Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00132
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/26/2012
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9681 SW WASHINGTON SQUARE RD C06
Project: Tesla Motors Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Low voltage for security system
Contractor: VISION SECURITY SERVICE Owner: PPR WASHINGTON SQUARE LLC
10874 SW ROLAND CT BY THOMSON PROPERTY TAX SERVICES
WILSONVILLE, OR 97070 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 502 -3909 PHONE:
FAX: 503 - 200 -2907
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/26/2012 $75.00
12% State Surcharge - Electrical 06/26/2012 $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 $84.00
Other Desc: Required Items and Reports (Conditions)
i
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other appli - • e -w ww •rk will
be done in accord n•■ , ith approved plans. This permit will expire if work is not started within 180 days of issuance, o ork is su-•ended = ore he 180
days. ATT ON: Oregon .w requires you to follow the rules adopted by the Oregon Utility Notification Ce -r. hose/ I-s ar. = fort. in OAR
952 -001-0 0 through OAR 952-0 • • • 1. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232 987 or , 2.2 44
Issue y: - .
/ /'
/ � � �Li � ! : _ Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the lob site until completion of the project
Approved plans are required on the Job site at the time of each Inspection.
Electrical Permit Application chile(: usl.: ONi
City of Tigard RE CE I ! FD DateB : Permit No.: q 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 5035981960 j Received DateBv: Other Permit: P %r,
TI l . D Inspection Line: 503.639.4175 UN 6 2012 Date Ready/By: hrie: 13 See Page 2 for
GA
Internet: www.tigard- or.gov Notified/Method: Supplemental information
CUP/ OFT1OApED
TYPE OF W19$ f �'� v PLAN REVIEW
' � p ° f Please check a ll that apply (submit a sets of plans w /items checked below):
❑ New construction fkAddition/alteration/rep acerhe V .
❑ 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, Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family 0' Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
r ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: Q�J (?*' 3IIA Q� I 9l IOOHP or more. occupancy.
// l ❑Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: eo �� �� ^/�f n ❑ Health facilities. ion ❑ Supply voltage for more than
L1�Jw ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: T ,5_...a f 1 (ro25 _ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. 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' 1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
` w , - , c S \i a ST Limited energy, residential (with a bove i sq. ft.) 75.00 2
f�l�' ' rte ' , l ' J ith above sq.
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
•
❑ PROPERTY OWNER ❑ 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
h 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 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 circuits with
❑ 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'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 6714 2
City/State /ZIP: 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
cve .eUIU J C.7 panel, alteration, or extension. '
Business name: V 131 OL � S Page 2 2
Each additional inspection over allowable in any of the above
Address: \ 5 (, `q ,C/k) r K6 c),---. Additional inspection (1 hr min) 66.25/ hr
W, l Q - " ' ' Investigation (1 hr min) 66.25/ hr
City/State/ZIP: 1 J �/ ) 000-76 Industrial plant (I hr min) 78.18/ hr
Phone: (5O 5C7 3 1 Fax: (69 ) o , a 0� Inspections for which no fee is 90.00/ hr
p specifically listed (Vs hr mm)
CCB Lic.: ` 11 Electrical Lie.< IL+ Suprv. Lic.: 3 7 L8A ELECTRICAL PERMIT FEES
. Suprv. Electrician s required: ? 42 /ici Subtotal:
Plan review (25% of permit fee):
Print name: P LA) b Dom- Date: • Z( . QJ)/ State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 81/`
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
I:\ Building 'Pennits\ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB
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:
El Audio and Stereo Systems* •
El Burglar Alarm
El Garage Door Opener* •
❑ Heating, Ventilation and Air Conditioning System*
El Vacuum Systems* •
❑ Other:
COMMERCIAL 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
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑, HVAC
El Instrumentation, , •
El Intercom and Paging Systems.
El Landscape Irrigation Control* • ,
❑ Medical •
El Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses.are required •
for all other installations
,I
1:\ Building \Permits\EJ.C- PermitApp.doc 07/01/10' V