Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT i I Permit#: ELR2013-00174
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 D® Date Issued: 07/22/2013
TIGARD 9 "ur/ Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9502 SW WASHINGTON SQUARE RD J03
Project: Wetzels Pretzels Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Low voltage for security cameras. 9/12/2013: REPRINT permit to correct contractor name and address.
Contractor: INSTALLATION&SERVICE TECHNOLOGIES INC Owner: PPR WASHINGTON SQUARE LLC
8340 MISSION RD STE B4 PO BOX 847
PRAIRIE VILLAGE, KS 66206 CARLSBAD, CA 92018
PHONE: 913-652-7000 PHONE:
FAX: 913-381-2819
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/22/2013 $75.00
12%State Surcharge-Electrical 07/22/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 1 Boiler Controls: 0
CCTV: 0 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: 0 Other: 0 Total $84.00
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 OA; •52-01_-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / jr,
Permittee Signature: ON *0/04" ` 2 77a
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.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
. COMMUNITY DEVELOPMENT Permit #: ELR2013 -00174
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/22/2013
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9502 SW WASHINGTON SQUARE RD J03
Project: Wetzels Pretzels Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Low voltage for security cameras.
Contractor: 1ST Owner: PPR WASHINGTON SQUARE LLC
8340 MILLSION RD., STE. B4 PO BOX 847
PRAIRIE VILLAGE, KS 66206 CARLSBAD, CA 92018
PHONE: 913 - 652 -7000 PHONE:
FAX: 913- 381 -2819
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/22/2013 $75.00
12% State Surcharge - Electrical 07/22/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: 1 Boiler Controls: 0
CCTV: 0 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: 0 Other: 0 Total $84.00
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 issu- ce, or if work is suspended for more the 180
days. ATTENTION: Oregon
� /►2 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 -00 - 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 2.1987 or 1.800.33. ;44.
Issued By: Permittee Signature: 0119.--1
. `fI4 _ _ ..:
OWNER INSTALLATION ONLY _ I
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 503.639.4176 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 Application RECEIVED FOR OFFICE USE ONLY
City of Tigard l i Received
, )l.. L 2 2 i3 Date/By:
° /3 el11,' ' ermit No..El, 0 /3
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' C - Phone: 503.718.2439 Fax: 503.598.19 Date/By: Other Permit:
=1 =1 ci n K a Inspection Line: 503.639.4175 TY OFTIGARD Date Ready/By: hris: ® See Page 2 for
Internet: www.tigard -or. ov BUILDING DIVISION Notified/Method: �� Supplemental Information
YPE OF WORK "PLAN REVIEW '
El 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.
El Demolition ❑ er: where the available fault current ❑ Marinas and boatyards.
CATE ' RY Ok 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 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
JOB "SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
. . .. ' ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 3%75 Job site address: '95 oz 50 & V fff� f A Six or or occupancy.
❑
(� ffJJJ��� ❑Six or more re a r residential units. Recreational vehicle parks.
City/State /ZIP: T /1 � O ` l Z Z� ❑ Health -care facilities. ❑ Supply voltage for more than
A 1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: J Project name: ' `,.d S P�> rS ❑ Service or feeder 600 amps or more.
V` FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
LOU) V O l l e, S e Cu 1 ' -y CA ' A A fLq
' Limited esi energy, multi-family aabove q. ft.) 75.00 2
�+► InUI l� V l residential (with above sq.
J Renewable Energy ❑ See Page 2 •
Services or feeders installation, alteration, and/or relocation
• '❑ PROPERTY OWNER I ❑ TENANT. 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( )
relocation
• 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
' ❑ APPLICANT ❑' ,CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: 1 each branch circuit
B. Fee for branch circuits without
Contact name: WI �AY(V service or feeder fee, first 56.18 2
.n branch circuit
Address: � ' 3 L( 0 M is S (of.) e(� S7T 3 Each add'I branch circuit 7.42 2
/� I r ( Miscellaneous (service or feeder not included)
City/State /ZIP:
i K,l LA IA .. , l�xD C,P t0.z0 co Each manufactured or modular
Phone: (9 IS ) 6 S z _ 7000 I Fax: : ( ) dwelling, service and/or feeder 67.84 2
Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR . .• ' ' , Sign or outline lighting 67.84 2
n l t 15T Signal circuit(s) or limited-energy I See
1 panel, alteration, or extension. Page 2 2
Address: /A) .5 + SE t Cc 'T ,J Lc6 / Each additional inspection over allowable in any of the above
City/State /ZIP: 7 r G Additional inspection (I hr min) 66.25/ hr
f-J Investigation (1 hr min) 66.25/ hr
Phone: (3 ,) azq _ 09 0 y F ax: ( ) Industrial plant (I hr min) 78.18 / hr
1 Inspections for which no fee is 90.00 / hr
CCB Lic.: ['c o 0 - 7 q Electrical Lic.: C L6 0 Supry. Lic.: N 6 sc, LEA specifically listed (%2 hr min)
Suprv. Electrician signature, require` _A' " ` !D /� y 'ELECTRICAL 'PERMIT FEES
�, Subtotal: S , . CFO
Print nameW V ` V_� e„ 4 a I 1 Plan review (25 % of permit fee): l
State surcharge (12% of permit fee): y t t7 U
Authorized signature: TOTAL PERMIT FEE: f y 6 -0
Print name: Date: This permit application expires if s permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building\P ermits\ELC_PemutApp_ELR_ERE.doe Rev 05/21/2013 4404615T(II/05 /COM/WEB
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552.26 2
❑ Heating, Ventilation and Air Conditioning OAR 918- 309 -0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva— no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is
charged at an hourly (1 hr min) 66.25/ hr
Inspections for which no fee is 90.00 / hr
specifically listed ('h hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE AR 918- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Chec Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ 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
❑ Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
C\ Building\ PennitssELC _PennitApp_ELR_ERE.doo Rev 05/21/2013