Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° ►'! o � COMMUNITY DEVELOPMENT Permit #: ELR2013 -00158
Date Issued: 07/03/2013
.T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9618 SW WASHINGTON SQUARE RD G -5
Project: Helzberg Diamonds Subdlvision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Protective signaling and CCTV for remodeling and expanding into tenant next door
Contractor: SIGNATURE SECURITY INC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 3322 PO BOX 847
VANCOUVER, WA 98668 CARLSBAD, CA 92018
PHONE: 360- 750 -6000 PHONE:
FAX: 360 - 846 -1891
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/03/2013 $150.00
12% State Surcharge - Electrical 07/03/2013 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 1 Clock Systems: 0
Data & Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom /Paging: 0 Landscape /Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 1 Other: 0 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 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: t
Permittee Signature:
/1/✓ /4 (1 '9 o A.1
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 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 Al) licati E • . : : -•.
_ 1;: Ole l�:C(.1;. USE ONO'
City elf 1'r lard ` I V Received
Dattni, 7 3 .-7 �, Pr -iiit .:Ea -20/3-004-5",
- • 1312.5 SW It.1I Bhii..Tigard, OR 97223 ...3'la lt�;.i - _,_,_� .
.--I l Is '••• lTh nc; 503. r211.1: 503.593,1 �,frh r L 3 2013 C11her 1'01 11 .
Daien3• IkeuPaQ /3 - (5040// t J 11 C Alm 1m:pe I inn Lino 503.639.4175 CITY tbet t /tiy. tuii: ( 10 Svc raw 2 for
Internet: www,titard -f.w.g v OF NMiJial/hfi>ihraI. ^- • _� , 7I l7 bulrirlrrnrndrrl Isir t:nlirm '•
W --- _ 7'1 C� ►�71VI _.... _ _ � PLAN REVIEW __- _---._ -
N i Now construction r;� - -' __ r1e;1eU C11CCk all llkni .apply (�u1171711t 2 f:ctr; of p1Pns, w /item checked 1 +c1Dto) ~
El Addilk aitor:itionimplacelm IN( craicn or finder • }t1r3 ,ne s rn nturr
0 `l M ❑ atheist ove Ihlc`c ::torics.
El Uuno.lition ❑ ()thcr; - - where 4w aril li 1;1�411cmr oral ❑ i i 5a iic [ oalyards
' • CATEGORY OF CONS en ds IMP) x190 at I S0 Y'i1I or 0 Flnatiott bt l lugs.
_..__.W .. _ _ __. ,_._. i to Holmes, or e:ri.cuds I1,Oq;i 0 t.tAnniCffihrt -urx aericullnria
0 1- and 2 -1 wnily dwelling [J Coatwtlorciaiiindusu-i ❑ ACi;C5so y building :ours frrart natter insunllatiuns. huildillgs,
a1v4ulti- I:itmily a Master builder D Other; El rive pular, 0I1141a41atinnat•150KVAnr
i018 SITE INFORMATION AND LOCATION _ --. -, 10 1?fIer5cncy syshi!. Isrger r:rparahly derived a)•stel:a.
. -__ ❑ Addi{ianci MOW hint F last„f 0 ''A " `(t 1_3 1 s'
Job rn. [Job siic address: 9618 SW W tsllimgtes Sq Rd 1001 or more. f occlrpaaic)•.
El Six or wide resideVial maim. 0 lteereal•imud vehicle p:uks
•
fall /State /LIP: Tigard OR 97223 [1 iLilldi - curd fnciliiics. ❑ •`ii IvIiw(,,M for raore IWO
- - - - -- -- _. ❑ I- idaE+s k+oaliuru, 600 v'1ir• nnmioai.
Sal itc'131dgIapt• no.: Project n,vnme.: ,7LEL,,,, ,,, i Service or feeder 600 amps at Mere.
- FEE SCIi1iDULE
Cross street/directions to, j ob site: t is scholls ferry rd 1)MCr ltG, -� ^-� r i " re,Gt J�
1 == Imot 1 r•.r.
I New rel:;dcnti d Rsiagle- el' nrtulli Caniily dwelling unit.
I--i Includes Mocked grirngc,
IY - -. . ._._, �^�'..... LOGO 511. R, or Ic;,`3 , - 168.54 +I
D Subdivision: l,oni on : _ _
U __....___- • P.S. add'I 500 sq. (I. or portion 3_3.9: 1
Ld 01 Tax 1413 tpatcd no.; mm . ___ 1 earl if,y,rciaidentiai 75,tYt1 ... -7
liE SCItIPTION OF tVowK _(';must a&1ovc sq. ll.) V , ..
1.1J 1.1J __ .-•..- --- ---- -- Littleton Crru'a, mclti4f rreity— 75.00
rrrsrdcnt•al (with above sq. Ii.)
Rr.newahlci;nergy • J 0 See rage 2 -
Q integrated rely /security ScrvicCS or Nedert installation, ;Otero ion, and /ar relucst�Iion
Z - �___-__ _ _ _ ____._T__.._,_.,_,_- _._.-. ', , dust or tens 100.70 2
C7 PROPERTY OWNFR � �] 7�N, VA1V'T T __.- .__._,- _._.__
201 reaps En 4(X) amps 133.56 2
F--I Name: Ildrberg
T _ •401 melds to 600 amps -�' �t 0.34 i
Address: s Illt. ail ilthoL'e 601 amps to 1.000 nirnps 30J1,04 2
-
Over 1,000 tulips i)r volts 552, .2r5 r —
1.ity/5.1i+1.Gf /•IP; T^ — fetalrtrrary scrviccs or f c ler81115t1lIIfl err aitcratian, ;trsd'or
Phone: (503)670 - 7885 I Fax: ( ) reloc:tlinn
^
200 mops or }0:-5 59.36 � 1
Owner ianstuillalian: This installation is being made, on properly that I own which is not 201 imps $o 4tA'1 imp — 125.08 2
intended for solo. beast:, rent, or extttauge, accordiotg, to ORS 447. 449, 070, and 701. 401 amps to 599 mops � 109 53_ �.._�.-
Owner signature: - - Dale: Branch riatnits -- new ulierstirob ur extension, Ile nnrl
0
APPLICANT 1 .:-- � CONTACT T PERSON RfiON A. Feu for braneli circui•Is w,with .:.
. _ - above. service or fecclor fee., ,
131.tsint.ss name: cockbbrunch) circuit 7'4 "'
_ - - B. Fco for branch circuits withal',
Contact name: service or Iced;r leer, 0051
56.18 2
c-1 �.- .--- -- --- - - -- - ._..,.._,..__..�.,. bruaclt envie
O i Address: Each add' I h iwh circuit 7.42 2
OD _._ MP:ccllhtneow; {service• or feeder ant Imdhuded) - _� - _
CityfState`Lll': _ . _
LID Each Inantif cured or modular
67.34 2
71- _____.__. _ ------ _ de/4110w > servkc oridI r (kt let
CO Pliant:: f ) Fax: : ( ) I.ccunl,crt:xly - ti 7.34 .
L snail: __._._._ --- . . �
t.0 -- _ _ __a Poole or irrigation circle 67.84 2
Cr) CONTRACTOR r _ _ Sint or n iliac ligkti)Ig 67.34 2
Business ii inn: Signature Security Signal *oars) or Iittutcd-onorg 2 . Sac _ .. 75
__� _ panel, aitcratiw), c',r eXIrnsiuu. 1'a re 2 _ 2
Address: PO Dux 3322 Each sidtlitiunai bus colon over altmrainlw in anv of the phon
(y ` "�` Addilinuo, in spedit n t (I In min) 66.2 S.' In
City /.State /ZIP: Vancouver WA 921668 ltaresti l ion (I 1r lriir) 66.25fhr
m P one (360) 750 -6(100 i Fax: (360) 846 -i811 Iiadaist'rixl plant (1 hr Irvin) 7;3.18 /11i _
-- -- T --- • --- ---- -__ liaspec(kins for wiuclr no fee is yri.1,�` in
CC Lie,: 1313693 rilk l Icctritsl Li�c.: 37 815 'L1 Suprv. Lie,: 4217L1:,A _sp" ifh:ollviisted Krrnirh,)_ _._,___-.
/ O - ELECTRICAL PERMIT FEES __
m Suprv. Electrician sig'nditufd, r egtliri:1' d `a �
5ubcol
� al: 150
N- --- ._,_.• .. f _---_ _ _ _._ _ -_ .
I'rintnainc:: JAMES RIISSELE l I Dde: 07/03iI3 _ Plan rov /ow (2``ri,ofpc1 mil lee): _ —
Cr) _......_._ w..._._. _ ___..- Slate srarrlrarpc(I2't of permit! fee): 18 v
Auhorized si gn1itu re: T
t TOTAL PL.RMIT PL.IS: 168
N__ _ T__._._ _ - _._ _ _
19 Print name'. name'. 'l pennk irpplitittion Crpirrs an pr - nrit is or,i oht041wd within Ytia
Print
____.._....__.__� I `O - dlh•n aI erit hsx lira mcepleA ns crrmphre.
' tdnall; of bnspcctiow AInnrd loci pynoet_
Itil3 ilili•glt` mniu 4 ;1.R_111F Jac Rev ?.Vj t /20f 3 •i -o.i■ 1 5Tr I Ib ?VCQRU1Jrib
Electrical Permit Application — City of Tigard
Page 2— Supptemental Information
N
m Limited En r'gy Permit Fees: Renewable E.i rgy Permit Fees:
L RESIDENTIAL WORK ONLY: _. .F srtil aY: t,l�
cz Fee for all residential systems combined...... S"75 n,i,•,;eii„a ___ of, r -- iqi. T 7Ur,,1 r
CL. Itcnotable clerirl ill cuergy ayisferas:
!CZ Type of Work Involved: 5 kva or i_ ) On.70 2
S 0l to 15 kva 133.56 2
❑ Audio and Stereo Systems* 1 0I w2skva 200.34 2
❑ i3urglar Alarm Wind gene.r•atIon sy*tciara in excel, 01''5.k
25.01 to 50 kva 301 04 1
2
❑ Garage Door Opener* 50.01 to 100kv:r l 552.20 2
>I&0kva (fee inaccordam:ewk SS2.:i; 2
[] Heating, Ventilation and Air Conditioning o•nitOls-309.Ot1ai ") - f --- .
System* solar gencra4init sysluns in eleesc of 25 kva:
} Patch additional kva ov1:r 2s 7,42 3
I El Vacuum Systems > 101) vil –no additiona1c1aorisc G.0 s
CK Elicit additional inspeetion over atlon ble i t any oldie above:
D ❑ Other: Exit additional ii paaion is 251 _
W I:hlarpcd at an hourt(I hr min) �
(J) Inaptxtitms for t.liich uo tee is 00.00' hr
vrcidiead y tilted (r% hr iniir
Li COMMERCIAL WORK ONLY: • t,LECTRICAL PERM FEES
D Fee for each comitierci:al system. $75.00 St+t,toial:
Q (SITE OAR 1 918 - 3090000) irly nrcvicty, ii'ngtaircd(2s'.!'oni'permit 1/0e):
C Z Ss bte surcharge (12% of permit l »:
cl Cheek Type of Work Involved: TOTAL PcltMrf FL[::
Tlrfe pumlit u.ppI cati90 eapirca If n permit is nna ntgained i 4Mu 1&)
❑ Audio and Stereo Systems drvs Act' it toil hoot' d cprc•tinsecmpleln
' ttnnUberodiaSj :eclioos rtlay.Cdperpengrd.
❑ Boiler Controls
(1 Clock Systems
❑ Data "1'elecomtnunication Installation
❑ Fire Alarm Installation
L] 1IVAC
m ❑ Instrumentation
CO
LO 0 Intercom and Paging Systems
m
•
CI ❑ Landscape Irrigation Control*
m
❑ Medical
Q E Nurse Calls
N
❑ Outdoor I.aiidsesipe Lighting*
m
Protective Signaling
Cr)
V, Other
N
t j Total number ot'commercial systems: 2
m
*No licenses are required. Licenses are regaired
m for all other installations
1 •J:uiki,,,..pcnahlG,, -.f. ,,u A.,_ CUR. CP.C.duc At i fl /3m1!
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