Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
III I COMMUNITY DEVELOPMENT Permit #: ELR2010 -00247
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/09/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9669 SW WASHINGTON SQUARE DR CO3
, Project: Express Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Low voltage for data.
Contractor: COCHRAN INC Owner: PPR WASHINGTON SQUARE LLC
7550 SW TECH CENTER DR. #220 2235 FARADAY AVE STE #O
TIGARD, OR 97223 CARLSBAD, CA 92008
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/09/2010 $75.00
12% State Surcharge - Electrical 11/09/2010 $9.00
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
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This p it is issued subject • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be d a in accordance with appro • pan . This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day ATTENTION: Oregon I- • re• ires y• • follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 001 -0010 thr• gh OAR 95 - 001 -009• • " ay obtain a copy of the les or direct questions to 0 • - •y ca • • • :-.661•• .1987 or 1.800.332.2344.
/_/.d I/ / _ 1� . �'1
1 sued By: _ _�� -_ /i I . Permittee _ .�. i rL
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: / /Arp/
\ /
LICENSE NO.
• , . ..39.4175 by 7:00 a.m. for the next available inspection date.
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 FOR OFFICE USE ONLY
- Cl of Tigard Received Permit No.: �" /� r � 7
City g Date/By: // 9 / D C.� pt0 /D — Oe2
-
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/13y: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK • PLAN REVIEW
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
' CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Icss to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 9669 SW Washington Sq Mall Rd 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, Or 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: CO3 Project name: Express Store ❑ Service or feeder 600 amps or more.
. FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add' 1 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK • • (with above sq. ft.)
Limited energy, multi- family
Voice /data cabling ( Oo to kO — c \ (019)3X residential (with above sq. ft.) 75.00 2
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
Name: Washington Square Mall 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 9585 Southwest Washington Square Road Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: Tigard, OR 97223 relocation
Phone: ((503))639 -8860 Fax: (503)620 -5612 200 amps or less 59.36 I
201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent. or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: Cochran Inc B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Jim Murray branch circuit
Each add'I branch circuit 7.42 2
Address: 7550 SW Tech Center Drive #220 Miscellaneous (service or feeder not included)
City/State/ZIP: Tigard, OR 97223 Each manufactured or modular 67.84 2
tY g dwelling, service and/or feeder
Phone: (971) 205 - 4242 Fax: : (971) 205 - 4268 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: jmurray @cochraninc.com
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy 1 �f — �67.84
Business name: Cochran Inc panel, alteration, or extension. Page 2 7•' 2
Each additional inspection over allowable in any of the above
Address: same as above Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Investigation (1 hr min) 66.25/ hr
/ Industrial plant (1 hr min) 78.18/ hr
Phone: (563) 2314 442 9o9 Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%z hr min)
CCB Lic.: 72942 Electrical Lic.: 37 -546C Suprv. Lic. :3( R_ • ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: �`�� Plan review (25 %of permit fee): ' i'p O
Print name: �,� p Date: `\„( ` p State surcharge (12% of permit fee): •
TOTAL PERMIT FEE: S 4.199
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1:\Building \Pcrmi is \HLC•PermitApp.doc 07/01/10 440.4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
'RESIDENTIAL 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 each commercial $75.00
system
(SEE OAR 918 - 309 - 0000)
Chcck Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
Clock Systems
ata Telecommunication Installation
n Fire Alarm Installation
n I-IVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I:\BuildingWcr nits\IELC- PcrmitApp.doc 07/01/10