Permit � rt CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
:' ° COMMUNITY DEVELOPMENT Permit #: ELR2012 -00063
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2012
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9459 SW WASHINGTON SQUARE RD A14
Project: Footlocker /House of Hoops Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (1) audio /stereo system
•
Contractor: TRITON COMMUNICATIONS, LLC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 1091 BY THOMSON PROPERTY TAX SERVICES
HILLSBORO, OR 97123 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 615 -5800 PHONE:
FAX: 503 - 628 -5689
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/06/2012 $75.00
12% State Surcharge - Electrical 04/06/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Y 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: 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 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5033.2 ` 32..1987 or 1.800.332.2344. �, /
Issued By: 6�A Permittee Signature: �L i �O' v
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 503.639.4176 by 7:00 a.m. for the next available Inspection date.
This perrnit 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.
04/05/2012 12:14 5036285689 TRITON COMMUNICATION PAGE 01/03
Electr Per mit A licatiOREC IVFD , -
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City of Tigard U � `' • 13125 SW Hall Blvd., Tigard, OR 97223 P R 5 2012 Daterg • /� �wi� Petmit No.: C� ���� / /
Pima Review aufo?o/r D4,Vi
' , Phone: 503.718.2439 Fax 503.598.19 Other Permit•
i ,\ i;.l? Inspection Line: 503.639.4175 Date R,eady/Dy: laZra B7 See Page 2 for
Internet: www,tigard-or.gov CITY OF TIGARD Notified/Mmhod Supplemental Information
.
T OF.W A�' . INC ; QA • • .k..:'',. • • PLAN REVIEW • ❑ New construction ® Addition /alleration/replacement Please check all that apply (submit E 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 130 votes or ❑ Floating building&
® Commerciailindushial CI Accessory building less to r all or exceeds 14,000 q Commercial use agricultural
❑ 1 - and 2 family dwelling
❑ Multi amps for sat °a iosWleUoas. buildings,
Y ❑ Master builder 0 Other: ❑ Fire pump. ❑ lnsrafation of 71 KVA or
JOB SITE INFORMATION' ANII., Ii.OG4TION D Emergency hem. larger separately derived system.
JO
. ON . .. C.. .. .:. ['Addition of new motor load of ❑ "A„, "E", -1 -2„ „1 -3„
Job no.: 4100 [Job site address:A8iee4'* Washington Sq Rd 10011P u room. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks,
City/State/ZIP: Tigard, 7223 ?f 59 ❑ liealtb-care facilities. ❑ Supply voltage for more than
Suite/bldgJa t I ❑ Harardons locations. 600 votes nominal.
p .. A 14 Projec name: FootLocker ❑Service or feeder 600 amps or more.
. :: FEE 3CIt E MJ :.; i::'' ::t :z:..
Cross street/directions to job site: tl�rt', I Fees Test I
New residential single- or multi - family dwelling unit
_ Includes attached garage _
Subdivision: L Lot no.: I.000 sq. R or less 168.54 4
Ea. add'1 sq, ft. or portion 33,92 I
Tax map /parcel no.: Limited energy. residential
.: DE5CREPTION OF WORK,.,;,. • : • . . • .: • • . • . (with above sq. ft.) 75.00 2
-
Limited energy, multi - family
Audio/Video install 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 • ' . . . • l TENANT • " 201 amps to 400 amps 133.56 2
Name: 401 amps no 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000
amps or votes 552,26 2
City/Statc/ZIP: Temporary services or feeders installation, alteration, and/o
_ relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.Og 2
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, r panel
Owner Signature: - Date: A. Fee for branch circuits with
0 APPLICANT.. above service or feeder fee,
[ � CO1V A .CI: ] PRSON b i 742 2 • each branch carnet
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
J
Phone: ( ) Fax :: ( ) Reconnect only 67.84 2
E Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR : .. Signal circuit(s) or limited -ewers
Business name: Triton Communications, LLC panel, alteration, or extension. Page Page 2 75 2
Each additional inspection over allowable in any of the abov
Address: PO Box 1091 Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Hillsboro, OR 97123 Investigation (1 termini) 66.25/ hr
Industrial plant (1 hr min) 78,18/ hr
hone: (503) 615 -5800 Fax: (503) 628 - Inspearoos for which no tie is 90.00/ hr
7 specifically listed ('/e hr min
CCB Lic.. 154665 Electrical Lic.: 34648CLE Supty- Lic -: 2826LEA >t )I,EC)( CAL PERMTT. FEES' ;' ; ::;
/% Subtotal: 75
Suprv. Electrician signature, required: (fir,.., - Plan review (25% of permit fee);
Print name: Aaron Van Fleet Date: 4/5/12 State surcharge (12% of permit fee): 9
/,% r' TOTAL PERMIT FEE: 84
Authorized signature: ( /' The pertait appbicatjon expires if a permit is Dot obtained within 180
Print name: Aaron Vail Fleet Date: 4/5/12 • days after it has been accepted as complete.
• Number of inspections allowed per permit.
tAn aildireyyce ,it,lEd,C.PermitApp.doo 0710140 440.46157(11 /051COM/WEB
04/05/2012 12:14 5036285689 TRITON COMMUNICATION PAGE 02/03
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
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: ` . •
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
® Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAc
El Instrumentation
E l Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical,
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
1: 1$ uitalag\PermittELC- PemitAyp.doc 07/01/10