation
n F ire Alarm installation
n Instrumentation
n intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ )\ledical
❑ Nurse Calls
n O • utdoor 1,andscape.Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I ikhne rcrmn> rt.c• -r •uniIA1,i,.aoc 07 01 10