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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 1114 a . COMMUNITY DEVELOPMENT Permit#: ELR2013 00223 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/05/2013 Parcel: 151260000300 Jurisdiction: TIGARD Site address: 9424 SW WASHINGTON SQUARE RD K05 Project: Hot Topic Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S Project Description: Data telecommunications system. Contractor: CALLAHAN ELECTRIC Owner: PPR WASHINGTON SQUARE LLC 4830 SE CONG ST PO BOX 847 PORTLAND, OR 97206 CARLSBAD, CA 92018 PHONE: 503-421-4553 PHONE: FAX: FEES Description Date Amount Specifics:, Restricted Energy Permit 09/05/2013 $75.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio&Stereo: 0 Boiler Controls: 0 CCTV: 0 Clock Systems: 0 Data&Telecommunications: 1 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 $75.00', 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. Issued B _ �s Permittee Signature: WIMP 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 .::1()1:.(11 MCI 1 tit.(),I A .Pi City of Tigard 3 Received — twit No.: Date/13 : 14 13125 SW Hail Blvd.,Tigard,OR 9 II • Phone: 503-718.2439 Fax: 503.598 w e Q (F.:... : Other Permit: / + 1, i 1\i Inspection Line: 503.639.4175 CJ� 1\G�� i1\. 1e Ready/By: >vri¢-,_ B1 See Page 2 for Internet: www.tigard-or.gov �( �`�\�S ed/Method: /4�--ce Supplemental Information TYPE OF WORK 'CO 0�� V PLAN REVIEW . ❑New construction Addition/alteration/lenient Please check all that apply(submit 1 sets of plans w/items checked below): El Demolition �--�Other: ❑Service or feeder 400 amps or more ❑Building over three stories. I..J we the available butt current ❑Marinas and boatyards. CATEGORY OF COptaraUCf1ON exceeds 10.000 amps at 150 volts or ❑Floating buildings. less to ground,or exceeds 14,000 0 Commercial-use agricultural er ❑ 1-and 2-family dwelling Commciallindustrial 0 Accessory building amps thrall other installations. buildings. ❑Multi-family ❑Master builder ❑Other ❑Fire pump. ❑installation of 150 KVA or Sffl'I3 A MAT>aRlll AND LOCATION O Emergency system. larger separately derived system. JOB Addition of new motor load of ❑ Job no.: Job site address: ,, II 100 or more 0CC parity. �y `� � I d'1 Q O six or more residential lulls. ❑Recreational vehicle pants City/State/ZIP: 0 vas ❑Health-care&chilies. ID supply voltage for more than 1 11 1 C ©Hazardous locatiosts. 600 volts nominal. Suite/bl J t no.: J Pro eat name: ❑service or feeder 600 amps or more. Project 1 � r �r��� FEE SCHEDULE - Cross street/directions to job site: J Aaer7ptioo 1 Qty. l Fee I total I • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less J 168.54 4 Tax map/parcel no.: . . Fa.add'I 500 sq.ft,or portion 33.92 1 Limited energy,residential 75.00 2 *IESCR1rrION OF WORK (with above sq.R) T limited energy,multi-family 75.00 2 :k�"‘-.cA 1 r h s2- — s-jr __ J a r. - �o residential(with above sq.ft) �"`t Reaewabie Energy ❑ Sec Page 2 Services or feeders installation,alteration,and/or relocation in PROPERTY OWNER I $TENANT 200 amps or less 100.70 2 �1 201 amps to 400 amps 133.56 2 Name: (Z 0+ QeJ 1 401 amps to 600 amps _ 200.34 2 r Address: Y 601 amps to 1,000 amps 301.04 2 Ciry/State/ZlP: Over 1,000 amps or volts 552.26 2, 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. 4 01 amps to 599 amps 168.54 2 Owner signature: __ Date: Branch circuits-new,alteration,or extensioner panel Q APPLICANT [ © CONTACT PERSON ' A.Fee for branch circuits with above service or feeder fee, 7.42 2 Business name; each branch circuit B.Fee for branch circuits without Contact name: service or feeder fee,first 56.18 2 branch Address: Each add'l branch circuit f 1 7.42 2 City/State/ZIP: Miscellaneous(service or feeder not included) _Each manufactured or modular 67.84 2 Phone:( ) J Fax::( ) dwelling,service and/or feeder Reconnect only 67.84 2 E-mail: _ Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: � Signal circuit(s)or limited-energy See i C•' \\�,�, r� ���4-,,,,,.c._ --LC/ panel,alteration,or extension. % Page 2 `7) 2 Address: ti C L....01101 Each additional lea ties over allowable in any of the above Address: X (� ^ Additional inspection(1 hr min) 66.25/hr �(]f`' ,lutQ 1?ae O G Investigation(I hr min) M 66.25/hr w Phone:(5o3)j I 4 - Fax:( ) industrial plant(1 lir min) 78.181 hr Inspections fur which nu fee is CCB.Lie!: lc\51cj•Q Electrical Lic,:C Suprv.Lic.;57-4.9RIS , specifically listed(A hr min) 90.00)hr Suprv..Electrician signature.required: ELECTRICAL PERMIT FEES Subtotal: 7 Plan review(25%of it fee): Print name: u e_ �a�� n 1 Date: State surcharge(12%of permit fee): ,/'� Authorized signature: TOTAL PERMIT FEE: [�j''")/ 1 This permit application expires Ka permit is not obraine�wi n 180 Print name: Date: days after is bas been accepted as complete. • Number of inspections allowed per permit. t:\Bullalnau'amfes■ilC Permlwpp nA F.RBAOc Rev 05212e13 440-4615T(1 v05;COMiwt19 Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: MR SCEISPULE Fee for a residential systems combined........ $75.00 . tt !0t. Ve j..4..... Renewable electrical enemy 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 ElBurglar Alarm Wind generation systems In excess of 25 kva: 25.01 to 50 kva 1. 301.04 2 ❑ Garage Door Opener* 50.01 to I00 kvn 552.26 2 >100 kva(fee in accordance with 552,26 2 ID Heating,Ventilation and Air Conditioning OAR 91&.309.0040) System* Solar generation systems in excess of 25 kva: Each addition)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: p Ocher. Each additional inspection is (,6.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fez is 90.00/hr specifically listed(' hr mink COMMERCIAL WORK ONLY: gum PEithiff lE Fee for each commercial system...................... $75.00 subtotal: (SEE OAR 918-309-0000) . Plan review,if required(25%ofpermit fee): State surcharge(12%of permit tee): .. Check Type of Work Involved: TOTAL.PERMIT FEE: ^. Thb permit application eaglets If a permit is not obtained within 180 ❑ Audio and Stereo Systems "4'dear It has been aceeptod as cowpleta. • Number of inspections allowed per permit ❑ Boiler Controls ❑ Clock Systems 15.,j 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: _ *No licenses are required. Licenses are required for all other installations MiuiWina\Pennits\ELC_PamitApp_ELR ERE.doe RCY OS/21/2013