Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00055
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/09/2011
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9640 SW WASHINGTON SQUARE RD G11
Project: Hanna Andersson Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: HVAC system.
Contractor: ARROW MECHANICAL Owner: PPR WASHINGTON SQUARE LLC
10330 SW TUALATIN RD 2235 FARADAY AVE STE #0
TUALATIN, OR 97062 CARLSBAD, CA 92008
PHONE: 503 - 692 -1565 PHONE:
FAX: 503 - 691 -1879
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/09/2011 $75.00
12% State Surcharge - Electrical 03/09/2011 $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 $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTEN a': Oregon -w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 • through OAR 952 -00 0090. Y. • • may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued =y: 4 — ' . /Ji _ Permittee Signature: C GL LLB
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application o \c`C) FOR OFFICE USE ONLY
• n � � , •':
City of Tigard , Received DAB Permit No: ^ / _
II
u 13125 SW Hall Blvd., Tigard, OR 97223 , _ �w� " ,�
_ � P lan Review
P hone: 5 03.639.4171 Fax: 503.598.1960 % ,;-:,,,$) Date/By:
Permit:
T I G A R D Inspection Line: 503.639.4175 P� .. , Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard or.gov ' Notified/Method: 21, Supplemental Information
F s-. r .. q. k.< y 3 ?>C z L > _ 7 . . t.r L . w - $ f g ' c'
: a . t 1 : y r ` ., s ,. . n u ' a3 r a . , a 1 it s -
'?.a,,.a4. -:. .s �. r ;�c� - '�,'�a-;.� � ° "��.. . .� �-�.. ,o'�: �` z:,.s ��.':v.' �.: R�a.- a r�"�-�.K. �S x ,.�,a ` �' �' _
❑ New construction Cr Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition Other:
El Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
RA P a A `x a t av x �` 'zs '� exceeds 10,000 amps at 150 volts or Floating buildings.
:i;,4A , , - 1 ..' r ,, ` � ,� -
'._ ' - : p ❑ g ga.
dwelling ,. # .,, C ommercial/industrial less amps ground, all other a or exceeds alga 14,000 ❑ Commercial-use agricultural
❑ 1- and 2-family g !J ❑Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
< N a ?X-,,-Itkak ❑ Emergency system. larger separately derived system.
u,Ts r4 s S t E R .$ $ 8$ &'� 1 s`A
., °s .�:2` x;�xvr..t...s�'' r.;�.+ o, > ;., -�... .. �/ �� �excb: n. . ��.� , ta '���- �r,�„st �� »e;;^ a ❑
❑Ad d iti on of new motor load of
Job no.: Job site address: � 5, :.•-• / 01/510":161.41,1 Z or more. occupancy.
Q ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: �‘ � ti ZD , DR_ 9 7 223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: 6,1/ I Project name: hi/ b J"¢ h ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: i ,a, t 1 � y . ^L� Total ,, , . 4,
>h> Qty . F
.
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential
�v
'; .as . - mo t ,a:. dig k., . ''''L.',',.-4,--., , s� . . S (with above sq. R.) 4 2
/ Limited energy, multi - family 67.84 2
i 5/C. yr residential (with above sq. 11.)
Services or feeders installation, alteration, and/or relocation
^�E wt "� 200 amps or less 100.70 2
' :; x -4,!'`.1.';',7 s t `" x iL� y , * x 1' 3 fi . ' x�
`* 201 amps to 400 amps 133.56 2
Name: 401 amps 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: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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, . • r panel
Owner signature: Date: A. Fee for branch circuits with
u , 4 t i c t` ` r '. above service or feeder fee,
.. , ,> , . . ..,..4 ma t .. 7.42 2
each branch circuit
Business name: ,'Jpt,_ f C /AO/` OCl4d- Cj2j 7 4JZA.S, /0‘..K_ , B. F e for branch circuits
,l U,� ill tservice or f fee,
k �
Contact name: ieza5Zr£4J` 4 ! - 56.18 2
eh circuit
Andress: Each add'l branch circuit 7.42 2
Miscellaneous (Service or feeder not included)
City /State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone:
( ) I Fax: : ( ) Reconnect only 67.84 2
E -mail: / R.R.c. ...1 M j4 c11 L F QGNT// j.. a >rt•\ Pump or irrigation circle 67.84 2
°` ; s_. :: ;"�' ?, ; s r o t 44 _ A t f.- ," S or outline lighting 67.84 2
� Signal circuit(s) or limited -
Business name: � ; Mt! /)1CiL- 4A il gdfc o23 / G • energy panel, alteration, or
Address: /6330 .� ,d 77p ) extension. Describe: 1. Page 2 7S,
t 2
City /State/1P: 7z .14 77 4 . g7D C Z Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (1 )3 ) 0 z_ /5 -4 5 — Fax: ( 5-co ) e 9! - 113 Investigation per hour (1 hr min) 66.25
CCB Lic.: 51 /3 Electrical Lic.: 31-- 7( 1 4 , Suprv. Lie.: Industrial plant per hour 78.18
+ cu .. M a s
` `
Suprv. Electrician signature, required: Ail ` r - .;
Plan review (25% of permit fee): —
Print name: Date: State surcharge (12% of permit fee): 1 az_
Authorized signature: ` � / -' TOTAL PERMIT FEE: �(,
J This permit application expires if a permit is not ob ed within 180
Print name: f�, -�, «� z c..(4.5 IL c Date: ' days after It has been accepted as complete.