Permit 4 CITY OF TIGARD j , ELECTRICAL RESTRICTED ENERGY PERMIT
111 COMMUNITY DEVELOPMENT
fteP `/ Permit #: ELR2011 -00222
•
T I G A RI_) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/18/2011
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9459 SW WASHINGTON SQUARE RD A14
Project: Footlocker /House of Hoops Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Low voltage for CCTV. 4/6/12, reprinted to correct address from 9771 to 9459 SW Washington Sq Rd
Contractor: VISION SECURITY SERVICE Owner: PPR WASHINGTON SQUARE LLC
10874 SW ROLAND CT BY THOMSON PROPERTY TAX SERVICES
WILSONVILLE, OR 97070 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 502 -3909 PHONE:
FAX: 503 - 200 -2907
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/18/2011 $75.00
12% State Surcharge - Electrical 10/18/2011 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: Y 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: 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 i r an 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. TENTION: Oregon -w r= • ir s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 1 -0010 th ugh OAR 952 -00 -0090. Yo obtain a copy of the rules or direct questions to OUNC by 7 or 1.800.332.2144.
1
Is ued By: ` _ I � dL _ — �� Permittee SIgnatu
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.
,, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' - • '' ; ' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00222
Date Issued: 10/18/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9771 SW WASHINGTON SQUARE RD D08
Project: CCS /Footlocker Subdivision:VASHINGTON SQUARE ESTATES NO Lot: 108
Project Description: Low voltage for CCTV.
Contractor: VISION SECURITY SERVICE Owner: PPR WASHINGTON SQUARE LLC
10874 SW ROLAND CT BY THOMSON PROPERTY TAX SERVICES
WILSONVILLE, OR 97070 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
J PHONE: 503 - 502 -3909 PHONE:
FAX: 503 - 200 -2907
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/18/2011 $75.00
12% State Surcharge - Electrical 10/18/2011 $9 00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo N Boiler Controls N
CCTV: Y 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' N Other N Total $84 00
Other Desc: Required Items and Reports (Conditions)
This mit is issued s. ect to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law ' II work will
be one in accordance with - pproved plans This permit will expire if work is not started within 180 days of issuance, or if work is s •ende• fo• •re the 180
da s ATTENTION Oregon I req . ou to follow the rules adopted by the Oregon Utility Notification Cente Those r a orth in OAR
9 - 001 -0010 t ough OAR 952 -01 -*.90 You y obtain a copy of the rules or direct questions to OUNC by calling 503 232 1 •: o 1 80 3 4
I ued By:' t I ,g/( -" / Permittee Signature: ��J
l.Jt_
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 OFF ICE. USE O NLY: „ '
CI of Ti and Received �� Permit No E �j`�.QG f
`1 g Date/B d i,
° 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
.' a Phone: 503 718.2439 Fax 503.598 1960 DateBy: Other Permit
inspection Line. 503.639.4175 Date Ready/By y ions See Page 2 for
TI GARD
Internet www tigard - gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ,,dddton /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
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling 1:Salmmercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system larger separately denved system
❑Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: x"1"11 SUJ vp pSNtwc,lbl.S Sep 100HP or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks.
City/State /ZIP: —11LJ0 t a- ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name: .. C a 5 ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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'I 500 sq ft or portion 33 92 i
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft) 75 00 2
, ' ,, Limited energy, multi - family
N 57�rI�i l��®lV C , L, STrstu residential (with above sq ft) 75 00 2
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 /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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 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
y dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67 84 2
Pump or irrigation circle . 67 84 2
E -mail:
Signor outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited- energy
1
Business name: 1 T t �- panel, alteration, or extension Page 2 2
�' D ' ` 1 S-' "v Each additional inspection over allowable in any of the above
Address: \ .) Li CCORI4r C7 _ Additional inspection (1 hr min) 66 25/ hr
/� Investigation (1 hr mm) 66 25/ hr
City /State /ZIP:10����7 °\1 Ow industrial plant (1 hr min) 78 18 /hr
Phone: (503) (:).D. 5-3061 Fax: O 0,00 r c..=:i O ff - Inspections for which no fee is 90 00/ hr
specifically listed (A hr min)
CCB Lie.: \ 15a- Electrical Lic.: p ay._.1 Suprv. Lic.: $ q (.. . ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: // Subtotal' 75 OU
Pla review (25% of permit fee): �
Print name: t} ` �1,J�� � S tk D te: \ Q • `� - O� - z I '1 State surcharge (12% of permit fee). / 7 ' ov
f TOTAL PERMIT FEE. g L f .DU
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
1 \Bsildmg\ Permits \ELC- PermiApp doc 07/01/10 440- 4615T(11 /05 /CO,'d/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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n G • arage Door Opener*
n H • eating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n 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
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n I • ntercom and Paging Systems
n Landscape Irrigation Control*
n M edical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
, Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I \Bu ldmg\Permrts\ELC- PermitApp doc 07/01/10