Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00052
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/03/2011
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9355 SW WASHINGTON SQUARE RD T19
Project: VERIZON WIRELESS Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Installation of low voltage systems for security, CCTV & audio.
Contractor: ACTION TECHNOLOGY SYSTEMS Owner: PPR WASHINGTON SQUARE LLC
835 SE 17TH AVE 2235 FARADAY AVE STE #0
PORTLAND, OR 97214 CARLSBAD, CA 92008
PHONE: 503 -231 -1992 PHONE:
FAX: 503 -231 -1402
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/03/2011 $225.00
12% State Surcharge - Electrical 03/03/2011 $27.00
Type of Use: COM Investigation Fee (Equals Permit Fee) 03/03/2011 $225.00
Class of Work: ALT Investigation Electrical 12% State 03/03/2011 $27.00
Total Number of Systems: 3 Surcharge
Audio & Stereo: Y Boiler Controls: N
CCTV: Y 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: Y Other: N Total $504.00
Other Desc: Required Items and Reports (Conditions)
This permit issued subject the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i accordance with appr• ed 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. AT ENTION: Oregon law re. • - s you to follow the rules adopted by the Oregon Utility N ;enter. Those ales are set forth in OAR
952-001-010 through OAR 952 -001 %0* I. Yo • ay obtain a copy of the rules or direct questions to 0 C by cal i • . ; 87 or 1.800.3 .2344.
Issued • : ` Permittee Signature:
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.
Mar 03 2011 11:40AM HP LASERJET FAX p,1
Electrical Permit Application I ti
�' 1" 4►t 1. l( t: t t►.i \
City of Tigard y Received pfir
" 131 25 SW Hall Blvd., Tigard. OR 97223 c ' \\ t0atae � �� � PertnitNo, � QQ `trSa
c
Phone: 503.639.417 J Fax: 503.598,1960 Dete/8y;
i Plan Review
Other Permit
rte;, \tar, inspection Lino: 503 e t P(� °?` +. •
Internet www -tl rd or. ov \V` � )J Dace Ae / d r�r r. SN Info
ad H
(sa g t ,\ !Notified/Method; / �r \ Supplemental Information
1 1t 7Fi, ,1:.�� 4 y ,. . a c l ��f xpA � � � �.b1 'Y 1 _ , ;;pp �r r i���� �t L iii
„• o4 •,0 .Orti .0, f r + :• , 14. ' . ,MWEILrd,, : 6 r .t1'to r l'. ` r, ! ..p{1'!,4 ,Y.`�i ,___ s' $6, i.,,i, kI , i „ i ��. 9 t'i. ►. •'i • 7 '' '.!, , i liell∎ w !,ii 1 '
' ,,
❑ New construction Addition /alteration /replacement Please check all that apply (submit sets . piste vehicles chocked below)'
Demolltlon Q Other: d Service or feeder 400 amps or more Q Budding over three stories
r) +i 7Ns,l:ys l R i)iF,p : where the evadable fault current El Marinas and belays de
' A � 1�4.'W'(s,k1 4) �?t'�!: Y D I , n b t "F" �"t"ts ,3 • m °i 1 ,;0 rx exceeds 10,000 amps at ISO volts or D Floatin
Ira , e,d .1 �� i r; >,:; lees r 6 buildings.
MI I - and 2-family dwelling w Commercial/industrial ❑ Accessory building a 6roond,erexceeis 14, 000 ❑Commercial- useaOticulture]
Y € amps for all other Inatailatione. buildings.
C Mutt i-famil 0 Master builder ❑ Other: ❑ Fire pump. ❑ Installation qt 75 KVA of
a ! S'13'*.' I � d ' i , „ 1 ` I O Emergency system, larger sepSrnlely derived system
2 0852 9 S 5 SW Washington S Rd ❑Addition anew motor land aP ❑ "A" "8" �' ' t•i
1 �
lob nn.: Job site address; d IOONhormore. Recrs aney
USIA or more residential unit ❑ Recreational vehicle parka.
CI facilities. ❑ supply vphege for more than City /State /ZJF: Tigard OR 97223
❑Haxardoua locations 500 volts nominal
Suite /bldg. /apt, no l Proiectname; Verizo'rt Wireles ❑ 9orvwcar feederti00am.aormoro .
7t �- N t11 1 bw$i l4 �gl r� �� }kf a, "31+ ' ., s �q� t r • 77
Cross street/directions to AIL � ' �� u„ i „u ° dr, k'' 'k4 ;,t
i F , .'';�
D cr lien MiSI -
New residential single- or multi - family dwelling unit,
includes attac stage.
Subdivision: Lot no,; 1. 1,000 sq, ft. or less ]49,17 4
Tax map /parcel no.: Ea, add 'I 500 sq. ft. or portion 33.40 I
�+, ' i Limited energy, residential
^S Y t;, '(� » 1 ;;, ` f Yin Sr.' tl a $ t six "I 3 , �i i{ �_ FlA.1!j� 1 t '! I � ) { � 7 5,00 2
( „5., i ,.• ' �i! . M.. i' (wit, above Sq. it) _
Limited energy, multi - family
7 5'00 2
r - s�
.ty am_ej 5 , alld _ __ _ residential (with above sq. ft)
Services or feeders Installation aaltera and/or relocation
. EUl9.l ' u'i• l tl 1 '�, li}� .tin,',.',„ . _ 2 00 amps or less 80.30 2
, f e: _ r i .i.r , � ' 1 i. , t ° it ,', ' '. i { , I , t ?, ,, 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
Address: 601 amps to 1,000 amps 240.60 2
Over 1,000 amps 01.14)4 454.65 2
CltylStatc/ZIF; Temporary services or feeders install alteration, and /or
relocation _
Phone: ( ) Fax: ( ) 200 amps or less 66,85 1
Owner Installation: This installation is being made on property t n which iE not 20i amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133,75 2
Owner signature: Date:
Branch circuits new, alteration, or e tension, per panel
L ,�+� A, Fee for branch circuits with
. ) '') '',htil;iv�� 1 ' ; i `st
es, - ii, S`i't l I n ': above ': �.�'�'r, . r• ) ,' �� , �,r' , t'� >; � i r: � c t'� a � �r ,,, t) c service or feeder fee, 6,65 2
Business name each branch circuit
B. Fee for branch circuits
Contact name: tvll/roul service or feeder fee. x6,83 2
.� first branch circuit
Address: Each add'i branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or teethe r not included) Each manufactured or modular 90.90 2
Phone ( ) Fax: , ( ) dwellin service and /or fader _
]teconneet only 66.85 2
C • mail
-
Pump or irrigation circle 53.40 2
I , YW.AYE`1u 9 " , 1 •. '�, i ®., , . e ,i i i r " -, p' l i'y i �, 1 s I v ?
� . t. t,i y ;: u , r , a r „? �,.) s, Sign Or outline lighting 53.40 2
Business name: Action Technology Systems LLC Signal circuit(s) or limited-
energy panel, alteration, or
Address• 835 SE 17th Ave extension. Describe: Paget 9 f 2
City /State /ZIP; Port land, OR 97214 Each addlttonsi inspection over allowabie in any of the above
Phone: ( Per inspection 62,50
501231 - 199
Fax: ( 50 ) . 1-1402 ^ tnvestigationpor hour (1hr,nin) 62.50
CCB Lie,: 157530 Electrical Lic,26 775CLE Supr . Lic.: 100LEA industrial plant per hour 73.75
:i /11 il :. ?a1da'i aV'tt n $'ti4 Q,_., is
Suprv. Electrician signature, required: . v ' l '1 ` '
c -- Subtotal, �a4
Print name: e 4 Date; T Plan re view (25% of permit fee):
�: 3/3/2011
State surcharge (12% of permit fee): /9,00
Authorized signature: / r
a�L� c .l < '� TOTAL PERMIT FEE 4 6A,06
' 2011 This permit application aspires If a permit Is not obtelned within ISO
Print name: Rena Kirkland Date 3 /3
. / days after It has beta accepted es complete.
I' IOuildin ,6Tcrn1161ELC•PermitApp,doc asinoo '' Number of inspections allowed per permit.
440.4615T(I 1105 /COM/WSS
Mar 03 2011 11:40AM HP LRSERJET FAX p. 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r.tV ••.,
Fee £or 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:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Li Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
71 Protective Signaling
Yj Other r✓ O. VINCrG
Total number of commercial systems: . L
*No licenses are required, Licenses are required
for all other installations
I.18ui: diiig3'm nIMeLC -i' rmnapp. W /IJ /06