Permit v CITY O F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
°' COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00427
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/19!2007
PARCEL: 1S12600-00300
SITE ADDRESS: 09302 SW WASHINGTON SQUARE RD VO5 ZONING: C -
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: LUCY
Project Description: Job No 2769
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQ. LLC TRITON COMMUNICTATIONS, LLC
9585 SW WASHINGTON SQ. RD PO BOX 1091
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: Contact #: PRI 503 -615 -5800
FAX 503- 628 -5689
FEES Reg #: ELE 34- 648CLE
LIC 154665
Description Date Amount
[ELPRMT] ELR Permit 11/19/2007 $75.00
[TAX] 8% State Surcha 11/19/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332 2344
Issued By: ! Permittee Signature: A ,
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'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Elects cal Permit A p p li c ation rim OrrlcE Hsi ONi
City of Tigard E CEflJED Received 4iiii Perm
Date/B t No. � , -.17-001-
13125 SW Hall Blvd., Tigard, OR 97 2 Plan Revie J
Phone: 503.639.4171 Fax: 503.598.19 0 V 1 y j ,1, . / l ,,,,, ;. - f 4� , Date/B . Other Permit `v �a0h , DO / �
Inspection Line: 503.639.4175 V /��� - -'I _ Date Ready/By. Juno ® See Page 2 for
Internet: www.ci.tigard.or.us CITY Of- � - Noufied/Method. Supplemental Information
RD�1FvVRHIRk`�I ®� PLAN REVIEW
- . New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: 0 Service over 225 amps, comm'I 0 Hazardous location
❑ Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling '§ ❑ Accessory building 0 System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: 'a'1- Job site address: g) - 5) c . 5� 2d Submit facility DOther:
c� Submit 2 sets of plans with any of the above.
- Q�
City/ State/ZIP: -ix 1C�t �� l 3 d c )--- The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: j t \ Project name: (-,t Gc_ A C x�J Cc,.X2r x I I I I ..
Description Q Fee. Total
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
` DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 . 2
•fir I A--2A. 1 ' 5Q .12 ct_ACiz.r 5 d. t\ -(. n C) S(.S -€._ ✓\ Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: first branch circuit
Each add'I branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included) '
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 • 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
'CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 -45 2
Business name: �� c ti stn... cc 01'15
Address: ?c.) '7 C IOC ( Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: o� ` s ‘00-y-- d , CT L. ..1 --- e..., Investigation per hour (1 hr mm) 62.50
Phone: ('ro3 )6 L - 5 gd(3, Fax: ( .9 62.:D`Z_- 64 g 4) Industrial plant per hour 73.75
' ELECTRICAL. PERMIT FEES* -
CCB Lie.: t 5 9(0(05 Electrical Lic.:n -(0q g([CSuprv. Lic.: ag� LE4 Subtotal --45
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) t;0
Print name: issp,,rO --n Uta.Xl ct e...2.. e...2.. Date: 11 / t'/o
TOTAL PERMIT FEE g
Authorized signature: This
permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Accts - mil Qovil Gee , Date: 1 t/ ( of ID Fee methodology set by Tri- County Building Industry Service Board
Number of inspections per permit allowed.
i \Building\Pennnits\ELC- PetmitApp doc 12/03 440- 4615T(10/02/COM/WEB
1, .
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information 1( r�c, l/li
LIMITED ENERGY PERMIT FEES:
dG
{ 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*
El Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
❑ Other:
rCONIIVIERCIM WORK ONLY:-
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
O Audio and Stereo Systems
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El 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 \Bwlding\Permus\ELC- PermrtApp doc 04/03
OTY OF. TIGARD
BUILDING DIVISION PERMIT #: ELR2007-0€ 00427
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/19/2007
Phone: (503) 639 -4171 � r�
Inspection Requests (24 Hrs.): (503) 639 -4175 ....' 'I L
INSPECTION WORKSHEET FOR DATE: 11120/2007 TIME: 7 :00AM PAGE: 53
SITE ADDRESS: 09302 SW WASHINGTON SQUARE RD VO5 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: LUC '
i' , DESCRIPTION: Job No 2769
OWNER: WASHINGTON SQ. LLC, PHONE #:
CONTRACTOR: TRITON COMMUNIGTATIONS, LLC PHONE #: 503-615-5800
Inspection Request Scheduled For: Date: 11/20/2007 Pour Time:
Code # Inspection Description • Confirm # Contact # Message
t: 059982 -01 503 -615 -5800 N
ctions /Commen s Instruc ons:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
P FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: . ni3i1 LE
Date: ‘1 2.0101 Phone #: (503) 718- 7-41-P0