Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00116
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2012
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9530 SW WASHINGTON SQUARE RD H10
Project: Apple Subdivision: Lot:
Project Description: Data telecommunications
Contractor: ADVANCED COMMUNICATIONS SERVICES INC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 231196 BY THOMSON PROPERTY TAX SERVICES
PORTLAND, OR 97281 -1196 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
•
PHONE: 503 - 598 -7082 PHONE:
FAX: 503 - 598 -7320
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/07/2012 $75.00
12% State Surcharge - Electrical 06/07/2012 $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: Y 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 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: �s�Y
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 soli of l ici: usi.: ()Nix
City of Tigard Received 617 42 PLA - - 09//!2
Permit No.
;� C ° 13125 SW Hall Blvd., Tigard,OR 972 Plan Review Other Perrc��.QQ/
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
r 1 C. A It D Inspection Line: 503.639.4175 Date Ready/By: kris: ^/ HI See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 776 Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement _
Please check all that apply (submit a 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 ' orrlmercial/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 derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address:9 vs &-
tnws . Six or more. occupancy.
ix o or r more re residential units. ❑ R ecreaton.
reational vehicle parks.
City/State /ZIP: �� D O�- � ❑ Health-care facilities. ❑ Supply voltage for more than
1 /3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: 1 601,14 Project name: ❑ 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 1
Tax map /parcel no.: Limited energy, residential 75.00 2
• D ESCRIPTION OF WORK ( with above sq. ft.)
Limited energy, multi- family 75.00 2
.0 � 77 - 1_6 - Cal i M (..e C61-7 a 4/s residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ 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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
n 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 wish
❑ APPLICANT I ❑ 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'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: Pv W� m \) panel, alteration, or extension. / Page 2 2
Each additional inspection over allowable in any of the above
Address: X442 5 j t %J 2 1 . ,, Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: �b r . 4 DAL C -23-LA punt (1 mm) 66.25/ hr
"' � 4 J Industrial plant (1 hr min) 78.18/ hr
Phone: (503 51C‘ Fax: ( ) Inspections for which no fee is
specifically listed (% hr min) 90.00 / hr
CCB Lic.: ! �1G1 p,1 /4� El ec .�, �► ical Lic.: g 3cj, Suprv. Lic.: I/5%1 ELECTRICAL PERMIT FEES
Suprv. Electrician signatu , re ir 7// y / / / //y Su
Plan review (25% of permit tt fee):
):
Print name:So1 t-'� d _ l � e) , c ON (t,‘ Date: 6 z_._ State surcharge (12% of permit fee):
�" TOTAL PERMIT FEE:
Authorized signature:
1 _ This permit application empires if a permit is not obtained within 180
Print name: v , 40 ,1 t . - ( Date: , days after it has been accepted as complete.
7 Z Number of inspections allowed per permit.
I:\ Building \Permits\ELC-PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information •
'o\\
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential- systems combined .. $75.00 -
Check Type of Work Involved:
•
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
El Other:
PCOMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
•
El Boiler Controls
El Clock Systems
Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10