Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Pernrl ELR2015-00264
13125 SW Hall Blvd.,Tigard OR 97223 503.710.2439 / ys- �-� Date Issued: 11/09/2015
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9642 SW WASHINGTON SQUARE RD G12
Project: Lolli&Pops Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: CCN system.
Contractor: SIMPLE SECURITY Owner: PPR WASHINGTON SQUARE LLC
PO BOX 80577 PO BOX 847
PORTLAND, OR 97280 CARLSBAD, CA 92018
PHONE. 503-574-2254 PHONE:
FAX 503-245-2998
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/09/2015 $75.00
Type of Use: COM 12%Stale Surcharge-Electrical 11/09/2015 $9.00
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo. 0 Boiler Controls: 0
CCTV: 1 Clock Systems: 0
Data&Telecommunications. 0 Fire Alarm: 0
FIVAC: 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 OAR 952-001-0090 You may obtain a copy oft IaC.p[direct questions to OUNC by calling 503 232 1987 or 1.80000.jj332.2344.
Issued By: �7" Permittee Signature: —r{_(�1 /'
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.
t, a;f CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
71
�'' COMMUNITY DEVELOPMENT
Permit#: ELR2015 00264
a. t Date Issued: 11/09/2015
TIGARID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
1.;1. Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9642 SW WASHINGTON SQUARE RD G12
Project: Lolli&Pops Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Remodel of existing tenant space.
Contractor: SIMPLE SECURITY Owner: PPR WASHINGTON SQUARE LLC
PO BOX 80577 PO BOX 847
PORTLAND, OR 97280 CARLSBAD, CA 92018
PHONE: 503-574-2254 PHONE:
FAX: 503-245-2998
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/09/2015 $75.00
12%State Surcharge-Electrical 11/09/2015 $9.00
Type of Use:
Class of Work:
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 1 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 Ce• -r Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a co•v of the rules or direct questions to OUNC by calling 503.23 :7 or 1.800.332.2344. \ ,
Issued By: L,„,.. _ _ 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 FOR OFFICE USE ONLY
Received
City of Tigard Da,e/B : //�g Permit 6
'r 13125 SW Hall Blvd.,Tigard,OR 97223 \I�� Plan Review
Phone: 503.718.2439 Fax: 503. 1 V Date/B : Related Permit it: eti I 20/s 0,,. 'a
• Inspection Line: 503.639.4175 Ready Date'By: Juris: ® See Page 2 for
TIGARI) Internet: www.tigard-or.gov 2015 Notified Method: G Supplemental Information
TYPE OF WO160 {`,00 A, PLAN REVIEW
❑ New construction ❑Addition/alter�(I ekeI r 't,('10N Please check all that apply(submit a sets of plans w/items checked):
l (^ wV ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: �`�iC; where the available fault current
❑Marinas and boatyards.
CATEGORY OF C UCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
El 1-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground.or exceeds 14,000 ❑Commercial-use mercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other:
El fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMAL! i D LOCATION ❑Emergency system. larger separately derived
lir Job#: Job site address: k _✓ n ❑Addition of new motor load of system.
�'I �ksk b R I00HP or more. ❑ A "E "1 1 i
City/State/ZIP: T' !(v, `-2 Z 7 ❑Six or more residential units. occupancy.
t �f "`i ! 7 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: / Project name: I-p L r F pep 5 ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more.
600 volts nominal.
Cross street/directions to job site: 2 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#: Ea.addl 500 sq.ti or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
L t V s (with above sq.ft.) 75.00
f..
Y s ��" v , Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
❑ PROPERTY OWNER l ❑ 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 1 33.56 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 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Ps to amps amps 599 s 168.54 2
Owner signature: Date: P
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
-
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: j ; wt / S CG L)R z" / ..t/t/C. Sign or outline lighting 67.84 / 2
n V Signal circuit(s)or limited-energy (,// I
Address: 17 S 7 ❑ See Page 2
Q Q panel,alteration,or extension.
City/State/ZIP: P N�( L G v 1 0 Each additional inspection over allowable in any of the above
/ Additional inspection(1 hr min) 66.25/hr
Phone:(5,13 ) 5 7.(4_ 2.2_64 Fax:(50-17 ) 2_Li G) z fQ ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 6;24/1 Electrical Lic.:3 I 3 -L-6 Suprv. Lie.: 7-11 LC4 specifically listed(' hr mini ,
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required:
,/✓I� L--- - Subtotal: "7 5`.
Print name: .i G(lit e((V Date:c' A/0 v 2,015 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): `4
er Authorized signature: TOTAL PERMIT FEE: Ills
This permit application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I:Building Permits'ELC_PermitApp_ELR_ERE.dac Rev 06 172015 440-4615T(I 105-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
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: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
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:
th r: G, Each additional inspection is 66.25/hr I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/_hr min)
_COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system:ONLY:
$75.00 Subtotal(Enter on Page I):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling I /
Other: C C V
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\IiLC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9642 SW WASHINGTON SQUARE RD G12,
TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00264
Jeff Grove
Violation Summary:
Inspector Contractor