Permit �
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
w .' COMMUNITY DEVELOPMENT Permit #: ELR2009-00321
Date Issued: 10/06/2009
T1 GARD 13125 SW Hall Blvd , Tigard OR 97223 503.639 4171 Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9659 SW WASHINGTON SQUARE RD M06
Subdivision: Lot: 0
Project: Spencer Gifts
Project Description: Low voltage for HVAC
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, Restricted Energy Permit 10/06/2009 $67 84
2235 FARADAY AVE STE #0 12% State Surcharge - Electrical 10/06/2009 $8 14
PHONE
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062
PHONE 503 - 692 -1565
FAX 503 - 691 -1879
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo N Boiler Controls: N
CCTV N Clock Systems N
Data & Telecommunications N Fire Alarm: N
HVAC Y Instrumentation N Total $75.98
Intercom /Paging N Landscape /Irrigation' N
Landscape Lighting. N Medical N
Required Items and Reports (Conditions)
Nurse Calls N Protective Signal. N
Security Alarm" N Other: N
Other Desc
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and at other applicable law. All work will
be done in - - • • - - approved plans This permit will expire if work is not started within 180 days of issuance, or rf work is suspended for more the 180
days ENTION Oregon - , requir you o follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -0 %1 -0010 through OAR 952 -0010 You ay obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800 32 2 4
I -ued By: crLae_44.? 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' 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.
glectrical Permit Application p F 8 v r
City of Tigard � /.'� 71 ived
13125 SW Hall Blvd., Tigard, OR 97223 . ^;, Datemy: /0 /4/ y 4 Permit No. E/Q /J Rl��
(� y ,+ Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 '+�PP// CJCJ
Datenty: Other Permit
� ■ („A R l a Inspection Line: 503.639.4175 y
Internet: www.tigard- or.gov CITY OF TIGARC NotifR od f ® Page In
form.
T O a !l.4l� C DIVI�IC� (((� sup plearontal rntlen
PLArcREzoIi`Y '
❑ New construction ddition/altemtion/replacement Please /deck all that apply (submit 2 sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑Building over three stories.
1:3 Demolition ❑ Other:
where the available fault current ❑ Mannas and boatyards
CATS e a RYY OF CONSTRUCT/ON exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
El 2- family dwelling ;.." Commercial/industrial ❑ Actxssory building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Multi-family ❑ Master builder ❑ Other: ❑ amps for all other installations buildings.
ther: Fire pump ❑ Installation of 75 KVA or
JOB SITE I1VF(>3t#TION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2" "1 -3 ",
Job no.: J Job site address: qS�. �� ' l o o or e occupancy.
-_� /' ❑ Six or mom mor residential units ❑ Recreational vehicle parks.
City/State/ZIP: �¢ ® 4 ❑ Health -care facilities ❑ Supply voltage for more than
,. ID Hazardous locations. 600 volts nominal.
3uite/bldg.lapt. no.: AZ' I Project n �'�ame:�y e_ �_ . > ( s ue " U r t d � ; ❑ Service or feeder 600 amps or mom.
Cross street/directions to job site: E.' 'r
Description 1 O4• i Fes. I ia.l 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
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential
��
DESCRIPTION OF WORK (with above sq. R.)
/ 75.00 2
/ ) �e)`, �' 47/1 .404 Limited residential ner ( (with 75.00 2
l Services or feeders installalon„ and/or relocation
0 200 amps or less 80.30 2
PROPERTY OWNER TENANT 201 amps to 400 amps 106.85 2
Name: `� _ <a 401 amps to 600 amps 160.60 2
'� - • 601 amps to 1,000 amps 240.60 2
Address qe / C 4, . (.,
� # R Over 1,000 amps or volts 454.65 2
City/State/ZIP: T � ` _ e Temporary services or feeders installation, alteration, and/or
I relocation
Phone: ( ) 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
I a A. Fee for branch circuits with
f APPLICANT . I -gt- CONTACT PERSON above service or feeder fee, 6.65 2
Business name: each branch circuit
A I t Row /p". re- 64-A14 / GA l /v /14 p 7 B. Fee for branch circuits
Contact name: A- / T without service or feeder fee,
first branch circuit 46.85 2
Address: 1 0330 /n4 "ruA tArnM Each Irdd'I branch circuit 6.65 2
City/StatePLIP: Miscellaneous (service or feeder not included)
'ToAtA rmi DfS 4' &L Z Each manufactw-ed or modular -
Phone: /� dwelling, service and/or feeder 90.90 2
E-mail:
( 4-03) n'7 2 .. 16 -6 4 - , - I Fax:: (603 ) 6I F -1. 879 Reconnect only 66.85 2
Pump or irrigation circle 53.40 2
COfiCT Sign or outline lighting 53.40 2
Business name: n 12bt.4 C AMj M � - d e T Signal p circuit(s) n al er or t imi , or
/ energy panel, ahetatiory or
�g 6,w tUA �ATyFf I� . e7 t g i L be: 1 Page 2 Sp 7- g / 2
Address:
City/State/ZIP: 1- A / N O R /f7 Z Each additional inspection over allowable to an of the above
Phone: (. j,7 )64Q -15-66- I Fax: (�-D 3) M1 r '8 74
Per inspection 62.50
P hwestigation per hour (1 hr min) 62.50
CCB Lic.:66- (q 3 I Electrical Lic.: M.. Lot* Suprv. Lic.: 13s�►'► . -•rEO Industrial plant per hour 73.75
Suprv. Electrician signature, /y ELl�eef'RICAL
Pry � � � 1Uimd tov 4
• Subtot to 7. S T
Print name: A
� � /1 • C. 1.4 s � Date: Plan review (25% of permit fee): KO
GK State surcharge (12% of permit fee): g. /q
Authorized signature: � , 9
TOTAL PERMIT FEE:
Print name: T This permit application expires If a permit is not obtained within 180
cc I/ �j�'f Date: 9/3.9/3.4,7 ��� days after It has been accepted m complete. mplete