Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
m COMMUNITY DEVELOPMENT Permit #: ELR2009 -00099
Date Issued: 04/06/2009
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.639.4171 Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9348 SW WASHINGTON SQUARE RD W14
Subdivision: Lot: 0
Project: Gap Kids Baby
Project Description: Install limited energy for voice /data
Owner: FEES
Description Date Amount
PPR WASHINGTON SQUARE LLC
BY THOMPSON PROPERTY TAX SERVUCES, Restricted Energy Permit 04/06/2009 $75.00
2235 FARADAY AVE STE #0 12% State Surcharge - Restricted Energy 04/06/2009 $9 00
PHONE:
Contractor:
ERWIN J. NATHAN
460 N Y ST
WASHOUGAL, WA 97045
PHONE. 503 - 443 -2178
FAX:
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Boiler Controls
CCTV: Clock Systems:
Data & Telecommunications: Y Fire Alarm
HVAC Instrumentation Total $84 00
Intercom/Paging: Landscape /Imgation
Landscape Lighting: Medical:
Required Items and Reports (Conditions)
Nurse Calls. Protective Signal:
Security Alarm Other
Other Desc:
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 R 952-004,0100 You m y obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1 800 332 2344
Issued By: + (3l £j\ 0 ' � Permittee Signature: - , r //4f/
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.
`' S EC IVES
Electrical Permit Applicatioln� t FOR OFFICE USE ONLY
City of Tigard APR - 6 2009 Received
(� Permit No ,0Ir
• III DateB • / • � l � � 6.6
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone 503 639 4171 Fax. 503.598 196CIT'( OF TIGARD Date/By Other Permit
TIGARD Ins Line 503 639 4175 SUILDthVG DIVISION Date ReadyBy ions ® See Page 2 for
Internet www tigard -or gov Notified/M 7 lc) Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 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 ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump ❑ Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system A
❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "1 - ",
Job no.: Job site address:_ / 9 314 g ► w4!4 h 1001-1P or more occupancy
/ ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: 7 /' Q f, �� ❑ Health-care facilities ❑ Supply voltage for more than
C� (� J El Hazardous locations 600 volts nominal.
Suite /bldg. /apt. no.: Project name: `i ' = f l ,L ,, ❑ Service or feeder 600 amps or more .14 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: I Lot no.: 1,000 sq ft or less 145 15 4
Ea add'I 500 sq ft or portion 33 40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft ) 75 00 2
� Limited energy, multi -family
de ' +/W 7 — Da4., C� / l X residential (with above sq ft) 75 00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454 65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66 85 1
Owner installation: This installation is being made on property that 1 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 599 amps 133 75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
g A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B Fee for branch circuits
Contact name: without service or feeder fee, 46 85 2
first branch circuit
Address: Each add'I branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only _ 66 85 2
E -mail: Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 53 40 2
Signal circuit(s) or limited-
( �
Business name: �,, l ,� � ' i N (A\r'C n energy panel, alteration, or
Address: � �f u n l 1 / e Sion Describe / Page 2 ? • j '� d
2
City/State /ZIP: 1 i l) 0 l s � (N f , - A, q -7 0 4—S Each addi inspection over allowable in any of the above
( 1 Per inspection 62 50
Phone: ( ) I • 2-? . IX Fax: ( ) Investigation per hour (I hr min) 62 50
CCB Lic.: / 5 Z 071 Electrical Lic.(Z 673, Suprv. Lic.: Industnal plant per hour 73 75
/�� a ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: r / (.�x // /,02,.., Subtotal
�"
Print name: � / �! Date: Plan review (25% of permit fee)
U' ' 1 State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit
I\ Building \Permits\ELC- PermiApp doc 05/23/06 Sq — G 5
7Q I 440 -46t5T( 1 1/05 /COM/WEB
7. `. I l
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
. RESIDENTIAL WORK ONLY: 77- 7 - 77. . )
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:
.COMMERCIALAWORK"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
❑ Fire Alarm Installation
El HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
LI Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Building\Permns\ELC- PermitApp doc 03/23/06