Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permlt#: ELR2015-00268
s 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/122015
Parcel: 1 S 126CC00100
Jurisdiction: Tigard
Site address: 9700 SW WASHINGTON SQUARE RD
Project: Nordstroms Subdivision: FAIRVIEW PLACE CONDO Lot: 20
Project Description: Fire alarm.
Contractor: FIRE SYSTEMS WEST INC Owner: PPR WASHINGTON SQUARE, LLC
600 SE MARITIME AVE#300 C/O NORDSTROM
VANCOUVER,WA 98661 ATTN:TAX DEPT
PO BOX 2229
SEATTLE,WA 98111
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/12/2015 $75.00
Type of Use: COM 12%State Surcharge-Electrical 11/12/2015 $9.00
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCN: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 1
HVAC: 0 Instrumentation: 0
Intercom/Pag i ng: 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 Ali
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 99522--0001-0090. You may obtain a copy of the Nies or direct questions to OUNC by calling 503.232.1987 or 1.800.3322344.
Issued By: 1r�r% �-e Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on pro rt/�c1fl�own w/`h^ch of nded for sale,lease or rent.
OWNER'S SIGNATURE: ( V z l ; Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4176 by 7:00 a.m.for the next available Inspection date.
This penult 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.
Building Permit A licatio �-4
Fire Protection System EUEIVED II ,
7FClta of Tigard
13125 SW Hall BIW Tigard,OR9idl
axu P.m«t p
Phone nn).91f2439 Fax 411.5q91(It (D TD 1Aie� e7J
W'r1kLtni.w,fi,mTl,ga1"I5 l:Uti��t. �.� Ki��� u}3MJ'Md: w SW,aPlossomit Wormanm
Q New e,macuctoo ❑De eschum Pmn t fen arc haled o the saice of the work perfonnM.
-- idrate the value(rounded to the neatest"[art of all
itioNalteratioNrcplacemcm ❑Other { cq pmenp materials,l hot overhead.and the prutit for the
, _ work indicatN on this application.
OW-",
❑ 1- nd?-Family dwelling mmrnialrndunnal Valuation: S
❑Accessary Wil ding •.. QNme-family Number of bedromms
❑ .
Nave,IrZ ❑Orhm I Number of bamrmms ---___--
.13' ` . .• "'. :. s ,;� ;='yw,^. Total numberaftlwrs. —.
lob sire address: 470,1 _Sw W A5t31 q G'Co-J S hJa �.� 1 New dwelling arca: square fe<t
Clry/Statezip 7 -3 GangNcmpon area: 'uare feet
Sair,bMS,apt.m.: Project nameiljcCovcrcd porch area: it.feet
Crus sveeVdira:tions to 10 site: Deck arta square Feet
Other structure arca: aquam feet
UA7A f06R18RGt'ACI�eKC�f:'-
Subdisision: Lot m.: Permit fen•are based on the salve fthe work performed.
Tan reap/pamel no.: Indicate Bre calm,(munded to the nearest dollar)of ali
cgmpment,materials,IaMq overhead,and nbe prolit for the
mlicatcd on[hila Icalio
CF �A CT` _ Valmtiom S Z
FTt6
.,,IG.t.I-eye �. ��,tin; EvvinS buildinS arca: square feet
7'r 4,jS h a 1TE'� New building arca: square feet
*F Number of storm:
^�-ItROrEREK-'O{T[VEN', `. "' �,
Nami r.p ofconvrucnom
iddreu Occupancy groups:
�' CirY:Smta ZIP: I Evsung:
C09TACI PEfBU3 �a .. ..
. ..,
a_
I Buatress tome ��F S�sCE�S Wc� 411 ccn, ter,and wbcaroacre,are regi red to be
Cmuaot nnrtre MAf LuA1�• t licensed with the Oregon Consvuttien C mllaciers Board
Gl./ under OR) of ani mo b requimtl to bt,licen,cilm he
\sklr<ssr ju 1 t 1 Icl k b ttg pe n d It th
_ MAPaZtnE AU6
as .0
(-it,
Sata7.IP: �91�V✓=2 W}A 9>;S(o(G� - P0l anl or fir". mod lh toll. s gums
Ph.mc ) 7 G�G Fax ( )
1,road
Gt a-�+
CONTRAfIOR RUILDLWFIRNnFBens-
Bosmnsname' -• f_Pba Mier or N2ukdt
—_— Pmnn fee
Addle"
State surcharge( of"out fea):
( nrSmtd2IP
FLS plea r i.W.. of permit Tec}:
Phm1e;( 2 Fac[ ) ,_ .!1 rwn a
Toal xrein fee,:CCBle
-c"ed: IS'P, 31 i
amthnriad,agnamre: ,( / ' /, Imo._.
Th., _____.
hi n.yyrc t -. y irap ed nonoMaie.
1 hrZr SeNA�fP>J l t lz. >�5 within IM)dao aper it has win accepted a,complete.
Date {«nrh,vh�bgv,n ny fdC:wnp BwlJing Irdmrry
s<,.weB,ml -f Fy, e—V
Inu�lmy narv�wF3Pmmea•ry J"Ula,ir �alaei I,.ii-[r.1tKh'ml
v2y'7. 31
Electrical Permit Application-City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
'REjNEN"GIAL_WO.RK014 Y:,. AWSWIV' - R le scxeouc_E l�#.'t'tk Ci".,
Devn nen - - n Eat6 Tonl
Fee for all residential systems combined: $75.00 Renewable dcctri<al energy sysremv:
Check Type of Work Involved: 5 kvanr l<s, 100.'0 _
501 to 1S kva
❑ Audio and Stereo Systems* 15.01 to 15 kva 2w A
❑ Wind e.,rmions ,,c aHees,or 25 it,.:
Burglar Alarm x5.01 ro 50 kva 301 0,1
❑ Garage Door Opener* 5001 In 100 k.a 552 26 _
>I00 kva accordance
w1M1 OAR
91 91&J09-0pa0) »x16 _
❑ Heating,Ventilation and Air Conditioning Sol., .t,r.ion system,utemess of 25 kva:
System* Etch eddmortl kva—,25 742 )
❑. Vacuum Systems* 100 kva-nuaddinnnzl drag¢ 00 )
Eaehoddilioml ins .ion overallovable inan nr the above
❑ Other Each addiliunalm,pmlionInmln 66.251 hr 1
<nar m n,an nwn U nr
Inspections rur whrtn no(Is 90 DO/h,
aifcally IisIN('6 Fr m
teL,1,PyER—yNlliE00N I
FS.' --
Suboml(E.,-oo Page 1).
Fee for each commercial system: 575.00 rva,net:�r.........sllowtd aranni.
(SEF,OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Sterco Systems
❑ Boiler Controls
❑ Clock Systems
F❑ ata Telecommunication Installation
ire 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: III
I
*No licenses are required. Licenses are required for all
other installations
I B.,W.191Pt111�ELC PamITAW-ELKEREdoe Ru` l''013
Electrical Permit Application FOR OFFICE USE ONLY
RECEIVEDReceived City of Tigard Date/By: /a13125 SW Hall Blvd.,TigardOR 97 Plan Review s_ /
1*� ��9 7]
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit# 4 (!V /
Inspection Line: 503.639.4175 N 0 V 12 2015 Ready Date/By: Juris: I El See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
❑New construction ❑Addition/al "i re c h'`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.
W.S. 01.,,<•::‘,...._ „GATE-- pxcoNSTI 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 agricuhnral
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
i
# m# .' a; 1 1 I.;OOATI® \t`-'` 1v ❑Emergency system. larger separately derived
?CD SUJ (1JA5i(fto10/J� ❑Additi000for.motorloadof system.
Job#: Job site address: loaHP or more. 0"A","E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: L 7 ZZ ❑Recreational vehicle parks.
�1 BP(t� ® 0 Health-care facilities.
Suite/bldg./apt.#: I Project name: A<�� ❑Hazardous locations. 0 Supply olts nominal.
for
more than
❑Service or feeder 600 amps or more.
Cross street/directions to job site: 44:MXIENTAC 4150
Description Qty. Each Total
New residential single-or multi-family dwelling unit.
Subdivision: 1 Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'1500 sq.ft.or portion 33.92 1
,417iiiSIIITT(# # ;# Limited energy,residential 75.00 2
^ _ n_ (with above sq.ft.)
A (Tt b t1 E -DR C SQ 65(7r= Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
0/..1 t-1 '/ Renewable Energy 0 See Page 2
3 i, iPT Wr 11 'f}' 4 :,k\ ilio.'''- 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
Branch circuits—new,alteration,or extension,per panel
-'APPLIC••• # A.Fee for branch circuits with
Business name: t cte. ,f5"--v2.- S 1,.1.0-3-\-- above service or feeder fee, 7.42 2
each branch circuit
Contact name: /Vlm Sc_j...k/i‘F-•f cdt. B.Fee for branch circuits without '
iviNe_('r.F }-�i� �` service or feeder fee,first 56.18 2
Address: �j � branch circuit
City/State/ZIP: V C Ci u0e1Z. ��, 9&be, ( Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: ( ) /,1 i��-78 .-,3s Fax: :( ) Each manufactured or modular
/ dwelling,service and/or feeder 67.84 2
Email: A e--K' l , fA i - Reconnect only 67.84
�; _4��
° <. _6 ,ter# 'q: . Pump or irrigation circle 67.84
Business name: i a,.-t -. 5 4�J\ 1N`3, We .1 Sign or outline lighting / 67.84 2
Signal circuit(s)or limited-energy ' �(See Page 2 2
Address: 42.03panel,alteration,or extension. lll""''L
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) investigation(I hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
! inspections for which no fee is 90.00/hr
CCB Li c.: L.�97,32- Electric Lic.: -G S Suprv.Lic.: 3Cl(,/DLEA specificall hsted ',hr mm)
Suprv.Electrician signature,reduir Com- Subtotal:
Print name: S(J C d&4, I Date: 'I`ja /o&-- 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: kfiz TOTAL PERMIT FEE: 6/3yco
This permit application expires if a permit is not obtained within 180
Print name: AA,GLS Sct,tA/tJ -20 Date: ((��Zf20/ days after i lhas been accepted as complete.
` * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
R> tpENT
Fee for all residential systems combined: $75.00„ Description ( Qty. I Each [ Total
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2 I
I I Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
I I Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
ri Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
I I Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
i 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
s.ecifically listed(%2 hr min)
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:
I I Audio and Stereo Systems
I [ Boiler Controls
I I Clock Systems
I j ata Telecommunication Installation
,t)t(Fire Alarm Installation
I I HVAC
I I Instrumentation
n Intercom and Paging Systems
I I Landscape Irrigation Control*
I I Medical
Nurse Calls
I I Outdoor Landscape Lighting*
I I Protective Signaling
Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:1Building\Permits\ELC_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
9700 SW WASHINGTON SQUARE RD, TIGARD,
OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00268
Jeff Grove
Violation Summary:
Inspector Contractor