Permit e CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 ; COMMUNITY DEVELOPMENT Permit #: ELR2011 00210
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued: 09/30/2011
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9597 SW WASHINGTON SQUARE RD B13
Project: Lush Subdivision: Lot:
Project Description: Low voltage for HVAC
Contractor: ARROW MECHANICAL Owner: PPR WASHINGTON SQUARE LLC
10330 SW TUALATIN RD BY THOMSON PROPERTY TAX SERVICES
TUALATIN, OR 97062 ATTN HILARY RAYMOND
CARLSBAD, CA 92008
PHONE: 503 - 692 -1565 PHONE
FAX: 503 - 691 -1879
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/30/2011 $75.00
12% State Surcharge - Electrical 09/30/2011 $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 set forth in OAR
952- 001 -001 OAR 1 -00 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
f
Issued B I r 1 � — ii ' Permittee Signature: `' ` °� GCiI/
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.
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E ectrical Perr i Ap nea t Io1 �} {' 7p-�) _ , 45S _ e,-- _ _
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.^ City - cif e 8ga£ (1J teBy l � J C��/��7`'��" y ' � v
� ' 13125 SW Hall 131vd., Tigard, OR 97223 I plan Rev,ew
L4 I Other Permit
Pho:aL: 503.639.4171 Fax: 5Q_ ; "59s.I96� 2 9 2011 Date/fly 1
,�� inspection Lute: 503.639.41 75 1 Date Ready/13y. I Jun. I 0 See Page 2 for
Internet. rvwx tigard- or.gov CITY OF TIGARD I Notified/Method I Supplemental Information •
CoAddition/alteration/replacement � -� = � V DID ". i
1 1 t = � eas., sit., i. that apply (submit sets of mans w /items caeai:e;: Y below)
__! New riSii �.iC1i0n . •' .: i ,< � Iid Y. i I Please t . P Y (submit below)
1 I ❑ Service or feeder 400 amps or more ❑ Building over three stones
1 0 Lemolitton II Other. I : where the available e current Marinas and _
- _ _ i � t h abl fault �e ❑ :< ar s h boatva t us
__ - - - ` - - - - :4y - -
1` exceeds I O 000 am sa 1.0 vo le or ^� Fl oating buildings
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7 n - p : ; ~ P o 5
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1' ...,., t ^� .. . ..........d s 1 4..,.,0 �..,,,......., a ^ncuhur...
. is ` �- - -" , r':: �.,. > ,: .: -- . , ;� 'F t__ b . C ,. � �. o..,.o.. �
j 0 1- and 2-family dwelling Commercial/industrial Accessory build
F NI Commranust ial j Accesy inu
dwelling building 1 amps for all other installations buudinys
I !!� r 1� Fire Li I KVA El Multi-family - - - - 1__I 1Vlaster builder � Other: � Pump Ln:;ta,lancr. of 75 1,\ A or
I - -_ _ - -_ - - - _ - _ - _ ❑ Emergency system larger separately denved system.
"
- - - - - - . _ ar3 - , - - -
^'M.-:i . `.A
- = d _,cr. r new motor load . f
- 1--� dl r 1
I Job no : I Job site address: 5 .. -. 44s ,:- . 0(1£ - - - me re Recreational occupancy
i - `i j,J / �T �V+JE�2iL r�' , J Six or more residential units ❑ Re ;eational vehicle parks
I r ! ( 0 Health -care facilities ❑ Supply voltage for more than
1 C ? tY/stat�, Z 'l':
/G q R� 17/ I7z / q
7 123 ❑ Hazardous'iocations 600 volts nominal
I Suite/bldg. /apt. no.: 3 / 3 1 Project name: 405y �5 . 1 ❑ Service or feeder 600 amps or more
i t S )L '/ � - _ - - ,?,s`r�yy�x.v�;C ,_y� q,,vim y `.F�` ' t - =:. � - _ - -
I Cross street/directions to job site: Description i gry. Fee. , iota
I I New residential s€ngle- or mult- family dwelling unit.
Includes attached garage.
I Subdivision: ' Lot no.: ( 1 1,000 sq. ft. or less I 168.54 I 1 4
1 Ea. add'j sq. ft or portion 1 i 33.92 1 I I I
1 Tax map /parcel no.:
r• Limited energy, residential 1
:. 67.84 1 1 2
- - v
t above s . ft.
(with :�s� r "�" DIY -3� � _ "''-;::.. ��:c`�� =.> 1 f
z
- J� , z
.. I Limited energy, multi-family
� -77:/'.12-1•410 rgy'^ 67.84 1 1
L: 2 I
'I /(,)at.) F Sr4r f : residential (with above so ti.) 1 1 1
I
I { Services - or feeders installation. alter` n. anor d/ r elodati a
u , 200 :nuns or less 1 a I�u.1n0.70 uz 2 1
t - :iii'
, �=,.Q;3
._ ,.
s; .:€A ,,'1±•±s'lt ^� - :•1+'N`�'�. _ ., am
, 201 400 amps 133.56 2
amps to
1 1Vai.e ' 401 amps to 600 amp 1 1 200 34 1 1 2
I 1 1 601 amps to 1,000 amps 1 I 301.04 1 2
Address:
I ( (Over 1,000 amps or volts ( 552.26 1 ( 2
Temporary services or feeders installation, alteration, ai .
1 City /State/ZLP: I relocation
1 200 amps or less I 59.36
I Phone: ( ) F ax: ( ) P 1 I ' 1 i
1 Owner installation: This installation is being g made on property that I own which is not 201 amps to 4 00 amps 1 1 1 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 I 1 401 amps to 599 amps 168.54 12
1 , j Branch circuits - new, alteration, or extension, per panel
1 Owner signature: Date:
, I Fee for branch circuits with I
1
r -' i '{ $� V j`a
,�i 'y .r
_ - -� <:
4. ,i'1= ��' "t'�k'.K4 +4h�. � »f.'r.` ,:kr . T� � � .3� "'`'a..ii,:.
- -- .ti''''p -^- � - � r _ _ _ „__ "_
i - . .a ' ° I 7.42 1 2
1 .; :` � <'' i=�xu�, - .., :o - , - ;....,� �> „ ��..«�� >s �.<.�;,-'% . ,...� <.. � -.:.., n _ : �..., � - I earl: branch circuit above service or feeder Zee 3
Business name: �-� _ ` 1 1 B F f or branch circuits
,�t�Oc� �IGP�f,41�1 j mt., �JNT �v 1 /�1 �' . - !
wi service or feeder fee,
Contact name. ( u '• i I 56 18
l./d ��40 O S /4 1 first branch circuit 1 2
Address: /6'330 .It.) 22)/1/44 2D4 1 Each accl branch? circuit 1 7.42 t 12
I �7Tr� Nlis•�ella.�vous (ser`vice or feeder not included) Cil /State/ : Eac ma nufactur ed or modular 1 I
3 1 % / (a g7a2_ I dwelling, service and/or feeder 67.84 f 2
f ' J 7
Phone: (503) t3 ) / _ / 8
9�- / � 6 � I Fax:: ( 5 ,� 6y 1 � Reconnect only 67.84 2
E -mail: /4-Z-42-0t3 M / F2 - //g ? , Co Pump or irrigation circle 67.84 , 2
- :;f'.:.: §, - , mot . . - - ,,•- 'T., °, i `� _ a sign or outl i 1
1
- = hue lighting 4 2
1,° - r - ' � m i 67.8
Signal circuit(s) or limited -
„ l�uSirteSS name: ;
,(]-21/ ,� r -1 , e/ i , e jp J > ,,� /r i energy panel, alteration, or 1 / ��757.f."1" Address: /0336 t j ,TJ/` �4 -7- -„ g))4 (, P ( extensi n. Abe: 1 ( 1 Page 2 /�' f 2
Ci 1
City /State/ZIP: . ) y j e �Z 9 7 x6 Z _" Each additional inspection over allowable in any of the above
Per inspection 66 25 I
Phone: (o3) ,r Fax ( )
F� 9� `r� "S I Investigation per hour (t hr nun) 66.2 ,
CCB Lie.. 579 3 Electrical Lie.: 3 y - '/7 GU j Suprv. Lie : y 3 0 L e8 Industrial plant per hour 78.18 l 1
! Suprv. Electrician signature, requtred: r f° r, Subtotal: /75 - '
Print name: p0 Si4LGE B21e: l , / Plan review (25% of permit fee): '�-
I� c. A �� �� / State surcharge (12% of permit fee): `e/ 9'.
Authorized signahlr " '' TOTAL PERMIT FEE: t Sh , C
This permit application expires if a permit is not obtained within 180
Print naive: /2� it, Date -7 .- / / I days after it has been accepted as complete.