Permit arL CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00029
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2012
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9573 SW WASHINGTON SQUARE RD B06
Project: The Limited Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
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)
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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. ATTEN • : • -.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0:10 through OAR • • -01 -r. 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 1987 or 1.800.332.2344.
/ . t
Iss -d 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. 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 OFFICE-USE ONLY -
y City of Tigard Received /4 / / , : / Permit No.: et_P� /? a
Date/By:
I
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: other Permit
T [GA RD Inspection Line: 503:639.4175 Date Ready/By: - luris: El See Page 2 for
' Internet: www.tigard.or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans wfitems checked below):
❑ New construction [ . Addition/alteration/replacement
❑ 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.
❑ 1 and 2 family dwelling ® Commercial /industrial ❑ Accessory building less to ground, a exceeds ons, ❑ commercial use agricultural
ry g amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATIO LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 9 4J�ISiI / , v � T p,� r 100HP or more. occupancy.
• T_D , ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: �� 2� r a ❑ Health -care facilities. ❑ Supply voltage for more than
I / DIZ / 7 3 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ' O6 Project name: `77-1/5± L/ M )T) ❑ 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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: L imited energy, residential
_ . 75 00 2
DESCRIPTION' ` OF ' . ORK_ _ _ . (with above sq. ft -) • . ,. • •
Limited energy, multi - family
75.00 2
k ( 4 ) I, 0 �,9-Q' g_ k fi 4-e-- residential (with above sq. ft.)
Services or feeders installation, alterat ion, and/or relocation
200 amps or less 100.70 2
' ❑ PROPERTY OWNER _ ...,I ' ., ; ' . . :TENANT 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
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 installa tion, 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
`' '!‘. .,' -- ® APPLICANT I - ® C above service or feeder fee
ONTACT PERSON _ 7.42 2
- - - - - _each branch circuit
Business name: Arrow Mechanical B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42
Address: 10330 SW Tualatin Rd Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State /ZIP: Tualatin OR 97062 67.84 2
dwelling, service and/or feeder
Phone:(503) 692 - 1565 Fax: : (503) 691 - 1879 Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
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Sign or outline lighting 67.84 2
.s ad iii- t - - _ - - - �'F'4:',,7. '"2, -', �:j ': , - "i'
- _ . _ Si circuits) or limited-energy 1 ---1,00 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) 66.25/ hr
City/State/ZIP: Tualatin OR 97062 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 6924565 Fax: (503) 691 - 1879 Inspections for which no fee is
specifically listed (%2 hr min) 90.00 / hr
CCB Lic.: 5193 Electrical Lic.: 34 - 47CLE Suprv. Lic.: 4647LEB ;„ i LL':.: ':_ , ' :4 ELECTRICAL' PERM1TTFEES ; ;', a ..` :°
Suprv. Electrician signature, required: Subtotal: 75 •dam
(1/2„.....--
Plan review (25% of permit fee)
Print name: John Chamberlain Date: State surcharge (12% of permit fee): , q,0 O
TOTAL PERMIT FEE D C/ r
Authorized sign ie: �i�
/ /',/ ms(.. This permit application expires if a permit is not obtained within 180
.• days after it has been accepted as complete.
Print name: /,G,(„: t, Ai /2JL -LL 5 zgzezas/E'iZ Date. , / 4 . f 2_ s Number of inspections allowed per permit.