Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
. COMMUNITY DEVELOPMENT Permit#: ELR2015 00168
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/15/2015
Parcel: 1 S 135BA00102
Jurisdiction: Tigard
Site address: 10206 SW WASHINGTON SQUARE RD
Project: Ulta Beauty Subdivision: OAKBURG Lot: 9
Project Description: Low voltage for EAS system,antennas at main entrance and restroom area.
Contractor: CHECKPOINT SYSTEMS INC. Owner: PPR SQUARE TOO LLC
101 WOLF DRIVE PO BOX 847
THOROFARE, NJ 080886 CARLSBAD,CA 92018
PHONE: 800-257-5540 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/15/2015 $75.00
12%State Surcharge-Electrical 07/15/2015 $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: 0 Other: 1 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 i •r•ance w -•proved 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. • TENTION: Oregon la, re• - you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 •01-0010 thr. gh OAR 952-00690. Y.0 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ ��`� l Permittee Signature: ' —AA - ice;
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 Applica 1 . I ()I: ()I I I t I I ,I ().1
City of Tigard CEIVEFDa era 7® Permit#: �',t,Qap/S GIv 1!o g•UPI 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.59.} 6 5 , Date/B : Related Permit#: ` - �� ��
Inspection Line: 503.639.4175 J V 5 ? Ready Date/By: Jas fa See Page 2 for
T I t;\R 1? Internet: www.tigard-or.gov Notified/Method:
�v/,,;;11 Notified/Method: Supplemental Information
OP
TYPE r4'b>l Kb PLAN REVIEW
❑New construction ®Additiabl lace > t it n► Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑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.
❑ 1-and 2-family dwelling ®Commercial/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
❑Addition of new motor load of system.
Job#:4000008778 Job site address: 10206 SW Washington Square rd. 100HP or more. ❑"A E', 1-z^,"l-3",
City/State/ZIP:Tigard/OR/97223-4459 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.4: Project name:Ulta Tigard ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Washington Square mall FEE SCHEDULE
Deicriptim 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#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
installing EAS antennas at main entrance and restroom area Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ® TENANT Services or feeders installation,alteration,and/or relocation
Name:Ulta Beauty 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:Checkpoint Systems above service or feeder fee,
742 2
each branch circuit
Contact name:Robert Beard B.Fee for branch circuits without
Address: 1345 SE 71"Court branch it feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Hillsboro/OR/97123 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(971)212-3755 Fax: :( ) Each manufactured or modular
67.84 2
Email:robert.beard @checkpt.com dwelling service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Checkpoint systems Sign or outline lighting . 67.84 2
Address: 101 Wolf Drive Signal circuit(s)or Limited energy VI See Page 2 7 2
panel,alteration,or extension.
City/State/ZIP:Thorofare/NJ/08086 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(800)257-5540 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Email:
/0//i7 Inspections for which no fee is
CCB Lie.: 187898 Electrical Lie.: CLE229 Suprv.Lie.: 3390LEA specifically listed(V2 hr min) 00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:A2 �� / ��' Subtotal: 75•�'C
Print name: Robert E.Beard Date: 7/15/2015 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 9Cl7
Authorized signature: TOT AL PERMIT FEE: g ,CC
This permit application expires if a permit is not obtained within 180
Print name: Robert E. d Date: 7/15/2015 days after it has been accepted as complete.
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total I •
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70 2
5.01 to 15 kva 133.56 2
p 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 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 66.25/hr 1
charged at an hourly(1 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(Enter on Page 1):
(SEE OAR 918-309-0000) ' Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ 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: EAS
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations