Permit II CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' 1 '' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00080
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/01/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9534 SW WASHINGTON SQUARE RD H -12A
Project: AT & T 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 04/01/2011 $75.00
12% State Surcharge - Electrical 04/01/2011 $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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are s- , forth in OAR
952- 001 -0010 through 0 • : • 52 - 001 - 0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800. 44.
Issued By ,�L� _ Perm ittee Signature: L�
��
/ 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 FOR ol;Fit F: t SE OMv
City of Tigard Received I I /1 � Permit No.: Et (- y 2t u _.oc `s (�gb
l �
- " 13125 SW Hall Blvd., Tigard, OR 97223 Pl Da an Review
i fq
Phone: 503-639 -4171 Fax: 503.598.1 �� ( V t� . Date/By: Other Permit:
T I C n R D Inspect Line: 503.639.4175 \ Q It Dote Ready/By: Jam= El See Page 2 for
Internet: www.tigard-or.gov , fied/Method Supplemental Information
u;,rx- a q p 2' *#, �, '2� +. *,E X x a t K > x :: ,.. - ,� f -. lg g, ' z `� s .; t m; .w k . .C „ . &' Y l , ?�; A z r < 3,,t4 4 � .y :`t `z s2�= r; ?s:" a-; _..... ti - . e.. *K..,<�.3
El New construction l5R1 Addltlori/alterahon/replac ie - 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 ❑ Other: � ~ where the available fault current ❑ Marinas and boatyards.
- M7 # 0 .0 IWAV } r t *'} ;r r .. ❑ Floating buildings
10,000 amps at 150 volts or g g
s
-; » '. - „' e e' less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling 64 Conunercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
r �.. ❑ Emergency system. larger separately derived system -
�s . ` 't"� a e 4e 3 "1_3 ❑ Addition of new motor load of ❑ "A» "E" "1 -2»
=� ° .� t "� -. ..e...+�`s. ��°7.°Y_ti -! f. ...:� =� + anti. '7' .c 'd ; s..a..., YLo..s . s,. .v +Yk.. r,..,x "���.... +i,.._i.xx._.
Job no.: Job site address: • , s,....) jetV- iitJ64?yr1 IOOHP or more. , ,occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: r � n Qn � 3 ❑ Health -care facilities. ❑ Supply voltage for more than
/'!/ !L ❑Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: X.7- ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: :, ` i t ' 5 xa . I '� ' ' 1 � '
Desatptba 1 ' Qty. I Fee. � Total f
New residential single- or main- fancily dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
I x itN ` .... t � a 3 . - £ " "" • f . �� ( with above sq if) 67.84 2
Limited energy, multi - family
,k)0- 3 1IT' p ST? T residential (with above sq. fl.) 67.$4 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
: Ate r - ss ' - '�. 1 t13 � . < , V i 201 amps to 400 amps 133 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, per panel
Owner signature: Date: A. Fee for branch circuits with
� y s � , ��„ f „ 3 �,� - N ;; ,+ � � � A '�° above service of feeder fee, 7.42 2
each branch circuit
Business name: A, tligeAfitiLli eistC cex0240 t5, «,JC . B. FSe for branch circuits
FV /� w t service or feeder fee,
Contact name:
K- K lift aftiehcircuit 56.18 2
Address: /033 (..5 lUt4t.*pij Ze)AP Each add'1 branch circuit 7.42 2
M iscellaneous (§ er or feeder not included)
City /State/ZIP: t IJA4gTjJ/ OR._ g 706 . • Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (sv3 ) e,7_15 I Fax: : (54)3 ) ‘7/ • /821' Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
_Wi. • k .` 4 - vi . x Zi - w `4 x ; s - ' ' Sign or outline lighting 67.84 2
Business name o, /j� Signal circuit(s) or limited-
/116044410k_ door 4C; S, /A) (. • energy panel, alteration, or
extension. Describe: Pa e 2 2
Address: /03 51- %I.)fFL A4p,..) `2.014- 1 g "7
City /State /71P: j � T� g 20e Z Each additional inspection over allowable in any of the above
J
(� 3 ) �' 2 _ s Per inspection 66.25
Phone: v / 6 r Fax: (S i3 ) G q/ - ' 7'
Investigation per hour (1 hr min) 66.25
CCB Lie.: fir' 9 3 Electrical Lic.: 3'- Suprv. L ie .: Industrial plant per hour 78 18
tl /Ct r f �0 L ��
Suprv. Electrician signature, required: r, J } ! y Subtotal: '�5
f r /� Plan review (25% of permit fee):
Print name: D p e tier. • LA Sq Date: / -// �.. State surcharge (12% of permit Yee): ✓
Authorized signature: - TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: / Date: z„/.../ �� days after it has been accepted as complete.