Permit I
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
III s COMMUNITY DEVELOPMENT Permit #: ELR2009 00123
Date Issued: 05/01/2009
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9530 SW WASHINGTON SQUARE RD H10
Subdivision: Lot: 0
Project: Apple Store
Project Description: Low voltage for data.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, Restricted Energy Permit 05/01/2009 $75 00
2235 FARADAY AVE STE #0 12% State Surcharge - Restricted Energy 05/01/2009 $9.00
PHONE:
Contractor:
ADVANCED COMMUNICATIONS SERVICES IN
PO BOX 231196
PORTLAND, OR 97281 -1196
PHONE: 503 - 598 -7082
FAX: 503 - 598 -7320
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 /Irrigation:
Required Items and Reports (Conditions)
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other:
Other Desc:
This permit - • - • • : - to the reguiations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law All work
will b •one in accordance wit alp. .. - • 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 Ore! , law req ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 - 001 -0010 thr gh OAR 952- r 0. may obtain a copy of the rules or direct questions to OUNC by calling 503.246. 9 or 1.800.332 2344.
Issued By: 1 `' 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'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.
Electrical Permit Application I.OIt :O FFlcF.liSL 0.1 Y • . .
R eceived c, �
City of Tigard �� Pe mit No : �-.-1� 0.," ?� /
Date/ft .
U PI a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' : C i - Phone: 503.639.4171 Fax: 503.598.1960 DateB Other Permit.
T G A R D. Inspection Line: 503.639.4175 Q Date Ready/By IIMII ® See Page 2 for
Internet: www.tigard -or.gov l —dol g 2. Notified/Method 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 agncultural
❑ 1- and 2- family dwelling ® 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 ",
Job no.: Job site address: 9530 SW Washington Sq Rd I or more occupancy
❑ Six x o or r more residential units ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: Apple Computer ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Washington Square 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 145.15 4
Tax map /parcel no.: Ea add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq fl )
Voice & Data Terminating Limited energy, multi - family 75 00 2
g residential (with above sq ft )
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER - 1 ® TENANT 201 amps to 400 amps 106.85 2
Name: Apple Computer 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 9530 SW Washington Sq Rd Over 1,000 amps or volts 454.65 2
City/State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)603 -9800 Fax: ( ) 200 amps or less 66.85 1
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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6 65 2
Business name: Advanced Communications Services, Inc 13. Fee for branch circuits
Contact name: Joseph Foti without service or feeder fee 46.85 2
first branch circuit
Address: PO Box 231196 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Portland, OR 97281 Each manufactured or modular 90.90 2
dwelling,
Phone: (503) 507 -9740 Fax: : (503) 598 -7320 Reconnect on service and /or feeder
Reconnect only Reconly 66.85 2
E -mail: jfoti@advcomserv.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: Advanced Communications Services, Inc. energy panel, alteration, or
Address: PO Box 231196 extension Describe: 1 Page 2 75 2
City/State/ZIP: Portland, OR 97281 Each additional inspection over allowable in any of the above
Per
Phone: (503) 598 -7082 Fax: (503) 598 -7320 inspection 62.50
Investigation on per hour (I hr min) 62.50
CCB Lic.: 179445 Electrical Lie.: CLE139 Suprv. Lic.: 1977LEA Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: - Subtotal: 75
Print name: Bryan Burleson Date: 05-01 -09 Plan review (25% of permit fee)
State surcharge (12% of permit fee): 9
Authorized signature: F TOTAL PERMIT FEE: 84 fQ/"÷
Print name: Joseph F i Date: 05 -01 -09 This permit application expires if a permit is not obtained within 180
p days after it has been accepted as complete.
• Number of inspections allowed per permit
1 \Building\Pemuts\ELC- PemutApp doe 05/23/06 410- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
4 Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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*
El Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
® Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El 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
IABuildmgTermits \ELC- PermitAppdoc 03/23/06