Permit III q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permittr: ELR2014-00062
Date Issued: 03/10/2014
TIGARD 13125 SW Hall Blvd.Tigard OR 97223 503 718.2439 Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9767 SW WASHINGTON SQUARE RD D07
Project: AMERICAN EAGLE OUTFITTERS Subdivision:VASHINGTON SQUARE ESTATES NO Lot: S
Project Description: Security system.
Contractor: VISION SECURITY SERVICE Owner: PPR WASHINGTON SQUARE LLC
10874 SW ROLAND CT PO BOX 847
WILSONVILLE. OR 97070 CARLSBAD. CA 92018
PHONE- 503-502-3909 PHONE
FAX: 503-200-2907
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/10/2014 $75 00
12%State Surcharge-Electrical 03/10/2014 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems 0
Data&Telecommunications 0 Fire Alarm. 0
HVAC 0 Instrumentation 0
Intercom/Paging: 0 Landscape/Irrigation 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal
Security Alarm: 1 Other. 0 Total 384 00
Other Desc. Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR Specialty Codes and all o.- -•plica. - law All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if ,...rk is s s. -_• r more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent se yi are et forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain f the rules or direct questions to OUNC by calling 503 232. -87 or.00.3 , 4
Issued By: ' _ ._ _ _ Permittee Signature: .41-41..
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application C��v � FOR OFFICE USE ONLY
CI of Tigard j Received / Permit No.:
#Y g DatclBy: 3 GC/it{ �'� ( r?f)!zi—air-,;-4
'. 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review f��J
I Phone: 503.718.2439 Fax: 503.598.1960 i 0 '101r Date/By: Other Permit: 4"w 2 yt 3_Cf�r?�$.
T I ci>R I) Inspection Line: 503.639.4175 MAR i Date Ready/By: Juris: FB See Page 2 far )
Internet: www.tigard-or.gov \DNotified/Method: 7.6 Supplemental Information
TYPE OF WORliO nt VlC1Q PLAN REVIEW
❑New construction vddition/alteratipp(�
Please check all that apply(submit 2 sets of plans w/items checked below).
O v ❑Service or feeder 400 amps or more 0 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 ammercialiindustrial ❑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 ,"I-2","1-3",
Job no.: Job site address. /(�, r ,�� I00HP or more. occupancy.
S✓ /. 3 w'' �� ❑Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: 1 1 )02, ell a0-3 ❑Health-care facilities.
0 Supply voltage for more than
� ❑Hazardous locations. 600 volts nominal.
--,
Suite/bldg./apt.no.: Project name: Y 192.,l t`J (_E ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. ] 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
En.add'I 500 sq.ft.or portion 33.92 1
lax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.) .
Limited energy,muki-family 7500 2
1 ; )V� d S residential(with above sq.ft.) _
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ 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 20l 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 I ❑ 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 circuit
Address: Each add'l branch circuit 7.42 _ 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone:( ) Fax: ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Signor outline lighting 67.84 2
Business name: J 1'3'0 ve,� )�)1 (j,Q Signal circuit(s)or limited energy I See rL
Vq !T 000 l panel,alteration,or extension. Page 2 7`/'- 2
Address: \ O L�1'� ..0 Cr"... Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP: AL,S:/�Ul j1 _q'} Investigation(I hr min) , 66.25/hr
Phone:(605) 50?,39 QC( Fax:(503) . 0-4 Industrial plant(I hr min) 78.18/hr
` `J" �� a-.4..
Inspections
pecifi i ll for which no fee is 90.00/hr
CCB Lie.: IA r Electrical Lie.: l . ,,L\ Suprv_Lic.: specifically listed('/:hr min) _
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 75-,W
Plan review(25%of permit fee):
Print name: Date: - 0. )44 -
State surcharge(12%of permit fee): 4.
Authorized signature: TOTAL PERMIT FEE: gii_"2.4"
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
1:5BuildingTermits1ELC_PermitApp_ELR_ERE.doe RevOS/21/2015 440-461 ST(II/OS/COMMIES
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 combinedS75.O0 Description I Qty. I Pee 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
n Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
I 1 Other: Each additional inspection is 66,25/hr l
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(V2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check 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
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
fiBuildingtPe`mite\ELC_PennitApp ELR_ERE.doe Rev 05/21/2013