Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
` "7 ! - COMMUNITY DEVELOPMENT Permit #: ELR2011 -00140
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/21/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9611 SW WASHINGTON SQUARE RD L03
Project: Victoria's Secret Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Low voltage for data telecommunications.
Contractor: PRECISION ELECTRIC OF WA INC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 2353 2235 FARADAY AVE STE #0
BATTLEGROUND, WA 98604 CARLSBAD, CA 92008
PHONE: 360- 260 -4544 PHONE:
FAX: 360- 260 -4833
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: 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 acc• • - • e 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. AT ITION: Ore" law equires you to follow the rules adopted by the Oregon Utili •• Center. Those rules are set forth in OAR
952 -001 '010 through OAR 9 , •01 -• 09r ou may obtain a copy of the rules or direct questions to 0 I • • r 7 or 1.800.332.2 4.
Issu • By: � � lF A. I Permittee Signature: A " / ' ,' ' !�_�
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.
Electricals Permit Application • IZECEIVED FoR OFFICE USE ONLY
City of d Ti an � ^_
101 g ' JUN. 2011 Rece;ved & /7 it c prrnit1s10,: 6,4,;20 /". -to /.
us
• 13125 SW hla11 T31vd., Tigard, OR 9722 Pktn Review �' - '
'' u . Phone: 503.718.2439 Fax 503.598.�4ti OF TIGARD flii1tl /Itv' Other Permit:
TiGAItD Inspection Line: 503.639.4175 . ' 1 i i Date Rcndy /By: Jena: El See Page 2 Cur
Internet; www,tigard- or.goy BUILDING DIVISION Nteilietlrntep"r>d: Supplemental Information
:: .�;. , ,..._..._ :: : : : :�_� ,. .icy, ... ,_, .,� :, :_.. ., :. :., yw': - - LLvr:...': '
au ;.�:. /.�eCCa� �?"- t'irira3;x > , rca� ■ .tw �''1P�. 15�," W[)IL.. r.. .. � "Y�'m ,: Su _ '''P� • RL�,1!"1L'W {aw *� , :.P `�?i" :wt
_ _- 'p�L1 - _
❑ New cutlstruct.iun El Addition /altertd.ioti/replacemcnl Please check all that apply (Submit 2 scL4 of plaits wliterlls checked below):
❑ Service or feeder 400 amps or 111011: ❑ limilding over three stories.
❑ Demolition ❑ Other. wlicre Ike available fault current ❑ Marinas andboatyaids.
00
.
-- "" : d1'�'iYn.n „ W :vr::rr.:..,, k . i ',i- - Cx m', 10,n amps . 150 volts or ❑ Floating buildings.
... _. " .�.mrr_� "er ,....,aC I:GMf./1x"�...pS' ti.oN+, :,M'iRA;iI�`.� _ ; ?ii::.' i, la's.
less to ground, or exceeds 14,000 ❑ Commercial -use offricultnrnl
0.1- and 2- family dwelling ❑ Commcrciul /industrial El Accessory building amps for all other installations, . boildir,pys, ' .
❑ Multi - family ❑ Master builder ® Other; ❑ Fite pump, ❑ Installation of75KVA or
'• :c :. : -. :.:.:,:..._,' ...,. � �,.,...... :,. -.... .. ,.... ,. ,wM .,:a,_.., , . _ -- - D l'alreritency system. larger separately derived system,
;..-:.K. M:• :;ac. ^MwM'�Mr 7 i w':
"r' :w :� _._�'.i - :. ,. :. : :.� :__ : : ° � �,,, :7.$ - �J�VF,W1iM�1'1j,lCJ ,. LOC,atiti'EO - :.�.w..; : : 0 A4dilion nf new motor load of GNU.'. washington s .:,. square R . : : :,�.. ",,,
- -' --" " Job Silo �• ' ^ -, :� ,.. : ° nddres: 9611 sw was6in •r J D "A", cu p a n "I -2 ", "t•3"
Rd
1001 or mo occupancy.
Job n0.:
❑ Six or more residential units. ❑ Recreational vehicle parks,
City /State/211s: 97223 ❑ Hcatth - care facilities, ['Supply voltage I'm more than
1:1 1•Imeminus Incutions, 600 volts nominal.
Suite /bldg. /apt. no.: Project name: victoria secret Q Service or feeder 600 amps or more.
• ,i, -rM: " _:.:;1` (1 W?'tl!: ;! h ,F.FI l f.�JIEAY« w� . ^hiss .IA *..IgiO." Mw:
'd :: c t ., l Total r..iW.': L :fMf
Cross street/directions to job site: spac L -03 " "' '- "� "' - ""
. ._ •I p' _UeMCrlPtlnn _ I QIY. 1 Fe', 1
New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: • _ 1 Lot no.: 1,000 sq. it, or lcss 166.54 4
Tax map /parcel no.:
Via. add'I 500 sq. ft, or portion 33.92 1
* rte ^ r�n5re ^mwx .,rrrrx}pgp"---- :,, -.— :..-- ergy,r 75.00 2
:::::.: .:._..sass.. _.
.�:�!'.'.. :.."..its' : :... n�ntM' �tk. �MiMlk. �;":.': F' �w '�i;..:l;.am.����l���ii.�. :..: . r„ l��l 'il�W. :W : v , y.: :R.J��..'.. w�� C (with above sq. i3.)
Limited energy, multi- family 75.00
running new data lines for com puters . residential (with above sq. n.) .
Services or feeders installation, alteration, un dlor relocation
a,.. r
200 amps or less 100.70 2
_. ,elf, t ,.. G .._.._....._. G kit "
.............._.... ,�' f4't" °' :. : -.: c�rti„ :❑ ..... ., , .t,,,�. 2 amps 133 56 2
. •H :N :. `r " i�'; %=. ..: amps 401 amps to 600 amps • 200.34 2'
Name: washington square mall
_.__ 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; iiiitl/or
relocation
Phone: ( ) • Pax: ( ) 201 amps or less 59.36 l
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on properly t.hid I own which is not 401 cups to 599 amps 168,54 2
intended for Sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701,
Branch circuits — sew, alterrdioi. or extension, perpanel
Owner signature: Dube; A, Fee for branch circuits with
a! :- - .•a
.:- - -a 1 F a-_ teswwx' ttba s r fee e fee.
7.42: d
tier : : : i „,,a :. : , :..- ,. , :�,1 :: d`,r)wi tC r-,'< : : : :. : r::: :.. :. ' :' : : :. �'1�'. �i�❑ IV'fA RSO . _' .....,.._
each vc brmch ci oil
Business name: precision electric of wa 13. Fee for branch circuits without
M service or feeder fee, first 56.18 2
Contact name: joe downing branch circuit
— Faclt add'1 branch circuit 7.42 2
Address; po box 2353 - miscellaneous (service or feeder not included)
City /Statc /ZIP: battleground wa 9K604 Bach munuiactured or modula 67,64 2
else n , service and /or feeder
Phone: (360) 2604544 Fax: : (360) 260 - 4833 Rcennnect Only 67 2
- - pump or irrigation circle 67.84 2
E -mail: joegpr- electrle.corn - .
!' r.p;; +'. - :._� ' := ;_: : :_ tiv_9'ty > :'s -. ' ..._._.__.' _.._......:.. . ' - - Sign lighting 67,84 :.' " i! ..,was :ww-T .,... ,r .� .. .. r ._ .
.=..' _ -:_ fit.,, -NCO .. GTOR ,, ,,' " i1.wiP' n m
= � -� Si g n al circuits) Or limited- enemy
Business name: precision elccti rc of wa ' tat.- panel, alteration, or extension, Page 2 , 2
' Each additional iuspeclioa over alluwahte in any of the above_
Address: Po box 2353 Additional inspection (1 hr min) 66.25/ lir
--
City/State/ZIP: battleground Wa 98604 Investigation (t hr min) 66,25/ hr
-
Industrial plant (1 hr min) 76.18 / hr
Phone: (360) 26114544 Fax: (360) 260 Inspections for which no lee is
, - (14 90A0/ hr
• (;Ci31..ic.: 168935 � , slteeltiCnllY lislcd hr min
__^,
/ /A Electrical L' ,. 153 1 Su ry Lic : 3829 4 -�- : '" "r E:
1I 1? /a �l -. : �w. �i. T, L` I'k :tf:;�'I.- , :t'k'ritl►tl'II'. r y; r
Stlprv. Eleetrici signature, Subtotal: 75
required:
• -- - ��. _. Plan review (25% of permit fee): �— .
. Print name: Ray _ ate: 6-17-11 State surcharge (12% of permit fee): 4.0°
Authorized signature: _ TOTAL PERMIT FEE; 5/ , DF�
L _ i'hx h e
irmit application expires if a permit is not obtaine within 180
Print name: Joe Downin Date: 6 - - days after it has been accepted u■ complete,
• Number of inspections allowed per permit.
1 arluildinu\ ermitsla'LC- PersIkApp.a.w: 07/01 - 440 -46 I ST( I I /UNCOAUWLIt
200/l00 EE9V09209E(XUJ) EE:Pl (IdJ)t102- /l -Nflr
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined $75.00 ".•
y
Check Type of Work Involved:
• a Audio and Stereo Systems'
El Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
•
n Vacuum Systems*
. n Other: •.
•
„.. tC
. .O��iX I;�:I.,�W.,U,I'�A.I\7 �- �'-'�, w "'W :.....gEE 3 Z.
•: 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
® Data Telecommunication Installation
❑ Fire Alarm Installation
❑ I - IVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting* .
p Protective Signaling
❑ Other
Total nutnl,er of commercial systems:
NO licenses are required. Licenses are required
for all other installations
I:\ uiJinglr.rnffn \ELc- rmitApp.doc U7Pol/ W
200/200•d EEOU09209E(Xdd) EE:Ut (IdJ)tt02- 2.t -Nnr