Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2014-00221
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2014
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9589 SW WASHINGTON SQUARE RD 809
Project: Apple Store 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 10/09/2014 $75.00
12%State Surcharge-Electrical 10/09/2014 $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: 0
Security Alarm: 1 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 • - applica. • 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 i sus.. '. • or ore the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent . T . - ul— =re s= forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a co v of the_cules or direct questions to OUNC by calling 503.232. ::7 or 1 • r • '.
Issued By: a = — Permittee Signature:
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 I ()It ()1 1.1( 1 I ',I t1\1 1
���� Received lull n
City of Tigard Dateiv : N (�] vJ� ...
UPI 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
Phone: 503.7182439 Fax: 503.598.1 1(� Date/B : Related Permit#: A i, — 0• -dr
Inspection Line: 503.639.4175 %`i- Ready Date/By: MEI % See Page 2 for
I !( A R D Internet: www.tigard-or.gov OC'\ _ Notified/Method: Supplemental Information
TYPE OF WORK `�1V`'p"�i(�� PLAN REVIEW
❑New construction ❑Addition/alteration/ l�n 0`i�"T+T' Please check all that apply(submit a,sets of plans w/items checked):
❑Demolition ❑Other: A,074- ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGO OF CONSTR N exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ommercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
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
J l.J P1- Cam^ ❑Addition of new motor load of system.
Job#: Job site addressq I► i1011� J('�Jl( IOOHP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: r\1�{y7 ❑Six or more residential units. 0 vehicle parks.
\ t '`y_J ❑Health-care facilities. P
Suite/bldg./apt.#: Project name: ,c7f)ls? Sirce , ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel 4: '
Ea.add'I 500 sq.ft.or portion 33.92 1
D ' ' I' IN I ' WORK Limited energy,residential
(with above sq.ft.) 75.00 2
)∎ 1' . 46, 1.6. .iItV .1. 1 Limited energy,multi-family '
residential(with above sq.ft.) 75.00 2
❑ PROPERTY OWNER TENANT
❑ Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
,
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits–new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: (MrZ 4S above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address:
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: �1S 1OIJ ��ci�t�e),'-- Spa' C t Sign or outline lighting 67.84 2
O��, ` �_ �, _ w
Signal ler n or limited-energy rn See Page 2 �✓ 2
Address: l.� w � panel,alteration,or extension. '[' g
City/State/ZIP: W%L�NMI�S 0� sC.A.O�O Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( C)N �a- '>q oq Fax:(603) O .Oev ` Investigation(1 hr min) 66.25/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90,00/hr
CCB Lic.:`A\\ 55D" Electrical Lic.QUE. 14 Suprv.Lic.:5g9[VI, specifically listed CA hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: -?5'w'
Print name:.) 4 5C)O E(J (E( JC)f j .. Date: \0- _4•X1,14 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): Z•
TOTAL PERMIT FEE: L all. l'-'4"
Authorized signature: —
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.
la Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 440.46I5T(I I/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:
Description ( Qtr. I Each Total I
y $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva orless 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over25 7.42 3
❑ Vacuum Systems* >l00 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min) •
Inspections for which no fee is 90.00/hr
specifically listed(%1 hr min) _
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 • Subtotal(Enter Page l):
�' • Number of inspections alllowed owed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n 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:
*No licenses are required. Licenses are required for all
other installations
1.\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014