Permit N. CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00020
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2012
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9636 SW WASHINGTON SQUARE RD G10
Project: Buckle Subdivision: Lot:
Project Description: Security system.
Contractor: 3 GUYS ELECTRIC LLC Owner: PPR WASHINGTON SQUARE LLC
2062 NW 15TH CT BY THOMSON PROPERTY TAX SERVICES
GRESHAM, OR 97030 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 729 -1522 PHONE:
FAX: 503 - 661 -7378
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/03/2012 $75.00
12% State Surcharge - Electrical 02/03/2012 $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 ark set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a cor • • - - s . - . uestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: -
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.
02/02/2012 10:10 FAX 5039883377 MULT COUNtY AttORNEY 2 001/003
cij;) •
Electrical Permit App]icati0tro hirrc OFFICE lar; i)Nl.l
City of igard -, 'L - Received _
.r I . PermitNo,! +* �� )
■ 13125 SW Hall Blvd„ Tigard, OR 97223 W V Da Review I iii,.. [ ' Phone: 503,718.2439 Fax; 503.598:1960' 1GP 1p1� a Other Permit
TI t': w R 1 t Inspection Line; 503,639,4175 k (* l� Date Rdedy /ldy: mrh; 21 gee „21..3 f or
internal: www.tigard- or.gov rC� _ Notified/Method: 9 .� - -e
,'1 ";i'�i� ; P,II � +; ; il'g " ; '. , V f 'I p r�li'4 „ "r^T l � , ,,, 1 ICJ' Supplemental Information
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❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sots of plans w /items ahooked below):
❑ Demolition ❑ Other: ❑ Service or leader C00 umps or more ❑ Building over throe stones.
'I' ?;'f!i,fj',j; '''' 1lil!lll'(�Iljllilllrs " '1 �y,, � , where the available fault current ❑Marinasandboatyards,
,II; „td ', I ∎ '4' i;,li „ ?1 1 1, Mjil,1,;∎ , I;i' ,, t it*041 t! ';I;0div iititt ,al it ,;' '' . ; ;i T, ,11 I , ', ';;ill l ',.. '' -coeds 10,000 amps of ISO volts or ❑ Mooting buildings.
less to ground, or exceeds 14,000
I- a nd 2-family dwelling �° ❑ C ilding cial.age agricultural
El Y g ® Com mercial /industrial ❑Accessory build amps for all other installations, buildingy,
❑ Muhl-family III Master builder Other: ❑Fir
❑ P. ❑ Installation ot'75 KVA or
mp;
`'1!',!`A� l ,1r i{+y ii ,1r,io i j v z14 ' I, ,, i..lio:p; I I•r,d'l , " lar a+ ❑ Emergency ayatem, ; ((11 i,1 ; , li,; , 1 lii1 ,,,,y}' i� ,li4!'wy,w,A r "; h:g
, ur�►'ifi ar. u,l ' ,dl i • IE� i, ? -a aer separately derived system,
i l , , I �, , � , I,Ib„j l y, ,il�j ,1r., I � I ��,
.;�I,�i,'If' ❑ Addition ol' ndw motor load of ❑ ^Q ", "I.2" "1.3"
Job no.: I Job site address -3886- Washington Square Rd. IOOHP or more, occupancy,
9 � 3 Cl Six or more residential units, ❑ Recreational vehlelo parks.
City / State/ZIP: Tigard, OR ❑ lioalth -care facilities, ❑ Supply voltage for more than
❑ Hazardous locations, 600 volts nominal,
Suite /bldg. /apt. no.: 1 Project name: Buckles ❑ Sarvlao or feeder 600 amps or morn,.
Crass streed it Washington Square '' ''; Description 'I .. ? �I ti9 SI "t. MP7'ilrll;ll,' tiltitiiil < 1 i , iP i f °1; II'
d actions to job site: rWa h Description Qry, Nee, I Two
- New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision; Lot no,: 1,000 sq. ft or less 168.54 4
lra, add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: _
,y;;f:;l(, 6' ail ((i li ;(((" I ?1'' ; !t,it 4 ";;;; l h p1 A
! �i'r , ;?�, , r� „I T , , n 1 I ,, I Limited energy, residential
! i ,; J" ;ai� I 1 ,1 ' ! , E I�' I ,i I IJi ' I § ��', lif: �, 1 141!'; :; Jk.* , ? '� I1/ , 1 0 1 I lip y 1r , 7s,oa 2
�?, t i J. "� ,,a ,� iii'I I ii �I'I �''',� ,"'r ';ll, °i1 a ll,l4,i,,iii 1 (with nbova aq, ft,)
Limited energy, Multi-11141111y
Install Anti-Theft System at Front Doors residential (with above sa, ft.) 75,00 2
- Services or feeder. Installation, alteration, and/or relocation
201 a 200 apps or less 100.70 2
{J � �{y a� 1''!' t. °11. ,I''i : !J ?„ I I,rf,'fii ll il ,1, , ,f , ,,,
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,,4, +1 ! 1„ '1' „ 71,',1 "�I} ._c'� ,,, ,' Ile�'„��,',IsrtL,j(Ili,,q�! la {�t�l'i y' � 'I;i +:�l'lu,iih i�l�llr,�",r�l I ,�,.,,A;,'1;' Ih(,'a' ,,, amps to 400 133.56
1. 4 ; '� ' , I L li ^ 't � (" },'l , 2
Name: 401 amps to 600 amps _ 20034 2
601 amps [0 1,000'amps 301,04 V 2
Address: Over 1,000 amps or volts 552,26 2
City/State/VP: - Temporary services or feeders installation, alteration, and /or
relocation . .
III
Phone: ( ) Fax: ( ) 200 amps or loSS 59.36 I
201 amps to 400 amps 125.08 2
Owner Installations This installation is being made on property that f own which is not qpl 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 circuity with
• ' y' I ,'9 J + °I , ' , ,.,' I' 1' S • , f'' t � N }Il ' 1 , ' "I q` 1'„ „ ,,
1 i r I I 'c' itl ,I .,I, above service or feeder to
(„ { 12 1 'l' " ',I ( �, I 0 ' ,I , � iii 7 i 1 , 1 ^ ,i 'V I` 111, y ,� { p, y ,y{ �h�+}��q, I Ii I e,
iI Ih ho';I',id', , . , , I ,1 -
I41;(I '�, .,, ' I 1 ,) i 1 1H +L' , Ill, 3 , .. .,, ,. ∎,,, ,,II!' I; 7,42 2
,'i!, 4 , ,,'� I'.�('i � each branch circuit
Business name: 3 Guys Electric, LLC >3. Pee for branch circuits without
service or {Cadet f oe, fi rst 56, I 8 2
Contact name: Wade Hadley branch circuit
- ---- Each add branch circuit 7,42 2
Address: 38871 Jorger St. Miscellaneous (service or feede not included)
Each manufactured or modular
City/ Statc/ZIP: Sandy, OR 97055 _ dwolllnH, service and/or Pother 67.84 2
Phone: (503) 729 -1522 LFax:: (503) 826 -1133 Reconnect only 67,94_ 2
Pump or irrigation circle 67,84 2
E -mail; wade3guysggmail.com
?t ., 8,., I 1p , yytll °' ! p1:Iq nr,,lu itI�t�l��it,t g I P ', ! ' a, f;d„a t! (; Sign or outline lighting 67.84 2
!
' I :' 1
, Ill,,, i , j !tlj`,q I lll f ,t! 1111 y� ;, i 1 "4 I Ill``Il, (J i! if'i I Il' "''I;I' I1 /I -
I .,.C' , I_, �r e ! , i,1: a,oi1l,41,II11'll ' �W' 1 TiY.• �I'! I' lti, I, 1 , ! 4 1': ! f , �y�J , I' ,,,,,, h , d;li�� ,�',',Il ,y ,,,;,iii S ignal circui�(y)Or'llRlll'ed•enOrgy
Business natnc: 3 Guys Electric, LLC panel, alteration, or extension. I Page 2 7500 2
- Each additional inspection over allowebie In any of the abov
Address: 38871,ferger St. Additional inspection (l hr min) 66.25/ hr
tiwcstigation (1 hr loin) 66.25/ hr
City /State/ZIP: Sandy, OR 97055 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 729 -1522 I Fax: (503) 826 -1133 InSpoctlons for which no to is
specifically hated (% hr mm)
CCB Lic.: 177242 90.00/ hr
Z ._ . Electrical Lic: CL IE120 S Li 516LE " r;' ,,,° ' 7 7 � j p f`\'r :r '' �;T4C�RTCiACIi''ItAY11T1FE'ES, ', / u rv, e,: A 17 Subtotal: 75.00
Suprv. Electrician sigma e, required:/) �� t ,e1"&o....._ Plan review (25% of permit fee);
Print name. Vinton Wade Hadley Date: 2 /02/12 State surcharge (12% of permit fee): 9.00
/ J TOTAL, PERMIT FEE: 84.00
Authorized signature: r „ ;& ,.... ,� 'thi permit application spires if a permit is nor obtained within 150
days after it hag been accepted as complete.
Print name: Vita Jane Hadley ate: 2/02/12 • t■lmnber of inapoctions allowed per permit.
'Mal lalm Parmlu\BLC- PermltApp,dw 07/01/10 140 4615TO1/OS /COM/WM
02/02/2012 10:10 FAX 5039883377 MULT COUNtY AttORNEY a 002/003
Electrical Permit Application - City of Tigard
Page 2 - SupplementaI Information
LIMITED ENERGY PERMIT PEES:
1 '1 1 � ', •�, a ^,111 ,i ,,• � •r, �. ��
i," i � t �,' °� I ��M141 !�, - �ir�� i �� %li{;�111I { {�o,{ {�11111i1t {�4i7�1 �����i� ;'' , {��I'� i�c,i0
Fee for a residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial $75.00
system •
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock S
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
I I Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other AntisheFt System
Total number of commercial systems: 1
*No licenses are required. Licensee are required
for all other installations
1;16 0 11 01 0 0 'arMIO1CiLC- pahAltApp.dcC 07/01/10