Permit (55) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2016-00097
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/14/2016
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9374 SW WASHINGTON SQUARE RD R05
Project: Verizon Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Low voltage cabling for(2)systems,audio/stereo and alarm,in spaces R05,R06 and R07.
Contractor: LIMITED ENERGY ELECTRICIANS Owner: PPR WASHINGTON SQUARE LLC
PO BOX 55275 PO BOX 847
PORTLAND, OR 97238 CARLSBAD, CA 92018
PHONE: 503-519-2345 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/14/2016 $150.00
12%State Surcharge-Electrical 04/14/2016 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio&Stereo: 1 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 $168.00
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 othe 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 wor i suspended for more the 180
days. ATT ION: Orego law re. fres you to follow the rules adopted by the Oregon Utility Notification Center. T••s rules are set forth in OAR
952-001 010 through OAR 952—'0 -0090 • may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or. .80'..332.2 .4. ,
/ e ��
Iss d By: i. /_ Permittee Signature: /V / aid
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 Applicatio ElV E IOR 0,.,.,,, I. t SI Oil.\
City of Tigard ReceDateBed Lf® Permit#: Cl-�-� G1G'231�7
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
•'PI Phone: 503.718.2439 Fax: 503.598.19 1 -- 6 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: loris: ® See Page 2 for
I I t, 1 It 1) Internet: www.tigard-or.gov UPI31' 11(7AA1.1) Notified/Method: Supplemental Information
TYPE oI3D1NG DIVISION PLAN REVIEW
slew construction ElAddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATS OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ommercial/industrial El Accessory building less to ground.or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑ Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: 137t/ $hi !W/43h► 53_ 1Qd, (ROS/ 0 Addition of new motor load of system.
100HPormore. ❑"A'."E","1.2.....1-3",
City/State/ZIP: l 4‘27 9'722-7 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: p �y,.�� 0 Hazardous locations. 0 Supply voltage for more than
`�� 5770,....4_,.-
"'
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: itiA,5j.j1 VII/ Si eel FEE SCHEDULE
Description I Qis. 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 sqfor portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
J���y�� (with above sq.ft.) 75.00 2
�✓ V /�� �' /vr� /►t Limited energy,multi-family
75.00 2
residential(with above sq.II.)
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER 1 0 TENANT , Services or feeders installation,alteration,and/or relocation
Name: )7p J,y1 S . jjtc, 200 amps or less 100.70 2
PO
/O>C J4 201 amps to 400 amps 133.56 2
Address: s'U!� vvv/ .
/S krill,'" CA
401 amps to 1,600 amps 200.341 2
City/State/ZIP: �f 601 amps to 1,000 amps 301.042
i
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 1 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: 4''01 amps to 599 amps 168.54 2
❑ APPLICANT ❑ CONTACT PERSON `Branch circuits-new,alteration,or extension,per panel
A.Fee fo' rranch circuits with
Business name: above service or feeder fee,
7.42
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:
Each add''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: L f6', � . t,, aerr( /e N1 Sign or outline lighting 67.84 2
�7 / ��� Signalnel, circuit(s)or limited-energy
See Page 2 2
Address: �() X � panel,alteration,or extension. 0 g
City/State/ZIP: , -/ 1 4 ii Oi i72 Zig
Each additional
nal inspection
inspection over allowable in2 any of the above
tri, _ U Additional inspection(1 hr min) 66.25/hr
Phone:( -) 'I ?- V Fax:( ) Investigation(1 hr min) 90.00/hr
Email: /,,,,//1-e h £4-7 V 6 �r(?Q 7� Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: /3LC-7-2-7--*.. '.- Electrical,l-ic.:a,-1/0 uprv. Lic.:///9664 specifically listed(/hr min)
"1g114 17///f7 / /e/z/z7 ELECTRICAL PERMIT FEES
Suprv. Electrician si••.r re,requ' d: v f! _ Subtotal:
Print name: �'l�� ' '�(3 Date: 7/y /� 0 Plan Review Required(25%of permit fee):
/ State surcharge(12%of permit fee):
Authorized signature:
TOTAL PERMIT FEE: fI� S'v0
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.
I:Building Permits ELC.PennilApp FLR—ERE.doc Res 06 17 2015 440-16151(11 05 COM WFB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
ttESIDOrtigo Wt5O14IN Description KrtIAQh. Each TotalDULE r,'
I 1
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
❑ 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
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
❑ 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('L hr min)
COMMERCIAL,WOlIIK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed 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:I3ui1ding Permits Ft C_PermitApp ELR_ERI-doe Res 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
9374 SW WASHINGTON SQUARE RD R05,
TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2016-00097
Jeff Grove
Violation Summary:
Inspector Contractor