Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
:. COMMUNITY DEVELOPMENT Permit #: ELR2009 -00296
Date Issued: 09/29/2009
T I 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: Install audio system
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, Restricted Energy Permit 09/29/2009 $75 00
2235 FARADAY AVE STE #0 12% State Surcharge - Electrical 09/29/2009 $9 00
PHONE
Contractor:
OHM SYSTEMS LLC
PO BOX 86833
PORTLAND, OR 97286
PHONE: 503- 484 -5700
FAX 503 -258 -0382
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio & Stereo Y Boiler Controls. N
CCTV N Clock Systems N
Data & Telecommunications N Fire Alarm N
HVAC: N Instrumentation: N Total $84 00
Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting N Medical: N
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 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 OAR 952- 001 -01 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800 332 2344
� r
Issued By: 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.
Electr Permit Applicatiof/ECENED FOR OFFICE USE ONE)
�+ t-j�a a � Q�
City of Tigard Received
DateB a9 / .. �fy- Permit No C4� - y_
° 13125 SW Hall Blvd , Tigard, OR 97223 S E P 2 9 2009 Plan Review
li . • Phone 503.639 4171 Fax 503 598 1960 Date/B Other Permit j / 'O _t1 /3r
T 1 CARD Ins Line 503 4175 CITY OF TIGARD Date Ready/13y June D See Page 2 for
Internet www ngard -or gov BUILDING DIVISION Notified/Method T Supplemental Information
TYPE OF WORK PLAN REVIEW .
❑ New construction [2 - 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
❑ I - 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 JNFORMAT N Ap,j OCATION ❑ Emergency system larger separately derived system
`fJ ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: 5 ,,,/ l.,/ -^ S IOOIIP or more occupancy
'i J „, '/i' ❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: i' j a 12, 1 ZZ 3 ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no. /y 0 ( Project name: s ^ ee r 'S 6 ; ft S ❑ Service or feeder 600 amps or more
P 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 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 75 00 2
DESCRIPTION OF WORK . (with above sq ti )
Limited energy, multi- family
A —J ; o Cy 5 Fr ,,,,, t`• s - 11 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 ❑ 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 ( ) 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, 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 ( ) Fax: : ( ) Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 53 40 2
Business name: D So f 1 )-C
Signal erg c p an e l,(a) e rltmi, or
M energy panel, alteration, or
D
U o 7c g / g 5Z e xtension. Describe t Page 2 ,s 2
Address: + ! 1
City/State /ZIP: �a. �1 Q,, a1 Z -6 Each additional inspection over allowable in any of the above
Per inspection 62 50
Phone (5 ) utco 5`7 U o Fax: (5 ) ZS-$ G3 S(Z Investigation per hour (I hr min) 62 50
CCB Lic.: 1(6 g I 01 Electrical Lic.: c i , E ` Suprv. Lic.: \0o LEA Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES
Supry Electrician signature, required: � 75...----- Subtotal. '-/ S. O O
/^ I Plan review (25% of permit fee)
Print name: C �,Idtir i� Date: V2 /o 9
State surcharge (12% of permit fee). y,
Authorized signature: TOTAL PERMIT FEE 'zi, (T0
This permit application expires if a permit is not obtained within 180
Print name. Date: days after it has been accepted as complete.
• Number of inspections allowed per permit
t \Building\Permns\ELC- PermitApp doc 05/23/06 440- 4615T(I1 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
F f Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buidmg\Permits\ELC- PermitApp doc 03/23/06