Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
g COMMUNITY DEVELOPMENT Permit #: ELR2013 -00062
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/18/2013
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9759 SW WASHINGTON SQUARE RD D05
Project: The Art of Shaving Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Low voltage for audio /stereo
Contractor: OHM SYSTEMS LLC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 86833 PO BOX 847
PORTLAND, OR 97286 CARLSBAD, CA 92018
PHONE: 503 - 484 -5700 PHONE:
FAX: 503 - 258 -0382
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 03/18/2013 $75.00
12% State Surcharge - Electrical 03/18/2013 $9.00
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
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This per s issued su• - to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be a in accordance with a . .. . . . . .- - s. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
d s. ATTENTION: Oregon la equires • • to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
2- 001 -0010 thn ugh OAR 9 -001 -1.90. - obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.:11.332.2344.
Issued 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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Electrical Permit Application RECEIV E i_ OR OFFICE USE ONLY
Received
City of Tigard Q Date/By: /O 43 Perm e2
itNo.: , ? /3 �00� '
13125 SW Hall Blvd., Tigard, OR 97223 • MAR 1 8 2013 Plan Review
' C : Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: /; ccPaolR,- D Otri
Inspection Line: 503.639.4175
Ins p CITY TIGARD Date Ready/By: Juris: El See Page 2 for
- r 1 G A RD
IT f Ready/By:
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New 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.
❑ 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 [- rommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION ND LOCATION ❑ Emergency system. larger separately derived system.
C � ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: I OOHP or more. occupancy.
S t✓ L✓' '^ ` � �^ S � ' K d. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: T �, J Q h I 77 a J ❑ H ealth -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 Project name: 'r 1.-, 4,4 _ or 0 Service or feeder 600 amps or more.
�` • FEE SCHEDULE
Cross street/directions to job site: Description I QM 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 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
� Limited energy, multi - family 75.00 2
V d1,,, ( Vo 1 L 3 e . ,4H J;�d Sf5'7<"! ,..-. residential (with above sq. ft.)
v Se rvices or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
h relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 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 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy 00
Business name: panel, alteration, or extension. 4 Page 2 7 ' S 2
^'t 5 Y S �r - ^ S / L L C Each additional inspection over allowable in any of the above
vi. Address: �p o e , ij � Additional inspection (1 hr min) 66.25/ hr
a 7c. City/State /ZIP: + ( J V tp q 72 6 4 Investigation (1 hr min) 66.25/ hr
rr' 't - r\ Industrial plant (I hr min) 78.18/ hr
Phone: (503) 18K s' 00 Fax: (S`C 2-51c 05 gZ Inspections for which no fee is 90.00 / hr
specifically listed (Y2 hr min)
CCB Lic.: i6 d gl 1 Electrical Lic.: CL g ( Suprv. Lic.: 1.1( 6 LE ELECTRICAL PERMIT FEES
o0
Suprv. Electrician signature, required: / �� Subtotal: 7S'
Plan review (25% of permit fee):
Print name: a / j -g 1 ` 1 ,. t 8 `�3 Date: 37 State surcharge (12% of permit fee): 9 • ad
TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(I1/05 /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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
p Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC- PermitApp.doc 07/01/10
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9759 SW WASHINGTON SQUARE RD D05,
TIGARD, OR, 97223
Commercial - Electricial Limited Energy
135 Low voltage
03/19/2013 00:00
ELR2013-00062
PASS
Violation Summary:
Inspector Contractor