Permit CITY OF TIGARD ELECTRICALPERMIT -
RESTRICTED ENERGY
����Ii� DEVELOPMENT H BMENT Tigard, ) 639 -4171 DATE PERMIT #: ISSUED: 00038
ED: 3/18/02
SITE ADDRESS: 09591 SW WASHINGTON SQUARE RD B -10 PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of low voltage for audio /stereo wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PPR WASHINGTON SQUARE LLC COMWERX
P.O.BOX 21545 12121 NE 99TH
SEATTLE, WA 98111 SUITE 2100
VANCOUVER, WA 98682
Phone: Phone: 1- 888 - 266 -9379
Reg #: SUP 1800JLE
LIC 117471
ELE 37- 780CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 3/18/02 $75.00 2720020000 Elect'l Final
5PCT CTR 3/18/02 $6.00 2720020000
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 fort in OAR
952- -0010 through OAR 952 d 0 !081. You may obtain copies of these rules or dir- ct , es; • n: e • UNC at (503)
24 1987. �� — ►� ,
Iss ed by !` Permittee Signature �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'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
1
%s. Electrical Permit Application
Date received: 3 /f,' 0P- Permit no.: e na,. ?
. ,,,,ey.,:-..'ilti City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.: •
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
!' TYPE OF PERMIT
❑ I & 2 family dwelling or accessory c- Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement 0 Other: ❑ Partial
3OB SITE INFORMATION •
Job address: 9/, a Al il A P 1 , 1 I r� Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: i tr, • , . ,,i Description and location of work on premises: Al. U
Ill - , .
Estimated date of completion/inspection:
:.: CONTRACTOR APPLICATION . FEE SCHEDULE .
Job no: Fee Max
Description Qty. (ea.) Total no. insp
t ` New residential - single or multi - family per
Address: / / , - 9 iIC dwelling unit. Includes attached garage. •
ICEINATIMMEMINE State: A ZIP: * , - 8 Z_ Service included
Phone: ' 1 , d /( . S3 Fax: E -mail: 1000 sq. ft. or less 11 4
e == =—
CCB no.: y 7 Elec. bus. lic. no: 37`� OGLE Each additional 500 sq. ft. or portion thereof
,� , Limited energy, residential 2
Egriz b . • i , 0 00 I .. 0 Limited energy, non- residential ___ 2
_ �� (4111P /✓f,... p Z Each manufactured home or modular dwelling
i_nature of supervising electrician (required) Date Service and/or feeder ■■. 2
Sup. elect. name (print): 19Q77 A) AfktS ' 41 License no: ' . Services or feeders — installation,
alteration or relocation:
• . -- PROPERTY OWNER 200 amps or less
1 1 .2
Name (print): 201 amps to 400 amps =NM _ 2
401 amps to 600 amps ___ 2
Mailing address: 601 amps to 1000 amps ___ 2
City: State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: E -mail: Reconnect only ___ I
Owner installation: The installation is being made on property I own Temporary servicesorfeeders -
which is not intended for sale, lease, rent, or exchange according to hu7auation , alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps ___ 2
Owner's signature: Date: 401 to 600 amps =MI _ 2
:', ENGINEER` . , . - Branch circuits - new, alteration,
Name: • or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit: __
... PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑• Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle ■■ 2
❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each sign or outline lighting ___ 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* �■ 2
O Building over three stories O Feeders, 400 amps or more •Descri ition: : ./�/ Il// /Ie l MEIMINIMMIll
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspectio , over the allowable in any of the above:
O Egress/lighting plan 0 Other. Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount
440-4615 (6/00 /COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
P Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4
Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1
Limited Energy $75.00 t 1 Burglar Alarm
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 n Garage Door Opener*
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System"
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 - 2 ❑ Vacuum Systems •
401 amps to 600 amps $160.60 2
' 601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts • $454 65 2 •
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. PI Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n , Boiler Controls
a) The fee for branch circuits .
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 ❑
Each additional branch circuit . $6.65 HVAC
Miscellaneous ❑
Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control*
Minor Labels (10) $125.00
Each additional inspection over El Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting*
Fees: ❑ Protective Signaling
Enter total of above fees $ n Other /
8% State Surcharge $ / Number of Systems
25% Plan Review Fee ///
See "Plan Review" section on $ * No licenses are required Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $ S i
Enter total of above fees $
•
❑ Trust Account # 8% State Surcharge $ ('
I
Total Balance Due $
i:\dsts\forms \elc- fees.doc 10/09/00
CITY OF TIGA,F F 24 -Hour
BUILDING • A Inspection Line: (503) 639 -4175 •
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 3 ' AM PM BUP
Location q s , r j i)i4 ; Suite MEC
Contact Person Ph ( ) I - 7 �' / PLM
Contractor 1 / Ph ( ) SWR
BUILDING Tenant/Owner ScLe ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear •
Int Sheath/Shear P P r s
Framing f'�
Insulation (P, J N
Drywall Nailing
Firewall 6 hQ,
Fire Sprinkler
Fire Alarm yi4.1E-
Susp'd Ceiling
Roof
Other: -- - --
Final
PASS PART FAIL
PLUMBING
Post & Beam b ( F
Under Slab '� 1-�`�. ,49\
Rough -In ' m,_1 1/b qytGL.a Water Service (�x� `N 1
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
• Final
PASS PART FAIL
ELECTRICAL
S ervice
ou -�
UG /SI -
•1
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line t /
ADA Date 2 / - e LIiispe o �•4 • Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from th job site.
PASS PART FAIL
•
CITY OF TIGA' 24 -Hour
BUILDING - Y= Inspection Line: (503) 639 -4175 �' r
INSPECTION DIVISION Business Line: (503) 639 -4171
MST
BUR
Received q Date Requested ` 7 AM PM BUP
Location / 5 91 w /- SQ• ( Suite MEC
Contact Person Ph () T � PLM
Contractor Ph ( ) X a 07 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC �
g Access: ELR ,206,g ,206,g OOW 3U r
Ft Drain
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation .
Drywall Nailing
Firewall �( I 6 ! ► S S
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: - Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL •
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS P RT FAIL
ELECTRICA
Service
Rough -In
UGUG /S
L
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
' FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date ` S — � 7� CJ Insect . / — Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL