Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 ii
° COMMUNITY DEVELOPMENT Permit #: ELR2009 -00109
T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/14/2009
Parcel: 151260000300
Jurisdiction:
Site address: 9665 SW WASHINGTON SQUARE RD CO2
Subdivision: Lot: 0
Project: ARITZIA
Project Description: TI - Low voltage for HVAC
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, Restricted Energy Permit 04 /14/2009 $75.00
2235 FARADAY AVE STE #0 12% State Surcharge - Restricted Energy 04/14/2009 $9.00
PHONE.
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062
PHONE 503 - 692 -1565
FAX:
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo. Boiler Controls:
CCTV Clock Systems.
Data & Telecommunications Fire Alarm:
HVAC Y 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 • =rmit is issued su •'- t to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work
will .e done in accordance a. ov =• flans. 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 - -s you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
95 001 -0010 thr gh OAR ;711100 /I / :y obtta copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 00 332 2344
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'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 Ina 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.
E1ec ncal Permit Application FOR OFFICE 1c F: l SI: ON I,1
-: City of Tigard / e/ 4p Permit No - gLii ,—.0(:) 4
lig 9
13125 SW Hall Blvd, Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By Other Permit
- i C_ A R D Inspection Line. 503.639.4175 Date Ready/By funs' _____ ® See Page 2 for
Internet: www.tigard- or.gov Nottfied/lviethod � C� Supplemental Information
E OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/itcms checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition El Other:
where the available fault current ❑ Marinas and boatyards
CAT RY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Co
❑ 1- and 2- family dwelling Commerrcialindustrial ❑ Accessory building buildings use agricultural
for all other installations bildings
❑ Multi- family Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: l G J 3Q (ki f5 k (n 6 6 : I 00HP or more. Recce nay. occup
❑ Sic or more residential units. ❑ Recreational vehicle parks
City / State/ZIP: 7ky/ •
„' r�,� � L �� .lf. Q / 70 Health -care facilities. ❑ Supply voltage for more than
C, / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.:(7 _ Z Project name. 7 4-R f =7/ t 4
/1%/zi f J�/ ❑ Service or feeder 600 amps or more
V " FEE SCHEDULE
Cross street/directions to job site: Dessrlptbe I QV. I Fee. I Tatal 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'l 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq ft )
y� ; Limited energy, multi- family
/Y.L 7 itcp f . 4 A, (_-,_ ) g 0v L.--r h o -f-e L S 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 I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 4 t Z f-t 401 amps to 600 amps 160.60 2
'n // 601 amps to 1,000 amps 240.60 2
Address: ((f / /(( jj A/ Su YYL C � _ , . up s � � ,i �� Over 1,000 amps or volts 454.65 2
City /State/ZIP: 772 /0' . 1 � /7 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 100.3 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
y � A. Fee for branch circuits with
121 APPLICANT I act CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: A i R Ds.) M e 4 i c I B. Fee for branch circuits
Contact name: �[ without service or feeder fee, 46 85 2
/" first branch circuit
Address: i O330 o - VA. orri, Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not Included)
City / State/ZIP: -1-0A it TI n: ex, 4-71562_ Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( 6 - 0 j) 6112 -16-6 Fax. : (60:5) / 4 1 - 1 6 - 7 1 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
-
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuits) or limited -
Business name A IS' Kb . I"'` E 14Am1 dAl energy panel, alteration, or
/ GO
extension. Describe: Page 2 75 2
Address'
1033r, 5v TuAL. red• 11 e-
City / State/ZIP: - ^ f A � O �,� L Each additional inspection over allowable In any of the above
h �) I ,,a Per inspection 62.50
(
Phone: J � 6Gi'Z —15-66— Fax: (geYj) (FYI 18' 1 Investigation per hour (1 hr nun) 62.50
CCB Lic.: fg- 3 Electncal Lic.- 34- Li 76/0 Supry Lie.: t 30 p Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required ` fi t X i Subtotal: -74 °0
Print name' RO °C ^ r c. 1.. " S* L e Date: Plan review (25% of permit fee): t4
State surcharge (12% of permit fee):
Authorized signature , TOTAL PERMIT FEE:
Pnnt name Date' This p ermit application expires If a permit is not obtained within 180
days after it has been accepted as complete.