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Permit .4 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00020 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2011 Parcel: 1S1260000300 Jurisdiction: TIGARD Site address: 9524 SW WASHINGTON SQUARE RD H08 Project: H & M Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project Description: Audio and stereo system. Contractor: DTI Owner: PPR WASHINGTON SQUARE LLC 8196 SW DURHAM RD 2235 FARADAY AVE STE #0 TIGARD, OR 97224 CARLSBAD, CA 92008 PHONE: 503 - 620 -1135 PHONE: FAX: 503 - 620 -1151 FEES Description Date Amount Specifics: Restricted Energy Permit 01/26/2011 $75.00 12% State Surcharge - Electrical 01/26/2011 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: y Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: N 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 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 adopte. b the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through • ' #!''2- 001 -0090. You may obtain a sepy of stions to OUNC by calling 503.232.1987 or 1.800.332. 344. Issued = „AI"' " _� G� Permittee Signature: ✓/� `��� / ✓ cC • NER 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. Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Received !PI �j� Date /B : EriMIE Permit No.: 1 .- - 't 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.19 � . Date /B : Other Permit: i .,0 10 ) (6 TIGARD inspection Line: 503.639.4175 . ��� „, n %`\\ Date Ready /By: 1 is s _ ® See Page 2 for Internet: www.tigard- or.gov itiD� `�� `. Notified Method: � y(� Supplemental Information TYPE OF WORK \ per C ,- , PLAN REVIEW New construction E Addition /alteration /re � l V� 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 CI Other: Other: C, where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTON exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling C ommercial /industrial ❑ A ccessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ® Other: Retail ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION 12 Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ", Job no.:Oc ;7 ?' Job site address) 9 SW Washington Square Road i or more. occupancy. t ,� ❑ Six x o or r more residential units ❑ Recreational vehicle parks. City /State /ZIP: Tigard, OR 97223 054-1 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: H & M ❑ Service or feeder 600 amps or more FEE SCHEDULE Cross street /directions to job site: /4/ask � tom/ Description I Qty. I Fee. I Total > New residential single - or multi family dwelling unit. next to the Apple store in Washington Square M 1 nea the new paring structure includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft ) Limited energy, multi - family 75 00 2 Installation of low voltage audio (speakers) residential (with above sq. ft.) 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: -,�N r l/ — i _) t 401 amps to 600 amps 200.34 2 I^ V / 601 amps to 1,000 amps 301.04 2 Address: 6 ��f e< L � zr , e y:31' , c / . z Over 1,000 amps or volts 552.26 2 6� " 7 Temporary services or feeders installation, alteration, and /or City /State /ZiP: )�� e . 1 � 1 60©a ` r r elocation Phone: (3/0 ! "73L/. o 2 s" I Fax: `) 2 G/6 — L /8 ? <- 200 amps or less 59.36 1 I ` 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that i 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 for branch circuits with [ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 42 2 �7 each branch circuit Business name: )1 O �''4 "Q L - B. Fee for branch circuits without r service or feeder fee, first Contact name: V P • /-0 G, branch circuit 56.18 2 Each add'I branch circuit 7.42 2 Address: - Miscellaneous (service or feeder not included) - Each manufactured or modular City /State /ZIP: Y r 1 ;' ,7x 772?-6/ ( � dwelling, service and/or feeder 67.84 2 Phone: ( G,, Fax: : U - - Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: €9 '.' G ao _ Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy Business name: DTi panel, alteration, or extension. 1 -7 „ C Page 2 /� . 2 Each additional inspection over allowable in any of the above Address: 8196 SW Durham Road Additional inspection (1 hr min) 66.25/hr City/State/ZIP: Tigard, OR 97223 Investigation (1 hr min) 66 25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: (503) 620 -1135 Fax: (503) 620 - 1151 Inspections for which no fee is 90.00/ hr specifically listed (Y2 hr min) CCB Lic.: 179868 Electrical Lic.: CLE158 Suprv. Lie.: CLE158 ELECTRICAL PERMIT FEES Subtotal: 75" ' Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: Jerry Koch l � GC ,,. I - Da te: 1/26/11 State surcharge (12% of permit fee): g ck.) A ` TOTAL PERMIT FEE: : Authorized signature: �� �_ This permit application expires if a permit is not tamed within 180 days after it has been accepted as complete. Print name: Laura KM& Date: 1/26/11 * Number of inspections allowed per permit. C\ BuildingTermits \ELC- 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: n Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: ® Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical ❑ Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\ Building \Permlts\ELC- PermitApp.doc 07 /01 /I0