Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
r p
g COMMUNITY DEVELOPMENT Permit #: ELR2012 00221
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/19/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9455 SW WASHINGTON SQUARE RD A15
Project: Things Remembered Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: New VAV & Distribution 124 lbs
Contractor: ARROW MECHANICAL Owner: PPR WASHINGTON SQUARE LLC
10330 SW TUALATIN RD PO BOX 847
TUALATIN, OR 97062 CARLSBAD, CA 92018
PHONE: 503 - 692 -1565 PHONE:
FAX: 503 - 691 -1879
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/19/2012 $75.00
12% State Surcharge - Electrical 09/19/2012 $9.00
Type of Use:
Class of Work:
Total Number of Systems:
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: 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 OA 952 - 001 -0090. You may 11 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: lA Permittee Sign.. J �� _
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 503.839.4175 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 �II FOR OFFICE USE ONLY '1 . 4, _; ,-T .
City of Tigard �
o('i y 112 s( Permit No.: .n.,12 p0(....,,„ Oa
13125 SW Hall Blvd., Tigard, OR 97223 S E P 1 9 2012 Date/BY:
Plan Review " t .7
Phone: 503.718.2439 Fax: 503.598.1960 D Other Permit: Mgt 3p 0.0pc 30
TI G A IZ ll Inspection Line: 503.639 CiTY O ° ; n Date Ready/By: luis: 13 See Page 2 for
Internet: www.tigard- or.gov �'r OF to r . Notified/Method: 11 (0 Supplemental Information
PR ti[ rili,lr linor nti:
TYPE OF WORK t vt PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wdtems 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 01 Commercial/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 ", "1 -2 ", 1 -3 ",
n �,` iL � ` 100HP or more. occupancy.
Job no.: W J ob site address: C � � / rwr C.IJ
3i / 54 - ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: // 241 171 O 7 Z Z--3 ❑Healthcare facilities. 0 Supply voltage for more than
��� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: A 1 5- Project name: ❑ Service or feeder 600 amps or more.
'�U�S �'" ��� ',�(/� �" 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 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
'/ Al Limited energy, multi-family
75.00 2
/....0 /,t) V a L7-m_d e �fL f/ v I/11 G 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
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 installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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 with
® APPLICANT I IN CONTACT PERSON above service or feeder fee, 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: gc iJa,j ,i4t.lSZ/Et.,,)5/ branch circuit
Each add'I branch circuit 7.42 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 Fax: : (503) 691 - 1879 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: Arrow Mechanical panel, alteration, or extension. / Page 2 75 2
Each additional inspection over allowable in any of the above
Address: 10330 SW Tualatin Rd Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Tualatin OR 97062
Investigation (I hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 692 -1565 Fax: (503) 691 -1879 Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lie.: 5193 Electrical Lic.: 34 -47CLE Suprv. Lie.: 4647LEB ELECTRICAL PERMIT FEE S
Suprv. Electrician signature, required: Subtotal: - 7 5 .O°1
Plan review (25% of permit fee)
Print name: John Chamberlain Date: State surcharge (12% of permit fee): 9.° 0
Authorized signature: TOTAL PERMIT FEE pi DO
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspectionsallowed per permit.