Permit V CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 11 COMMUNITY DEVELOPMENT Permit #: ELR2009 -00138
Date Issued: 05/22/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 639 4171
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9724 SW WASHINGTON_SQUARE.DR.F06
Subdivision: Lot: 0
Project: Gap
Project Description: Install restricted energy for audio /stereo system
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, Restricted Energy Permit 05/22/2009 $75 00
2235 FARADAY AVE STE #0 12% State Surcharge - Restricted Energy 05/22/2009 $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: 1
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 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1 800 332 2344
Issued By: � Qu 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.
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.■ g-EGEIr,c,_
" Electrical Permit Applicat \ � f ,, „,. FoR
City of Tigard AY 2 0 2009 Received
13125 SW Hall Blvd., Ti ^� DatelB : • Permit No : lies 0 :
Bard, OR 9722 "' �s
' • Phone: 503.639.4171 Fax 503.598. 9 � n Plan Review — Other Permit
T i (. A lc n Inspection Line: 503.639.4175 ( I I T OF T GARD Do Bl�/gy 1'1 I® see p
Internet: www.tigard -� age 2 for
�LI LQ1NG 1IVIS ON Noti6e Supplemental Information
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�1;4��c. �.1i.4:sF.�1l it a.. iii :�:.,n�t'n�ltC�n�.a�a•�����:.�1 A��e4t�. - rF� t� �^ tfUMiWl' "!+i„
❑ New construction 1 ' . dition/ alteration /replacement Please check all that apply (submit 1 sots of plans w /items checked below):
❑ Demolition
• Other ❑ Service or feeder 400 amps or more ❑ Building over three stories.
"t 14� n ?; a where the available fault current
0 Marinas and 3 At-..� o l eMletkuh,aae i e& r 1 a t ti . 11 bit '`%' . , r l i r i ,` r �A 1 i � I,,, `..1. e' ; exceeds 10.000 amps at ISO volts or ❑ Flaati g bu boatyards.
da.
ID 1- and 2 - family dwelling �CommerciaUindustrlal less to ground, or exceeds 14,000 ❑ Commercial -rue agncultural
❑ Accessory building
❑ Multi amps for all other installations. buildings
_ w y ❑ Master builder El Other: ❑ Fire pump. ❑ Installation of 75 K VA or
i ^ -c L CElli t 1 `k r au rr�g i µ,i
1 'af'i`" rQ 17vyArsr�i r x F is ❑ Enxrgee system larger separately derived system
a :,a9ar„ c "' u r l . i ua trsiwtr> 41W �.r:., k;.J: ❑ Addition n of new motor load of
Job no.: Job site address: 0 HP or mo
1 ¶ ` Z Su/ �✓ � �� �p L ❑ S or morn residential re units ❑ Rec e�onal vehicle parks
City/State./ZIP: �� d p -77.2-3 J bbb ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal,
Suite/bldg. /apt. no.: I Project name: 01" ❑ Service or feeder 600 amps or more
l ;,'1 : ' t{d ` {t F t` I I 'e E '%.raJ t� P or a; It
Cross stree Udirections to job site:
u ,,, r i
n et�p e OO Qw. Fee. Total •
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'I 500 sq. R. or portion 33.40 1
(with above sq. ft)
r' o 'r�?1E; 3 r t i s . e rm er, , ! Limited energy, residential
:iCg€i�l.od %o-�4!o °s4#e�t ,�>r1 y 75.00
tux`s. air i . : o ' 3ttt 'r � x" 2
L O , � V 1 }4 .,e Limited energy, multi - family
c' , d, n S .. residential (with above sq. ft.) 75.00 2
I A -,1t, k,,�t Services or feeders installation and /or relocation
} a� = r l bra N 7y�; •fir A 200 amps or less 80.30
a?� its- .�}4�eti I xy 't•'l�s ... I.e„ iS. �n . i, ' .'l 201 amps to 400 � 106.85 2 2
VW/ l
Name:
401 amps to 600 amps 160 60 2
Address: 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( )
I re
200 amps or less 66.85 I
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, r panel
t w1;1. cur+. rr , x„ a� � A. Fee for branch circuits with
" R t t r y i � - ' °d above service or feeder fee,
u a � ri�la. rr�f�:' �s� ;.'�.:� -r�rr� tl' `$iY� ` � ���;
Business name:
each branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder feu,
first branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City /State /7IP: Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: ( ) J Fax: : ( ) dwelling, service and/or feeder 90.90 2
E -mail: -
Reconpect only 66 85 _ 2
y � Pump or irrigation circle 53.40 2
r Z i1�6'�H1N�ia," 'u`k' �i, h 1 V,l rr�q. t d �C roJ(�x eat: - ,
, ti.n."EE,. .316 ? >., ; • ,a1�, '� ,,, ' Si or outline lighting 53.40 2
Business name: v� SY Ie S , i^ Signal circuit(s) or limited-
� 1 C energy panel, alteration, or
Address: 7 IJ gg g--3 extension Describe: i Page 2 75 —,.. 2
City /State /ZIP: Q Each a dditional inspection � a ^ f-- � � ff j pectlon over allowable in any of the above
Phone: ( ) rime Per inspection 62.50
NA - " e I Fax: ( S ) Zgg c t Z. Investigation per hour (i hr min) 62.50 '
CCB Lie.: 1 1,6 4'1 % f Electrical Lic.: ac 6 I Suprv. Lic,: --0 GFA Industrial plant per hour 73.75
Suprv. Electrician signature, required: r� '` `);'�'''' W {!m'r �.- �' ;�' +,1 �ga�q��q� "}
_{ Subtotal: 15; o
Print n ame: 0440 13 .5 ,^ I Date: ��010 Plan review (25% of permit fee):
Authorized signature:
State surcharge (12%ofpermit fee): 9 ,
TOTAL PERMIT FEE: gi 00
P rint name: I 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. 1 UturldieglPennhI\aLC- PemnitApp doe 05/23/06 440.4615T(I I MS/COM/WF8
May 20• - nO09'10:51AM HP LRSERJET FAX p.2
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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. .G,q.cfi�. .Jt.,..- .m.yseeu.�ac4 ",�' "�+ �l. . -w i.�� 7 • r l'a'%.� . },,�
Fee for l residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
E l Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other
A' Vi�t�•j t , � ia:; �'e �' � 41 i' .'y'q. 0 ; '• � Si y,1S > �' `' l5ti . 1 ' �' Cpl ':�Yt}p a
mfi�t,.w : �'� 1d� �.;s.ii.:rYM
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
)12, Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
11 auilding1PermlMELC- PermhApp doo 03/23/06