Permit _ y `' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT •
�_ COMMUNITY DEVELOPMENT Permit #: ELR2010 00262
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/24/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9524 SW WASHINGTON SQUARE RD H08
Project: H & M Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: HVAC system.
Contractor: PACE HEATING & AIR Owner: PPR WASHINGTON SQUARE LLC
1884 FESCUE ST SE 2235 FARADAY AVE STE #O
ALBANY, OR 97322 CARLSBAD, CA 92008
PHONE: 541 - 926 -4328 PHONE:
FAX: 541 - 926 -4543
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/24/2010 $75.00
12% State Surcharge - Electrical 11/24/2010 $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: N Fire Alarm: N
HVAC: Y 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 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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: t ■ .A.71..):---. 0. V.x,•Fp1 ACC
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. .
11/23/2010 TUE 8:12 FAX 5032667238 21002/003
Electrical Permit Application �� 'e�
� FOB olrtcc us» ONLY
' t Rermlal
Cite of Tigard q Datc3,. v 1 / . j�
t " 1312 S \\ Hall Blvd.. Tigard. U012 9722.1 3 `l4"" Plan '
Imo.: 103.71 $.2439 lax: 503..S98.1960 J Duce ly: Other I'enmI: ArrIZ (d - 1� j •
1 t ' I rem S • C' ,
ItCiARI) 0 1x00 i onL.inc. 503.639.417. �, Date CJ Iag021'or
Internet: wwlv.ligsuc! -or. 0�' CIAN o 61 c ` k)•ylificd%R)cthod: ^ -w__T 7J i Supplemental Information
'1'\'1'11 OF \\'OR1 I��3 L ll 1'L;\N RE \'IE\1
❑ NOW C()ItSII'tlel1011 ®Ad(Ii11011 /altera11 fepl tlC einent Please cheek all That apply (subntil 2 secs or phlox ,viit0ms checked below):
❑ Service 01 Roder 400 mops or more ❑ Building over three stories. '
❑ l)en oIiti01) ❑ Olhel: ,vhcro the available Gad( ei nem ❑ Marinas and bonl001ds.
(ATECORV' OF CONS - 1'RI I (:TION exceeds 10.000 amps at 1011 0005 or ❑ Floating, buildings.
less to ground. or exceeds 14.000 ❑ Commercial-05e agricultural
❑ 1- and 2- Tamil) dwellini2 M Commercial /industrial ❑ Accessory building amps for an other installations. buildings
❑ Multi- lalltil` ❑ Muster builder ❑ OIlicr: ❑ Fire pump. ❑ Installation of75 KViA or
❑ ):merge) es 0cstcm, larger separ,nelr derived 00060. •
3013 SITE INF012\1A'170N AND LOCATION
❑ Addition of uely to■lur load of ❑ "Al .. - 1 - 2". - 1 _ .1
( ) Washington 100111' m more. occupancy.
.lob no.: .lob site address: 9524 S\\ \\ Sq. 411 - 08 .
❑ Six or more resulen021 units ❑ Recreational \chicle parks.
City /State /ZIP: Tigard, OR 97223 ❑ Health -vale laeilities ❑ Supply voltage l0r more than
❑ I la'r_ardoos locatio (1(10 dohs nominal.
Sulie /bldg. /apl. no.: 11-08 Project name: 1 t1S220 ❑ Service or feeder 000 amps or mole
.
FEE SCUM 1 ,E •
Cross street /directions lo job site: Washington Square Mall n.,,,co 1 Qir. I Frc. 1 Tool
New residential single or multi - family dwelling unit.
Includes attached garage.
SOI )division: L ot no.: .000 sq. fl. I0 less 168.x1 ___� 4
hia. add') 500 sq. ft_ or portion 3392 I
'Fax ntap /parcel no.:
limited energy, residential
DESCl211''170\ OF \VOlili (with above 09. 11.) 75.(10 2
Limited energy. multi 75.00
Low Voltage 1-1VAC Controls residential (with above sq. 0.)
Services or feeders installation, alteration, and /or relocation •
Two sets of mechanical plans mailed 1 1 /3/2010 200 amps or less 100.70 2
..` ❑'PIWI'l.R'1'\' OWNER " ❑ T'ENAN'T . ' . 201 amps to 400 amps 133 56 2
1(01 amps to 600 amps 20(1.34
Name:
601 amps to 1.000 amps 301.04 2
Address: Over 1,000 amps or volts 552.20 2
- hentpor:u•)' services or feeders installation, aiteraliou, and/or
City /Stale /ZIP:
relocation _
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on properly That 1 own which is 110)
intended for sale, lease, rent. or exchange. according to ()RS 447. 449. 670. and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner sigttaturc:..._ ....____.__._-- --- ...._. - .._. _.._ _...__ ............._._._....... _........_.,....._ I) ate:._. ..__._..._..............._,.._. A. Fee for blanch circuits Irish
® APPLICANT above service or feeder fee,
❑ .CON" TACT PERSON each branch circuit 7.42 2 •
Business name: Pace Heating & Air 13. Fee for branch circuits without
service of Icccicr rec. first
SG 2
Contact name: "Trisha Marshall branch circuit . 18
Each x44'1 hranch circuit 7.42 2
Address: 1884 Fescue St. SE \Iiscell iueous (501 or feeder not included) -- Each manulaclurcd or modular
City /SUlfeai Alban)', OR 97322 ■elline, service and /or feeder 67_84 2
Phone: (541) 926 -4328 Fax: : (541) 926 -4543 Reconnect only 67.84 2
I'uutp or irrigation circle 07,84 2
1i - mail: trishain@pacecomfort.com
Sign or outline lighting, 47 .84 2
CONTRA "TOR Signal c or limited -mere) nn
Business name: Pace Heating & Air panel, alteration, or uxlCnyion. I Page 2 2
Each ad0ition;d inspection over allowable in and of the above
Ad(h'css: 1884 Fescue St. SE Additional inspection (111r min) 66.25/ hr
Investigation (1 11- tnin) 66. hr
City/State/ZIP: Albany, OR 97322
industrial plant (I in min) 78.18 /11r
Phone: (541) 926 -4328 Fax: (541) 926 -4543 Inspections for which no lee is 90.00/ hr
specifically listed ('A_ hr min)
C12,13 Lie.: 7713 -- FleclricalI.ic.: / -/C c.al Suprv.Lic.: 33LI: E1.EC'TRIC:\L.I'E12MI'I' - - FEES•• ,
-� Subtotal: 75.00
Suprv. Electrician signature. required: Plan review (25% of perm il fee):
Print name: {)ate: State surcharge (12% of permit fee): 9.00
I )(1
` TOTAL //191111 1.1)1): 0<5
Authorized signature.. � / v' �� aj -
f 1 � This permit application expires if a permit is not obtained within 180
Number of in
Print. Ilat11C.`_ ( r 1 ( ) 7 � 2 C)(� d:qx after it has (1( n accepted as complete.
�. - sy \cd� Date: f
(j � � G '' inspections allowed ,c1. >orm±l.
I'Un 111110cll'rlo1h''.l ii ('•l'n mil App.doc 07'01' 10 -140•.101 S1'i 11.00.cONrk - 1 ll
11/23/2010 TUE 8:13 FAX 5032667238 2003/003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Infotmation
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
• Check Type of Work Involved:
I I Audio and Stereo Systems*
I 1 Burglar ;Harm
n Garage Door Opener*
n 1icat.in Ventilation and Air Conditioning System*
Vacuum Systems*
Other:
•
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEF OAR 918 - 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
I 1 Boiler Controls
n Clock Systems
n Data Telecommunication Installation
I I Fire Alarm Installation
® 1IVAC
1 Instrumentation
F . Intercom and Paging Systems
Landscape Irrigation Control*
1 Medical
I Nurse Calls
I 1 Outdoor Landscape ].,ighting*
n Protective Signaling
Other •
'total number of commercial systems:
*No licenses are required. Licenses are required •
•
for all other installations •
I'',Raildinc \Pcn„itslliL(' Pei niicApp.Juc OJ +OU16
11/23/2010 TUE 8:12 FAX 5032667238 0001/003
C----- PACE scu�e St. SE
Albany, OR 97322
p
HEATING & AIR f 541.926A328 f 541.926.44543 543
PACECOMFOAr.CO!✓1
TO: (`A_ c) .c. - ( p r o DATE: f (IL?)! 201
ATTN: 0 , A , A D'L 'C
FAX NO.: 5- esc 5 - f 0 (_.0 TOTAL PAGES: 3
(INCLUDING COVER SHEET)
FROM: IRoc.._
P.O. NO.:
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