Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
g....- COMMUNITY DEVELOPMENT Permit #: ELR2012 -00028
131 25 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2012
TIGARD .. , g Parcel: 1 51260000300
Jurisdiction: Tigard
Site address: 9636 SW WASHINGTON SQUARE RD G10
Project: Buckle 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
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 692 -1565 PHONE:
FAX: 503 - 691 -1879
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/14/2012 $75.00
12% State Surcharge - Electrical 02/14/2012 $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: 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 -0010 t g 952 -0 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
�i
Issued 8 l Permittee Signature: i,,,
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 by 7:00 a.m: for the 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.
i
Electrical Permit Application :it v , . FOR'OFFICE 1SE ONLi h
c y _r /•-f-- Permit No : 0 ,,
,... .
illii a T City of Tigard Da�e�B� .�,.>✓�
13125 SW Hall Blvd., Tigard, OR 97223
Plan Review A
' Phone: 503.718.2439 Fax: 503.598.1960 D Other Permit: Nf(�QZOI„2.-fAD
Ins - ction Line: 503.639.4175 Date Ready/By: Juris: See Page 2 for
TICrAKD �
'. Internet: www.tigard- or.gov Notified/Method: Supplemental Information
. TYPE OF WORK PLAN REVIEW • -
ID New construction IN Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wfitems checked below):
El Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 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 ®. Commercial /industrial ❑ Accessory building amps for all other installations- buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB "SITE INFORMA ON , AND LOCATION "
0 Emergency system. larger separately derived system.
. ❑ Addition of new motor load of ❑ "A , "E", "1 -2", "1 -3",
Job no.: , site address. ;> ".(f,:: JiJ t J4 /,# ,, » t &q 71> , , boor or more occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 77‘'"1-2- 2 2 El Health -care facilities. ❑Supply voltage for more than
/ 0l2 7 o`r' ❑ Hazardous locations. 600 volts nominal,
Suite/bldg. /apt. no.: 6 _ ,p I Project name: ';a 33 e..,/ �L � ID Service or feeder 600 amps or more. street/directions to job site: Description FEE.,S( Ii I E
1 Qty. I Fee. I Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 1 1 168.54 J 4
Tax map /parcel no.:
Ea. add'I 500 sq. ft. or portion 33.92 ' 1
Limited energy, residential 00
75 2
' DESCRIPTION OF WORK (with above sq. ft.
,/ Limited energy, multi- family [ 75,00 I 2
/I.) 1 H'/ / 57'15 residential (with above sq. ft.) -
Services or feeders installation, alteration, and/or relocation ,
200 amps or less 100.70 2 1
❑ : PROPERTY OWNER TENANr ' ' - . :: 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2 1
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 599 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. a
Owner signature: Date: Branch circuits — new, alteration, or extension, Qer panel
A. Fee for branch circuits with
.
above i . .
.,. . ',,..- - ..: ..,.:. ... ... : each branch circuit ��
® ,- <, CANT - � ®:= CONTACT . 7.42 2
eac ranc c u
Business name: Arrow Mechanical B. Fee for branch circuits without
• service or feeder fee,- first 56.18 2
Contact name: K .l ='t+.) kizo.s J`K) • branch circuit .
Each add'I branch circuit 7.42 1 2
Address: 10330 SW Tualatin Rd Miscellaneous (service or feeder not included)
City/ State/ZIP: Tualatin OR 97062 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 692 - 1565 I Fax: : (503) 691 -1879 Reconnect only 67.84 2
•
E - mail: Punip or irrigation circle 67.84 2
:, ,.,. _ 67.84
= ; a ": ` %. - CONTRAC1 OR; Y.0 Sign or outline lighting i 2
- :2 Signal circuit(s) or limited-energy
Business name: Arrow Mechanical panel, alteration or extension Page 2' 2
Each additional inspection over allowable in any of the above
Address: 10330 SW Tualatin Rd Additional inspection (1 hr min) 6625/ hr __
City/State/ZIP: Tualatin OR. 97062 Investigation (1 hr min) _ 66.25! hr
Industrial plant (1 hr min) 78.18/ hr 1
' Phone: (503) 692 -1565 I Fax: (503) 691 -1879 Inspections for which no fee is
90.00/ hr J i
specifically listed (y hr min)
•
CCB Lic.: 5193 - Electrical Lic.: 34 -47CLE Suprv..Lie.: 4647LEB • + $s`• <:= .`'. ,
- : - .zL ,ECT_RLati9P.ERMoo i- x ?Y =43-g ;.
Subtotal:
Suprv. Electrician signature, required: Plan (25% of permit fee)
Print name: John Chamberlain . Date: a - /p - / 2- State surcharge (12% of permit fee):
Authorized sign. '' J /' J y TOTAL PERMIT FEE
L �' /, i6ez- -- = This permit application expires if a permit is not obtained within 180
• days after it has been accepted as complete.
Print name: / v/� i/ 2c 5 24:244, ySiGt Date: ;Z / '" / Z • Number of inspectionsailowed per permit.