Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2013 00079
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2013
T[ G A R O 9 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9704 SW WASHINGTON SQUARE RD F10
Project: S Wireless Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: (1) low voltage for audio system and (1) low voltage for CCTV
Contractor: GLOBAL SECURITY & COMMUNICATION Owner: PPR WASHINGTON SQUARE LLC
3212 MAIN ST PO BOX 847
VANCOUVER, WA 98663 CARLSBAD, CA 92018
PHONE: 360 - 693 -1900 PHONE:
FAX: 360 - 906 -9692
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04 /10/2013 $150.00
12% State Surcharge - Electrical 04/10/2013 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: Y Boiler Controls: N
CCTV: Y 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 $168.00
Other Desc: Required Items and Reports (Conditions)
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 -0090. You g ma'y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,14L(ti Q�`^ u�' Permittee Signatu al A Ple-t 64-1701d
o/J
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.
Apr. 9. 2013 1:14PM No. 8463 P. 1
Electrical Permit Applicati `- ECEIVED 1OR OF! 1(1• 1'I U \L\
ReOerved it b 13 ALL POI 3 - ems? `l
City of Tigard Date/By u Pet mitNo.:
13125 SW Hall Blvd., Tigard, OR 972 R 0 9 2013 Plan Renew
Phone: 503.7182439 Fax 503.598. 1960 Duel . Other Permit:
1 -
L L Inspection Line: 503.639.4175 Date ReadyfB �
y ' BI See Pate 2 for
Intender www.ti,`ard- or.gov CITY OF TIGARD Notified/Method: I sapplemeatal Iafsrmaboe
TYPE A�G DIVISION Prix .
CI New construction 12 Addition/alteration/replacement Please check all thee apply (submit j sets of plans whims checked below):
❑ Service or feeder 400 amps or more ❑ Braiding over three storied.
❑ Demolition ❑ Other
where the available faun current 0 Marinas a sd boatyards.
Ctm ����• 9� .�� ? t �� � exceeds 10,000 amps at l50 votes or ❑ Floating buildings.
... Y _t ::. p •. S r , . S : r. ' ' c less to
ground, or exceeds 14.000 0 Commeroial.use agrieuhural
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. 0Instellation of 75 KVA or
'/f / ❑ Emergency system. larger separately derived system.
�L j B SITE INFORMATION AND LOCATION ❑ Addition of new motor load of 0 "A'•. "E", "1 -2 ", "1 -3",
Job no.: Job site address: () !, r001� or more, occupancy.
, _ __ f 1 "� Sift,/ 'NaS`Z l� S ,� ❑Six or more residential units. 0 Recreational vehicle parka.
City /State/ZIP:1) c✓` t I ( , , +Q C4 7 5 p(ct V F/n 0 Healthcare facilities, ❑ Supply voltage Ar more than
S ❑ Hazardous locations.
600 volts nominal.
Suite/bldg. /apt. no.: F 1 0 Project name: S Wireless ❑ Service or feeder 600 amps or more
,1r r_ FEE SCHEDULE :;,
Cross street/directions to job site:
tkscription 1 Qry, � Pte. I Torts I •
New residential single- or multi-family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less , 1 6 8,54 4
Tax map /parcel no.: Be.. add'! 500 sq. ft. or portion _ 33,92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
tta IbL4 (! iv residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
PROPERTY OWNER . , 'L 1 rlF Ar(;J ;. s ''l ,4 : 201 amps to 400 amps 133.56 _ 2
1 .
401 amps to 600 amps 200.34 2
Name: 601 amps to 1 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /Statc /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 ]
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 2
intended for sale, Iease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 W 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
0 A 'P 0 CONTACT PERSON above service or feeder fee, 7A2 2
. each branch circuit
Business name: B, Fee for branch circuits without
service or feeder fcc, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit I 7,42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: _ dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67,84 2
Pump or irrigation circle 67.84 2
E - mail: 1' 67 84
Y c, z b c� , . Sign or outline lighting 2
4.7.; _,fir ., - - s a .1e. O5` .i .... Signal circuit(s) or limited- energy
Business name: Global Security and Communications panel, alteration, or extension. 2 Page 2 75 2
Each additional inspection over allowable in any of the above
Address: 3212 Main St Additional inspection(1 hr min) 6625/ hr
City /State /ZIP: Vancouver Wa 98663 investigation (1 hr min) 66.25/ hr
I,1 Industrial plant (1 hr min) 78.18/ hr
Phone: (360) 693 -1900 % 11b \(' Fax: (360) 906 -9692 d t '1y' — Inspections ns for which no fee is 90.00/hr
906-9692
AI, specifically listed Oi hr min)
CCB Lie.: 69705 1 A Electrical Lic.: 26-711CL Sup ; / 'c.: 3635LEA .. - 't , LECTRICAL FERMYT FEES
Suprv. Electrician signature, required: /� / � � Subtotal ' 150.00
( Plan review (25% of permit fee):
Print name: Kirk Tipp ( ( (2, ` / (( a : te: 4 -9 -13 State surcharge (12% of permit fee): 18.00
TOTAL PERMIT FEE: 168.00
Authorized signature: This permit applicadoo expires if a permit Is not obtained within 180
days after it hes been accepted as complete.
Print name: Jeff Isla Dare: 4 - 9 - * Number of inspections allowed per permit,
r:\BulldinaTemn,\SLC -Penek pp.doc 07/01/10 440 4615T(11 /05,COM/WE
Apr. 9. 2013 1:14PM No. 8463 P. 3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORIUlIY::.., . : „ • -
Fee for all residential systems combined......,, $75.00
Check Type of Work Invohred:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
Vacuum Systems*
❑ Other
COMMERCIAL WdRK`ON Y W ,
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
® Audio and Stereo Systems
❑ Boiler Controls
Li Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
i4 Other CCTV
Total number of commercial systems! 2
*No licenses are required. Licenses are required
for all other installations
I; 18ulldinerrrnite \ELC- PamivADD.doe 07/01 /10
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9704 SW WASHINGTON SQUARE RD F10,
TIGARD, OR, 97223
Commercial - Electricial Limited Energy
198 Low voltage final
PASS - No C of O
ELR2013-00079
Jeff Grove
Violation Summary:
Inspector Contractor