Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 COMMUNITY DEVELOPMENT Permit #: ELR2010 -00248
T t GARL? 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9416 SW WASHINGTON SQUARE RD K08
Project: GNC Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Low voltage for data.
Contractor: CACHE VALLEY ELECTRIC COMPANY Owner: PPR WASHINGTON SQUARE LLC
6200 SW ARCTIC DR. 2235 FARADAY AVE STE #O
BEAVERTON, OR 97005 CARLSBAD, CA 92008
PHONE: 503 - 431 -6600 PHONE:
FAX: 503 - 624 -1436
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 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 a 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. ENTION: Oreg I quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 - 001 -0010 through OAR 9 -001 -0 90 l ou may obtain a copy of the rules or direct questions to OUNC by call' 03.232.1987 or 1.800.332.2344.
Issued By: / !!✓[i t ''� �Y(� Permittee Sicnature: 1t
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 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.
11/08/2010 13:12 FAX 425 424 9966 CACHE VALLEY ELECTRIC IJ002
RECEIVED . ...........
9 2010
Electrical Permit Applic��on rc1R 01 c 1: usr, o\1.1
City of Tigard CITY OF TIGARD IRWIN , Pamil N.. :1' • Joie' -"
n
13125 SW Hi it Blvd„ c• , Plan Review /� � p j
Mena 503.639.4171 °`'•,.y ; i,� , VI SION > Hi Otter Permil A PA I , 00 O ,,
r!,.;A : cr Inspection LW: 50.3.639.4175 Date By
Internet www.ligard -orgov
$� e']: "�-'.7`. k: .a'+ z- A?Krti r A: - �R�." :��.:,��. b$�! � , � 1, �" �
:._ '. � L . t r '��y';1c 1 x ar - �����z"'3a�`�*�R'i�.
o New construction { 1 AdditionlatteretfOnfrepkeemont AMC cheek elI that apply (submit 2 selt plans wRIime checked below):
❑ Service or feeder 400 amps or more ❑ Balding over three earths.
❑ Demolition ❑ Other where dm ovallabto fault current 121 Mathias and boatyards
s ti c A A. � t ;2' . • s s f t S l•. ,e.,4 . s� ; r ; r .., : M'. ? o . t exceeds 10.000 RIMS at 150 volts or El Floating buildings.
: toss to ground, or exceeds 1 ❑ Commeroia4ase agricultural
❑1 - and 2- family dwelling M rmmeroialRnduslrial ❑Accessory building ads for all other installations. headings.
❑ Multi- Ibmily s l i— ❑ Master vi
builder ❑ Other: ['Fire pump. ❑ instalationof75KVAor
t "� iairpS 7 �1 s jh�ri7 r r,:r.i %.) v - A
0 ❑ Additionohm,motorbridal ❑ "uer ."I- 2". "I- i "edsyalcnt
Job na 2 J1 J JYV log M Q� lob site addra I 1 s: � ,� 1/��`' l i r G 1t1011P m more oc nay.
} y� 1 G D/ ci six m• morn rosidmni°l omits. ❑ Recto:01050l vehicle auks.
City/Stlrte/LIP: 4 `a [,� ❑Hazen •
em e lo s . I] Supply voltage for more than
❑tlazaldoua /melons.. 600 volts neaninaL
Suite/bldgJapt. no.: . ' Project name: R. ( 1 A O Service or Rader 600 maps or moore. tL,
Cross street/directions to; site: , Description Q41. For. Total •
New residential single- or molt1 -family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. it or less 168.54 ' 4
Ea. add'I 500 sq. IR or portion 33.92 1
Tax map/parcel no.: t Li tutted energy residential 7500 2
+ �trr e. h) m t ' 4 A r ) t :F .... { `'r r d. t (with above sq. ll.)
t, • . LI ' Z el 4 , an / r Limited (with above senergy, (with ab ove se,. e sq. @.) _ 7300 2
,�
Services or feeders installation. alteration, aod/or relocation
uV 1 -4. Q ne. • 200 amps errless 100.70 2
` r , s ` `fir, - 201 amps to 400 ems 133.56 2
Nome: 401 apps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
•
Address: Over 1,000 amps or' volts 552.26 • 2
City/State/ZIP: relTemporary
ine services or feeders installation, alteration, and/or
Phone: ( ) l Fax: ( ) 200 amps or less 59.36 I I
Owner installation: Thii: installation is being made on property that 1 own which is not
I
201 amps to 400 amps 125.08 + 2
intended for sale, lease, amt, or exchange, aocording to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 12
Branch circuits - new, alteration, or extension, per pane
Owner signature; Date: A. Fee for branch circuits ma
�,^•w ;-' y- sir -{<xR e service o feeder fee
y p "' la r''�'s' § �r; Tea. e ■ A oa t 7.42 2
-.r `� � �� ' •. � � :.v „� �:� > >�•• above each broach circuit
Business name: YJ hi \ 61! B. Fee for branch circuits wdbord
( �
service or (baler fee, first 56.18 2
Contact name: /� IS n brands circuit
l0 �, \ � -$ ''r ' ' �j ; 1 r Bach add' l branch circuit 7.42 2
Address:
Add bb �' ) AT , L 1/IC. W.L � Miscellaneous (service or feeder not iadudcd)
City/Stato/ZIP: �Q �n t t�"'iD
Each �ciceand/malWar 67.84 2
t3 d welll service and/or feeder
Phone; () > `' , 0 p Far : ( tali • `. pump or irrigation circle 67.84 2
E mail: ��Q r eC • e. V t Q Sign or outline lighting 67.84 2
' ' '-�� N m A Lg . c i g \ * r Signal slicks) or limited-energy
Business name: /� d A N :V an
C. panel, alteration, orexeension. t _ Page 2 1 _ 2
U C O •.�y.� Each additional inspection over allowable in any of the above
. Address: Additional inspection (I Iv min) 66.25/ hr
Clty/Stateizw' • Investigation (1 hr min) 66.25/ in
Industrial plant (1 hr min) 78.1 B/ In
Phone: J Fax Inspections for which no fee is
90001 he
1 s finallyIKYad(Ysbrmini
CCB Llc.: I4'aad I Electrical Lie.: Supry Lie.: 5mo 5 :..., -- falgeBrita IIEBRi ' ��t` _ r
Su rv. Electrician s' nature, requi •'• •: , >- ✓�� Subtotal: r Iaj.DD
P MI, Pfau surcharge OS% of permit ice):
Print dame: ji,D ”— Date: , + State sntvhar (I2% of p ermit &o): • DO
Y 1 u�
TOTAL PERMIT FEB: FEB: •DO '•
Authorized signature: This permit application expires it a permit Is net obtaltsed within IS
days after it hm been accepted as complete.
Print name: I Date: • Number of inxpeciione allowed per permit.
1:' iIdi°allorroIriail- rermitAyp.dos 07/01/10 440.615 01m31COMMED
•