Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' . COMMUNITY DEVELOPMENT Permit #: ELR2009-00128
Ti GARD 13125 SW Hall Blvd , Tigard OR 97223 503 639 4171 Date Issued: 05/12/2009
Parcel: 151260000300
Jurisdiction:
Site address: 9665 SW WASHINGTON SQUARE RD CO2
Subdivision: Lot: 0
Project: ARITZIA
Project Description: TI - Installation of burglar alarm Job No. 3448810
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, Restricted Energy Permit 05/12/2009 $75.00
2235 FARADAY AVE STE #0 12% State Surcharge - Restricted Energy 05/12/2009 $9 00
PHONE
Contractor:
STANLEY SECURITY
15495 SW SEQUOIA PKWY #100
PORTLAND, OR 97224 -
PHONE 503 - 968 -3353
FAX: 503- 968 -3398
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 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: Y
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 ace. • -nce 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 X90 days ATTENTIO Or- . •n .w requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952,01-0010 through OAR 9 '01 -010' •u may obtain a copy of the rules or direct questions to OUNC by calling 503 24 699 or 1 800 33 4
Iss •d By: • / �/ ,L� � , - / /\/
y: Perm 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.
4
Electrical Permit Applicat' CEIVED FOR OFFICE USE ONLY
City of Tigard
Date/By d 5 /?. a 9 Permit No es2 - j p..ge
° 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
illiq 7 ' Phone. 503.639.4171 Fax: 503.59E W. t 12 2009 Date /By Other Permit.
TiGARD Inspection Line: 503 639.4175 Date Ready /By Juns ® See Page 2 for
internet. www tigard -or gov CITY OF TIGARD Notified/Method. Supplemental Information
TYPE RUINING DIVISION PLAN REVIEW
*..., w e 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
El Demolition ❑ Other: where the available fault current ❑ Mannas 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 "i - ", "I - ",
Job no.: 3iJ J ob site address: ( C, c �n/7 � Six or or more occupancy
/yla / J J J El Six or more residential units ❑ Recreational vehicle parks.
City /State /ZIP: n ❑ Health -care facilities. ❑ Supply voltage for more than
j �/ F1] 712 3 ❑Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: Co a Project name: 4 $i rzi ,.1 ❑ Service or feeder 600 amps or more.
r 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
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 ft )
1 Limited energy, multi- family 75 00 2
fi .� f •T4u 1 urged ioa) sy,/'i�vf residential (with above sq. ft.)
J �I Services or feeders installation, alteration, and/or relocation
200 amps or less I 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: ( ) 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: STAN )Qy .a L 0 B. Fee for branch circuits
without service or feeder fee,
Contact name: STAN
spy tilt / V 1 o -e Iii u a first branch circuit 46.85 2
Address: 1 9.175 Si) 9Ubl A9 1 #/00 Each add'l branch circuit 6.65 2
/ / Miscellaneous (service or feeder not included)
City /State /ZIP: ph �T n � � 9 1 Each manufactured or modular
dwelling, service and /or feeder � 90.90 2
Phone. ( p� {/ � � 7 /� 3 F (S 3) 9 ' 3 ?c ,� Reconnect only 66.85 2
E - mail: D J / Pump or irrigation circle 53 40 2
CONTRACTOR �/ panel
Sign or outline lighting 53 40 2
� a 1 e2T j2.RI24 ► 7 Signal circuit(s) or limited -
Business name: 60 , C C V energy panel, alteration, or
Address. �C .501.4A "-r--. extension Describe. Page 2 2
City /State /ZIP: 7' I ` ` O V Each additional inspection over allowable in any of the above
�t,(� C Per inspection 62 50
Phone: ( ) �Q 191 eo Fax: ( ) 3 7 -05 Investigation per hour (I hr min) 62 50
CCB Lic.: 1U ! °J' f p - 7 Electrical Lic ei 4)/ (; p Suprv. Lic. Industnal plant per hour 73 75
ELECTRICAL PERMIT FEES
Supry Electrician signature, required: /O / ,//l Subtotal.
Print name Date Plan review (25% of permit fee):
State surcharge (12% of permit fee)
Authorized signature: - TOTAL PERMIT FEE c t ') S oD
Date: . b This permit application expires if a permit is not obtained within ISO
Print name
9 , � v�� f✓u 1Z days after it has been accepted as complete.
* Number of Inspections allowed per permit
I \Building \Pei mas \ELC- PermnApp doe 05/23/06 440- 4615T(1 I /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:
❑ Audio and Stereo Systems*
X13urglar
Alarm
❑ Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other
COMMERQAL WORK 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
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control=
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: ,
:: licenses are required. Licenses are required
for all other installations
I \Building \Pet inns \ELC -Pet mitApp doc 03/23/06