Permit ^ ,, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
`'4 = - COMMUNITY DEVELOPMENT Permit #: ELR2009 -00195
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2009
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9677 SW WASHINGTON SQUARE DR CO5
Subdivision: Lot: 0
Project: GAP
Project Description: Low Voltage for Protection Buzzer
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, Restricted Energy Permit 07/21/2009 $75.00
2235 FARADAY AVE STE #0 12% State Surcharge - Electrical 07/21/2009 $9.00
PHONE:
Contractor:
CHRISTENSON ELECTRIC INC
111 SW COLUMBIA ST, STE 480
PORTLAND, OR 97201
PHONE: 503 -419 -3300
FAX: 503 -419 -3695
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. Y Fire Alarm: N
HVAC. N Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting. N Medical: N Required Items and Reports (Conditions)
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 ' 52 -QJ11 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 246.6699 or 1.800.332 2344. l
Issued By: Perrnittee Signature: i' O>�
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.
PP P JUL -20 -2009 MON 01:31 PM CHRISTENSON ELECTRIC, INC FAX NO. 95034193695 P. 01
Electrical - Permit Application rOlR 0I11t, I:. test; O,NI.\
City of Tigard RECEIVE ` u "y. Permit No.:
, a , 13125 SW Hall Blvd., Tigard, OR 97223 , Plan Review t> Pa>mic
Phone: 503.639.4171 Fax: 503.598.1960 ii IL 2 0 200 Date/By
Inspection Line: 503.639.4175
Internet: www,tigard- or.gov Date Ready /13y: Jerks M Sea Page 2 far 16 f I G A h! � otifiedftNnlmd Supplemental Informndoa
i
vt• [t[a'(', _`y'iY x> • Y ! V n y 0' :. ;a p . j, ;' *,i W;r ` l` 1 '' i " . r @' ' Fi C ' !S.a rt �'+F:3F ' , lie 1 •
i !F U „ 4r.L•:i . :r ;' :31. dl .: . r t. -. ar I M; s ` un,.o .n% r*•
Please check all that apply (submit 1 sets of plans w /tenq checked below):
few construction Addition/alteratio - replacement ❑ Service or feeder 400 amps or more ❑ Building ova tine stories.
El Demolition • Other where the available fault current ❑ Mariana and boatyards.
`• m , '" -,,, n A,4;., 150 volts or ❑ Floatitt buildings
: • _ 7� ti •r i i !' I�+•' I� , '1�;, + exceeds 10,000 amps at
- 2 , 00V .� i .H s • i' •r�` W itAlE•�C41I,l�ttl"Q/S":'. *:i4,c 7 '' ' Ii 413' less to groand, or exceeds 14,(00 0 Comriueial•u:e agiculnuol
CI I - and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family 0 Master builder ❑ Other. ❑ pump. system 0 laeger of 75 telY de ived system. KvA or
' y; ., ".r , 1', : �_�? " >` r R ,j�� 4 '1 ���.,, �h" iv fi,`,`'�2'�' ap ;... " ,. ,. _
•`'ti; %'tlf;?Yf�* �� "�N 4 r.�?�.',
c' �x�• Q�p��. v', �pf'! Flcn����� • � �.�r,- V . fy : ����: ❑Addition of txw motor land of ❑
Job no' Job site address q(011 ,,,,1_ �+ p d Six °mo tea occupation.
�6 S � c'j �o11 UJ W t.On1y Y X 72 t� ❑ Six armote rexiden6al units D occupancy.
cteauonal vehicle palm
1 ❑ Healih r Within- is. CI voltage for more than
City/SlAte/ZIP:�` • y x r CI ❑ Hazardous locations. 600 volts nominal.
Suite/bld J t. no.: /_ Project name: (4,r1 . a _ ❑ Service or feeder 600 amps or more.
� V .'.;p:,,•tti.n rc$1'14.4.'34>[i'1?rPiff$ CitA7i+t'• "a .,rte.' %t r1 k - 9t >.�
Cross street/directions to job site: nealptlaa I on. J II rout I •
^ New residential single- or multi- family dwelling unit.
\"(. r _, ^ ai `c ---412,R4 includes attached garage.
Subdivision: CYJ 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
`r•r;r i .. ,. - %: i.__l� �,�, . �a"yi \..•:
; �',�_� tics? s,:: �. ,,�s 1 ; �; di'; �s� 6; 11 +a Y �RI�C�if' • •`.,G�WRIC•.._ .s •;�t'.....,e ..f r,:'.. Iwi tbabovesq. R)
Limited energy, multi - family 75.00 2
*, - • � '. Abp_ - k"lvy... 0_, .. residentiallwith above s4 ) „
Services or feeders Installation, alteration, and/or relocation -
200 amps or less r 80.30 2
r 2;:+, p��rf l "',•r t ,•I
1 `:"'• ' ; .:S. {`,`i i NISI P'l �7 a;'i,,> ^A; 201 amps to 400 amps • 106.85 2
� #�i ?l''�'•5:�:,'����M, err- TiPil' y�� kf�.�.��C�•`'.�'v�'�4.''4,�'r ': . u ^: �kF.[ i� '! '+ "r*12iQ!.3!.'•;'�. "t'. ` G�
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 J 454.65 2
' ' /State/ZIP: Temporary services or feeders lastailaton, alteration, and/or
relocation
ruune: ( ) I Fax: ( ) 200 amps or loss 66.85 1
Owner installation; This installation is being made on property that I own which is not 201 amps io 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, pepanel
Owner signature: Date: A. Fee for branch circuits with -
f; { ' "� !, above service or feeler fee
:r "k ■ ;, ' '' t.' f:Q;44 iii,,'. '��? rte`.. ;'� O1 . . I;A :' Fe:'; - `_,' 6.65 2
each branch circuit
Business name: . B. Fee for branch circuits
without service or feeder fee, ,� 65 2
Canister name: 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 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
r,: rr r •, c , ' H'7 ONTRAC7 OR ' %i ';n" - Sign or outline lighting 53.40 2
Signal circuit(s)
Business name: Christenson Electric, Inc. r limited
energy panel, alteration, or
Address: 111 SW Columbia, Suite 480 extension. Describe: Page 2 2
City/State/ZIP: Portland, OR 97201 t,j C - Each additional Inspection over allowable In any the above
11 Per inspection 62.50 •
Phone: (503) 419- 3300. �3r;,t (A I Fax: (S03) 5 _' s Invc,4tigation per hour (I hr min) 62.50
CCB Lic.: 458 Electrical Lic.: 26 -34C uprv. Lic.: 1 "4S 4S Industrial plant per hour 73.75 „ ^
! i^ �:,•.,'„ �V;'-:.,•:,,' ?, E1�C :1'RI(.°A�XT,'�FLES:'.:.,'::- .r.,,,,
Suprv. Electrician signature, required: � ` ^ Subtotal: ,�
P rint name: Robert Axt Dom; — Plan review (25% of permit fee):
State surcharge (12% of permit fee):
I _
.,iorized signature: TOTAL PERMIT FEE:
This permit application expires If a permit to not oboed within Ian
Feint name: Date: W days after it has been accepted as complete.
• Number of inspectionb allowed per permit.
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