Permit r CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�'l F - COMMUNITY DEVELOPMENT Permit #: ELR2011 -00135
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/21/2011
TIGARD Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9530 SW WASHINGTON SQUARE RD H10
Project: Apple Store Subdivision: WASHINGTON SQUARE MALL Lot:
Project Description: Low voltage for HVAC wiring.
Contractor: JACOBS HEATING & AIR CONDITIONING Owner: PPR WASHINGTON SQUARE LLC
4474 SE MILWAUKIE BY THOMSON PROPERTY TAX SERVICES
PORTLAND, OR 97202 ATTN HILARY RAYMOND
CARLSBAD, CA 92008
PHONE: 503 - 234 -7331 PHONE:
FAX: 503 - 808 -9108
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/21/2011 $75.00
12% State Surcharge - Electrical 06/21/2011 $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. Tho e rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0090. You ma • - - - • • • •irect questions to OUNC by calling 503. 9877 .332.2344. 34� / y�� p
Issued By: /L _�� -' Permittee Signature: }t.l �/ Y UO-Pi h ,_ 1
sod 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 Applications n FOR OFFICE USE ONLY
City of Tigard L L 1 144 9 Date/B
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n 13125 SW Hall Blvd., Tigard, OR 97223 ro R
Plan Review ��11 �� Permit No.: / de/ Z/� /[ 3i
Phone: 503.718.2439 Fax: 503.598.1,960 H 2011 Date /By: Other Permit: ..---
TIGARD Inspection Line: 503.639 Date Ready /By S El See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGA =,D Notified/Method: � /7 l/ ' Supplemental Information
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1=I New construction I/I Addition /alteration /replacement 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.
.r
;; >�;, : " z ' � ° . ` �°��a`� Y��'::v x=` ='�� -� excee 10 000 amps at 150 volts o Flo buildin s.
:.. t , G .O CONST 7IIGTIUN : ::t ' ' g g
say:•::: .; "s;;' ,, >,:. n,,,.:• -:.: . , .:..,::...:..,.., -..:k- - ,
_" " less to ground, or exceeds 14,000 0 Commercial-use agricultural
❑ 1- and 2- family dwelling Commercial /industrial El Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
. ,; ; ;,- ,,,,,;, ; .,, ro ,::- ❑ Emergency system. larger separately derived system.
: ;• .ros =,srTE mFOxI411ATN nN.. �ocaTlox :, A 4 3
�:' < .. , .. �� , .. ....,� �. . , - -'� �� „:- ... ��.<• ,.. <�:.�•.;.�..:fa�» •.� •� , ���snam:��,�'� ❑Addition of new motor load of ❑ .. ..l `1
/'� 100HP or more. occupancy.
Job no.: Job site address: ` i)J 1 � ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 19a Yd R C1TD,D3 qua- ❑ Health-care a do facilities.
❑ Supply voltage for more than
❑Hazrdous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 1 Project name: t t {'p lf ❑ Service or feeder 600 amps or more
'' ` FEE "SCHEDULE 3 ":
job site:
Cross street/directions to cr . ,, . , °. s •
,l Description I Qty. I Fee. 1 � / Total 1 *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 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 I
:.,... residential 75.00 2
Limited energy, residen
,::: c , A `n ' ? i.,� ,,,'' :' (with above s . ft.)
: 't , " - a ,,: .D Q l2 ) ON , o -N " ( q
y
Limited energy, multi -family 75.00 2
• L63 \) Q , - 4 I I L „' - A- e ` cn O residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
,.;;�_: �� , 1:, »� tea--:- tea•• ;4: � ,5 t ,;+i 5 :.< ..
® " >; PROPERTY' ;OW NER° A , z W : ; , Y ' Et1AN, . ," 201 amps to 400 amps 133.56 2
, ,K. ; ,� a:: ,,,.:• .�>; .:«: ..: ;,,- °��<.... <,:.�. <._..,: %.>��. a�x�r•,'v, " ms s: 1�''v. .��
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: ( ) 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 extension, per panel
Owner signature: Date: A. Fee for branch circuits with
" ., •, ••\,,, - above service or feeder fee,
as APPI ICAI\T ;, i .. .:..,. : GO VTE,CTa PER " 7.42 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'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
?CQNi'RACTO[t��. � ,�: >z�;,,= � `a �� 67.84 2
>:.
cV�.�,.� -..,.. �,�- ,�,,.>,Ye�i„ ><r;�.:��- - ...:. ........_..�- x��-�� .,. �ka� :�,- �N.- >��. >:do;.., ";�:�'- Signal
/
Business name: _y_, panel, alteration, or extension. ' Page 2 7 S 2
l �� Ll n 1 �. Each additional inspection over allowable in any of the above
Address: `'C`4 ", LA �� t \ k io ` O t ,Q Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: t [ 5 'v v 1cad I q'�a
o Industrial plant (I hr min) 78.18/ hr
Phone: 9 " %' X1 (4 .2 Fax: ( aq p ` Inspections for which no fee is 90.00/ hr
u
...y--)., specifically listed (/z hr min)
'��R •' 1" �:,, �' � E> EGTRTGAIiREERNITTQ 'isE'EES��.�����<:,:,�x °; <•��.
CCB Lic.. � Electrical Lic.: �� Suprv. Lte.: a i0 .e„r, -, „��,�
W Subtotal:
_ r � �
Suprv. Electrician signature, required: ` 2 7 � �
Plan review (25% of permit fee):
Print name: J�k� / %L ( Date: State surcharge (12% of permit fee): OD
J (' TOTAL PERMIT FEE: , 04,
Authorized signature: Y�� yt �v(Y1 n
. I l 1 t 1 Ut This permit application expires if a permit is not obtained within 180
f � days after it has been accepted as complete. - LW Print name: D v. m� cy Date: li . I5 .1 1 * Number of inspections allowed per permit.
t \ Building \ Permits \ELC- PermitApp.doc 07/01/10 440.4515T(11/05/COM/WEB