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Permit 11 ,, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT s COMMUNITY DEVELOPMENT Permit #: ELR2011 -00083 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011 Parcel: 151260000300 Jurisdiction: TIGARD Site address: 9534 SW WASHINGTON SQUARE RD H -12A Project: AT & T Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project Description: Security system. Contractor: ADT SECURITY SERVICES INC Owner: PPR WASHINGTON SQUARE LLC 2815 SW 153RD DR 2235 FARADAY AVE STE #0 BEAVERTON, OR 97006 CARLSBAD, CA 92008 PHONE: 503 - 469 -7212 PHONE: FAX: 503 - 469 -7114 FEES Description Date Amount Specifics: Restricted Energy Permit 04/06/2011 $75.00 12% State Surcharge - Electrical 04/06/2011 $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: 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 $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 tgrth in OAR 952- 001 -0010 through OAR 952 -001 -0090. You may o. n in a copy • , • •iwctguestions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: (� — Permittee Signature: f rn. r, 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 OFFICE USE ONLY Received permit N o.: City of Tigard DateB : il � t�� //— .. .. :. • 13125 SW Hall Blvd., Tigard, OR 972,334 it Plan Review Phone: 503.639.4171 Fax: 503.598. '1, Date/By: Other Permit: ` kris: ® S ee Page I G A k l) Inspection Line: 503.639.4175 is 5 - 6 1 Date Re /By �., ge 2 for Internet: www.tigard-or.gov Notified/Method: j Supplemental Information l' TYPE OF WORK r PLAN REVIEW ❑ New construction ddition /alteration /replacement Please check all that apply (submit 2 sets of plans witems checked below). ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings. less to ground. or exceeds 14.000 ❑ Commercial -use agricultural ❑ I - and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SiTE INFORMAT t LOCATION ❑ Addition of new motor load of ❑ "A", "E ", `l - 2", "I -3", IOOIiP or more. occupancy. ' 3 Job no.: J site /'� //', ,' �� QQ qn �y�a - / e address: S� W ❑ Six or more residential units. 0 Recreational vehicle parks. City/State/ZIP: /) d 972 3 O ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no de• 11 Project name: / j ,h ? t /, T .) ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qtv. I Fee. I Total I * New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 ''a (I_ , Limited energy, multi - family 75.00 2 II /� 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 2 401 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/Zi P: 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 40 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 extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 2 each branch circuit 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 included) City/State/ZIP: Each manufactured or modular i 67 84 2 ty dwelling, service and /or feeder Phone: ( ) Fax: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited-energy r� Business name: se-60,e/ r panel, alteration, or extension. Page 2 /� 2 y Each additional inspection over allowable in any of the above Address: tikls-- 6.0) /53 3d si b2 Additional inspection (1 hr min) 66.25/ hr City/State/ZIP: ,e6- 7Z A) ©, - 9700 6 Investigation (I hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: (53?) 94,9 7 6 f Fax: (+03 ) 1 /69 - V/ 44 Inspections for which no fee is 90.00 / hr '' // specifically listed ('/r hr min) $- CCB Lic.: 9 9 7� Electrical Lic.:24 ! 09 eaf Suprv. Lic.: 3 y(,E9 ELECTRICAL PERMIT FEES Subtotal: Suprv. Electrician signature, required: /A Plan review (25% of permit fee): Print name: i e te Date:' �p // State surcharge (12% of permit fee): y 0 0 TOTAL PERMIT FEE: ,94f, 06 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. I: Bu ,ldineermits PcrmilApp.doc 07/01/10 440- 461ST(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* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ 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 i ❑ Boiler Controls ,n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation L HVAC I I Instrumentation n Intercom and Paging Systems Li Landscape Irrigation Control* ❑ Medical , ❑ Nurse Calls • n Outdoor Landscape Lighting* • Protective Signaling Xf Other C. / g2/ / e CA/6 y SCG' U ?i Ty .5/'S% E/V Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:` Buildin `,PermitsELC- PermitApp. doc 07 01 10