Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2010 -00242
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2010
Parcel: 1 S135BA00100
Jurisdiction: Tigard
Site address: 10205 SW WASHINGTON SQUARE RD
Subdivision: WASHINGTON SQUARE TOO Lot: 0
Project: Thirsty Lion
Project Description: (1) Audio and (1) CCTV system.
Owner:
FEES
PPR SQUARE TOO LLC Description Date Amount
BY THOMSON PROPERTY TAX SERVICES, Restricted Energy Permit 11/04/2010 $150.00
2235 FARADAY AVE STE #0 12% State Surcharge - Electrical 11/04/2010 $18.00
PHONE:
Contractor:
CENTURY ELECTRIC LLC
PO BOX 10646
PORTLAND, OR 97296
PHONE: 503 - 241 -8020
FAX: 503 -244 -7041
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: Y Boiler Controls: N
CCTV: Y Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
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: 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 throu R 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2699 or 1.800.332.2344.
/ A
Issued B Permittee Signature: _A, Alan
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.
al NEW construction
• Dentolitton
... . : ...... .. ...... ...::,:: .... . .....
• 1- end2dlinnily dwelling
0 Multitiunlly
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....
Job no.:
CilyilltattalP: ' 1
74 Additiontalteretion/rep -•::"..
• Other
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Yob see addresa 0 Se,e/
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ant
Ili Amnesty WWI
S Other:
• URN._
54, - 4 IC,V4,
L'
Sulteilidgiapt no.: Project =no: ir , -
cross sireet/directicene to Job site:
re add'1500 sq. It. cr patio@
=MI
Tex new/pared no.:
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sddrearc
aty/Einta/ZIP:
*id I own 1 -1 1 ., aot
447, 449, 610, and 701.
Data:
P() 1:3111.11111111111111
Owner tostailatioto - , 1 , : . , is — , _ , - - on prcssarty
intended for sic, lease, rot, or ea:change, according to ORS
Owner agoature:
• '7 _ ..,,,
Buskin a miff: '
Colitact Salm "
Addison ah• 0
My/State/ZIP: • a , ‘,..
'Phones ( a -4
Bina T e0 k7r
Business name: . _ A..,
Addreion
Clty/StsterZiP:
Limited energy, molts-family
residential (web above se. 8)
7,41it
-lei 4 , _ - •2 C C— GC--
. °If .
0
2 4 0 c
e 4 ''' 2 96
4 0: 1 a Free : (5D.,0 2 ' a all
0 rk (- s ''' • Azrzwamonsw
- ,
. 44 A.-
Phoned ( )
CCB Lk.: / 697
4 1up7v. Pled:ids signature;
Electr1c51 L1c.: 5
raquired' -' ,,,..:-,
.-
■-•- 'Ca V1_
•
Sum. Lc.: ITO 5
-
Datc / -3 - r-e) to
hint tom Jr
i ,000 R. ft. or less
145.15
4
re add'1500 sq. It. cr patio@
33,40
I
Limited energy, resicksitial
(with above sq, it),_
75.00
2
Limited energy, molts-family
residential (web above se. 8)
7 5 40
Mormon
2
Services or feeders towelluntoolteristtou
)
200 amps or lesa
80.30
MC-
201 slops to 400 amps
106.85
401 amp to 600 amps
160.60
601 1ILMS to 1,000 mg
240.60
2.
Over 1,000 isms or volts
454..65
Temporuy sairsicas or feeders Installation, duration, madfor
reheat:km
240 a cc tea
66.85
1
201 amps to 400 amps
100.30
2
401 as rips to 599 !we
133.75
2
Brunch etecolts— oar, alteration. or eirseskak per Mel
A. Fee for branch circuits wait
above service cr feeder fee,
each branch circuit
6.65
2
8. Fee for branch circuits
wiThaat service or feedar fee,
fret branch circuit
46.85
2
Each add'i branch circuit
6.65
2
harelhautous (eryl= or Order oot =laded)
Each manuanurest or modular
dwelling, saviors and/or folder
90.90
2
hemmed only
6685
2
Pump or irriortion circle
53.40
2
Sign or outhne lighting
5340
2
Signal circuit<s) or limited.
energy paw', alteration, er
enteral= Describe:
. 2._
Per 2
. - 5 .-- d ....'
2
Nadi additkinal WW1= over allowable In . , of the above
Per inspection
62.50
I n n e s t i r t i a n per hour (1 br nig)
6250
Industrial lart . rebuts:
Stibtotel:
73.75
—
t..i.d1! .'
P1 rev= (25 at of peril fee);
State auishirge (PA of permit fee):
1111Wialt2
117310r 6
_
TOTAL.P12.14ITTFEE:
Electrical Permit ADalicatioq
City of Tigard
19125 W1161E1%1, Tigard, OR 9722
Phone: 503'539.4171 Fax: 503.598.1
Thispectiou Line: 503 .639.4173
hdorriet: tigard-or. goo
T • d
IirOL2E0S
i I , I I l• I ■ ' ,
neliserateguid.
7
1:11 Service or feeder 400 =Fs or toors
whore dte available ft* outran
exceeds I0,000 emin st 150 volts or
less to gosiad or ameads 14,000
amps far all oiler inatothaiona.
1:1 Fire pump.
o Emergency eyes=
of iiew =oar teas of
04 Or mom
residential unss.
Nesla• care facilities
o Hoses Jona=
o sensed or find& 600 sew re mors.
BEM:
Oilier Pend:
Ayr
TPO
ruitt itintor
New redder:1W 412 nAdd-riutdly &Nang
Medusas sttactre
W
IN Su Piga !kr
!supplemented Mammal=
Huildiog time amnia.
1:134arima sorl ha:awards.
?Iodine Ingliliasp.
comassmigine eglicuatrid
buildings.
Manikin of TS EVA or
larger repwalaly derived system
occupancy,
Rimmetionel vehicle parlm.
P Supply vohage for snore thou
00 eche nasal:ad
........ ....
nut obd ISU
dews 00 .. 401 .s es ortwohloto
31H13313 Adil1N33 WdLZ:2 0102 CO now
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RZsmENTIAL WORK ONLY:
Fee for all 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.
COMMERCIAL WORK ONLY;
Fee for ggeh commercial system
(SEE OAR 918460 -760)
Check Type of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls
[] Clock Systems
❑ Data Telecotmnunication Installation
❑ Fire Alarm Installation
❑ HVAC
[] lnstnunentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
«Other (r V
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1,∎ ■8wlgatyWemde t.C- P®itApp.doe w103
$75.00
2 ' d 1 bOLbb2E0S 3I2113313 AdnIW33 WdLZ:2 0102 E0 A014