Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELR2009 -00090
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/17/2009
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9677 SW WASHINGTON SQUARE DR CO5
Subdivision: Lot: 0
Project: Gap Kids
Project Description: Install protective signaling.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, Restricted Energy Permit 03/17/2009 $75.00
2235 FARADAY AVE STE #0 12% State Surcharge - Restricted Energy 03/17/2009 $9.00
PHONE:
Contractor:
CHECKPOINT SECURITY SYSTEMS GROUP
8180 UPLAND CIRCLE
CHANHASSEN, MN 55317
PHONE: 971 - 212 -3779
FAX: 503 - 772 -1070
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: Instrumentation: Total $84.00
Intercom /Paging: Landscape /Irrigation:
Landscape Lighting: Medical: Required Items and Reports (Conditions)
Nurse Calls. Protective Signal: Y
Security Alarm: Other:
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 2 o r 1.8� .332,2344.
Issued By: CS2 `1 _ LJ ,1(l 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 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.
RECEIVED
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard R eceiv ed Permit No
13125 SW Hall Blvd , Tigard, OR 97223 MAR 1 20 Plan Review
l O � �f 20�'f • 0009%0
Phone 503 639 4171 Fax 503 598 196trry of TIGARD Date/By Other Permit
TI G A R D Inspection Line. 503 639 4175 1. v. i in 1 Date Ready /By. luris ® See Page 2 for
Internet. www tigard -or gov BUILDING D Notified/Method '• ' 1 Supplemental Information
TYPE OF WORK PLAN REVIEW
r• Please check all that apply (submit 2 sets of plans whtems checked below)
❑ New construction /,i Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ 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
❑ 1- and 2- family dwelling Af 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 A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
7jjQlB �� � / A Six or or more residential R occupancy
Job no.: /(�rJ t) Z Job site address: y40/77 � �iN7Y / t f ��(, f�� ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: 7,/, j /� �j 2 , 41 Health -care facilities ❑ Supply voltage for more than
/ ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: � 7 c%/ Project name: 6f/ ie.. i d 0 Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. 1 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 fi )
Limited energy,
/� I A� (with abov e sq ft ) 75 00 2
`�� ,�� /,/���,/f� /_ ,j 4, �� /j Q/J7 residential (with abov sq ft
r &ii /g , /1 - Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER d TENANT 201 amps to 400 amps 106 85 2
Name: r��� id/63c/ 401 amps to 600 amps 160 60 2
� 601 amps to 1,000 amps 240 60 2
Address: %C> 7 , t . & Z� /. �/ij�w/ / Over 1,000 amps or volts 454 65 2
City/State /ZIP: 7- 7,0,j4 �� J /ZZ3 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: ( 6/, /3 4 .0; � energy panel, er or t o limited-
�`� energy panel, alteration, or
Address: €04/..16' ��1���e.„7 6A;7/3« extension Describe Page 2 2370, 2
City/State /ZIP: G /) / �ir/f/ 6' . —' ���� l �� Each additional inspection over allowable in any of the above
/ Per inspection 62 50
Phone:.. /) j/ �j Fax: (524 M., /4176 Investigation per hour (I hr min) 62 50
CCB Lie.: ` Electrical Lic.: Suprv. Lie.: lndustnal plant per hour 73 75
G. 2 ( § 7.1.‘ 1 c G l • t • tt ELECTRICAL PERMIT FEES
Suprv. Electrician sign t required: ,� / /f „,�.. ��/,!„ Subtotal
Print name: /2/ /���`� DateK�� ,/, Plan review (25% of permit fee)
State surcharge (12% of permit fee) c * . OG
Authorized signature: TOTAL PERMIT FEE OA .00
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit
i \Budding\Permits\ELC- PermiApp doe 05/23/06 440-4615T( 1 1 /05/COM/WEB
0 4 ..
Electrical Permit Application - City of Tigard
Page . 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: ;
RESIDENTIAL. RYWI ONEW „' 7 .7 . 71
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
-COMMERCIAL WORK ONLY: - - I ._. ° .}
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
n Outdoor Landscape Lighting*
i f A l Protective Signaling
❑ Other
/ ..
Total number of commercial systems:
*No licenses are required. Licenses are required
' for all other installations
I \Buddmg\Permits\ELC- PermitApp doc 03/23/06