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Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ' 1 1 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00081 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/05/2011 Parcel: 151260000300 Jurisdiction: TIGARD Site address: 9534 SW WASHINGTON SQUARE RD H -12A Project: AT & T Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project Description: Data telecommunications system. Contractor: DYNALECTRIC Owner: PPR WASHINGTON SQUARE LLC 5711 SW HOOD AVE 2235 FARADAY AVE STE #0 PORTLAND, OR 97239 CARLSBAD, CA 92008 PHONE: 503 - 226 -6771 PHONE: FAX: 503 - 226 -7720 FEES Description Date Amount Specifics: Restricted Energy Permit 04/05/2011 $75.00 12% State Surcharge - Electrical 04 /05/2011 $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: y 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 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952- 001 -0090. You m�tain a • - • • - ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / r Issued : . /S Permittee Signature: ._ 1. - - _.L..... 4112111. MI t/ 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. 2011. APR. 04. M0N 12:53 DYNALECTAIC SALEM FAX No. 503- 391 - 2817 P. 001 Electrical Permit A.ppliicatiion. . FOR OFFICE LSE ONLY City of Tigard RRe v cei a s it r si Permit No j �, ,�, r �, a 13I25 SW Hall Blvd., Tigard, OR 97223 play, Review - 1 a • Phone: 503.718.2439 Fax: 503.598.1960 Date/By. Other Permit: /�rL1 /I _ fi �- Ti V A 4t 1� Inspection Line: 503.639.4175 Date Ready/By: Jun!: See Page 2 tor Internet: www.tigard or.gov Notified/Method: . Supplemental Information a,�w,r „wxut " , °' 4 r , � T rr<1t�(k ;S 1 i ltt� dal[ r .4 tibD a.�5i f ll ll rfF F CtO r.nirm, A,,Q` ' „J ® New construction III Addition /alteration/replacement Please check all that apply (submit z sets of plans w /items checked below) 0 Service or feeder 400 amps or more 0 Building over three stories. ❑ DertsOlition D Other: where the available fault current i] Marinas and boatyards. ' " ` 1 ` �,,� YAM y�} exceeds 10,000 am ❑ s at 150 volts or Bioa b o ' '.l r,, WAI, , ,b, , ,! s irh �. t , ' . , t : ' 1 Ira' .. si less to ground, or exceeds 14,000 0 Co -use agricultural ■ D I - and 2- family dwelling ® Commercial /industrial © Accessory building amps for all other installations. buildings. 0 Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 7$ KVA or t � � r , i ■' ,.',. i.. 01 , s1 , ,, , , t . O Emergency system, larger separately derived system, x g ilt , }! ni ,I' v o 173E-N.;,..,-m3,1 � ®. '�Ts�t �r�r�h {? L 1 'l t 1! ❑ Addition of new motor load of © • r w1w!e , .M�.. t , rs "1-2", lyderiv Job no.: 111076 -1090 $ Job site address: t SW Washington Square Road loo[1P or more. occupanc 0 Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: Tigard, OR 97223 - ‘9.(311 ❑ Naalth -care thclities. Q Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: I Project name: AT &T Mobility © Service or feeder 600 or more Cross street/directions to job site: Washington Square Mall iigN i t S b 1 � gl ta i cription I Qty. I Fee. I Tagil i New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. tt. or less 168-54 4 Tax map /parcel no.: - Ea, add'l 500 sq. ft. or portion 33.92 1 p Limited energy, residential rr `ii>}L.jsl '' t +, t r . +. :i,.aa t i il l ,, , ,• 4 ( 10 ; - ,,7 `?tirh� i itiItlil / (with above sq. ft.) 75.00 2 c ! ,, r ,' ,th. C R,., 0i,i i ■ .as. i:4:iw..,' Limited energy, multi - family 75.00 2 Voice & Data Cabling residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 rs, era k. r , , 1,0 DA ib i inif ml r Oflt • R ,,,, v ;aL, • + , 1 % If a , ors . k }try ;" tl a ' Vi i , i i 0. 0 • f {i t .1 . ;'1,;,.„ 201 amps to 400 amps 133.:$6 2 +f 401 amps to 600 amps 200.34 2 Name; 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State/ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner Installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits- new alteration, or extensloner pastel Owner signature: Date: A. Fee for branch circuits with r 7 f t f° { , .t I ?� i •� �9 L g�,.r�`, 4� 1 , p i '�, i,i . !r , t ' P" ��L'i ,,17 above service or feeder fee, iicl tk ilt.i i l:l<rr,..,ig, ak t'a/ i�t:7,Gti:21. '� iiiG. l »,lfiilhi:. {atct4 b 0. . O5 ,.. ,° i 7.42 2 each branch canon Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit - Each add'[ branch circuit 7.42 2 Address: Miscellaneous (service or feeder not inclu ded) City /State/ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) I Fax : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 -marl i , +, .. ! 1,.. 1 .G.,fit i , ,,F't�r!r� z ... ; l, d ,' '4i''. ' . . � f; 6 7.84 p!t&�t yy��t¢Ff, J��4�� 1810 or outline lighting 2 f �� °�� r � itr., ,#$..., �� 'tl'N,,tt,0�'� -:. � ,.. �, � i : 'i ,..,".',..`r - Sigaal Clrcuit(3) or limited-energy Business name: Dynalectric Co panel, alteration, or extension. 1 Page 2 75 2 Each additional inspection over allowable in any of the above Address: 5711 SW Hood Avenue Additional inspection (1 hr min) 66.25/ hr City/State/ZIP: Portland, OR 97239 Investigation (I lu min) 66.25/ hr Industrial plant (1 In min) 78.18/ hr Phone: (503) 484.0206 Fax: (503) 484.0233 Inspections for which oo fee is 90.00/ hr speci listed ('k hr min) CCB Lie.: 66793 Electrical Lic.: 26 -59C Suprv, Lie.: 4653 S t'w r # ;i'r '± 1". ' ;' ti;E71✓' ij)(�;�;R1 , nt, ww, r Suprv. Electrician signature, required: ( j Sut ): 7 j� C `yn� � ' Plan review (25% potmi fe e N/A t fee): N/A Print name: Edward Ryding Date: 4/4/11 . State surcharge (12% of pernah fee): 9 -00 Authorized signature: TOTAL PERMIT FEE: 81.00 $' . W �r►� . . - 1, .4 • .4 J .i , A This permit application expires if a permit is sot obtained }within 180 days a fter it bas been accepted as complete. Print name: .: ' ... _ ( ten i1�9 e ' , Date: 4/4/11 ' * Number of inspections allowed per permit 1: 1BuildingWamits1ELC-PermitApp .floc 07/01/1100 '7' 440- l615T(11 /05 /COWWSS 2011, APR. 04. M0N 12:54 DYNALECTAIC SALEM FAX No, 503 - 391 - 2817 P, 002 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for au residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* Li Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: ; A,. ? OVA _ ipf•3 i.i.220 I';+rr'.i'Et. imam ; " Fee for each commercial' $75.00 system (SEE OAR 918 - 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems Z Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irtigatiou Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required iall installations I AELtOduag\Pe+wps\ELGPamtApp.aoc 07/01/10