Permit ^ a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00023
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/03/2010
• Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9677 SW WASHINGTON SQUARE DR CO5
Subdivision: Lot: 0
Project: Aeropostale
Project Description: Sound system
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #0 Restricted Energy Permit 02/03/2010 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 02/03/2010 $8.14
PHONE:
Contractor:
JUSTICE COMMUNICATION CO
3337 SE HAWTHORNE BLVD
PORTLAND, OR 97214
PHONE: 503 - 232 -6163
FAX: 503 - 232 -6902
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 $75.98
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 0 R 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: s Perrnittee Signature: ��P L /e - Tlll.\./
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 603.639.4176 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.
Electrical Permit Application RECEIVED FOR OFFICE LE ONLY
,t Received
City of Tigard FEB 0 2 2040 Date/B : C - Id ,.t41; Permit No.:ZZA070 /0 ' 0 / /
Ili 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �, r�
C Phone: 503.639.4171 Fax: 503.598.1960, Date/By: Other Permit: ett /0?00 / � — O0 /9 /
T l v ` l; D Inspection Line: 503.639.4175 �TY OF TIGA D Date Ready/By: s RI See Page 2 for
Internet: www.tigard - or.gov liar., gm DIVISAC Notified/Method: I 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
❑ I- and 2- family dwelling ® 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.
❑ Addition of new motor load of ❑ "A ", "E ", "I- 2 ", "I -3 ",
Job no.: Job site address: 9677 SW Washington Square Rd. looHPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, Oregon ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1083 Project name: AEROPOSTALE ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: WASHINGTON SQUARE MALL Description 1 Qty. 1 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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
SOUND SYSTEM Limited energy, multi - family
67.84 2
residential (with above sq. ft.)
Services 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
Name: 401 amps to 600 amps 200.34 2
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
relocation
Phone: ( ) I 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
Owner signature: Date: Branch circuits – new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: 56.18 2
first branch circuit
Address: Each add'l branch circuit 7.42 _ 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
67.84 2
Phone: dwelling, service and/or feeder
( ) Fax: ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: JUSTICE COMMUNICATION COMPANY Signal circuits) or limited -
energy panel, alteration, or
Address: 3337 SE HAWTHORNS BLVD. extension. Describe: I Page 2 67 2
City/State/ZIP: PORTLAND, OREGON 97232 Each additional inspection over allowable in any of the above
Per inspection 66.25
hone: (503) 232.6163 ✓ / �� f i 'Fax: (503) 232.6 :l
Investigation per hour (I hr min) 66.25
CCB Lie.: 67545 El
I L c.: 26 -11 p ic.: 617LEA Industrial plant per hour 78.18
L ' ' / j ELECTRICAL PERMIT FEES
Suprv. Electrician signature, r:• ' � � 0 !�� � ►0
� �" Subtotal: 67.84
Print name: L� Y C. JUSTICE Date: 1 -28-10 Plan review (25 %of permit fee): •
`.y State surcharge (12% of permit fee): 8.14
Authorized signatu ....,„, ,,,�1 /o- TOTAL PERMIT FEE: 75.98
This permit application expires if a permit is not obtained within 180
Print name: Date:
days after it has been accepted as complete.
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $67.84
Check Type of Work Involved:
El Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
❑
Other
• COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
® Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations