Permit (44) CITY OF TIGARD j ELECTRICAL PERMIT
''NE COMMUNITY DEVELOPMENT 8_41014_ Permit#: ELR2016 00197
TI R
AD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/10/2016
Parcel: 1 S 126CA00700
Jurisdiction: Tigard
Site address: 9350 SW WASHINGTON SQUARE RD
Project: JC Penney Subdivision: None Lot: None
Project Description: Data telecommunications system.8/16/16, REPRINTED to correct address from 9500 to 9350 SW Washington
Square Rd
Contractor: BRY-COM Owner: PPR WASHINGTON SQUARE, LLC
14244 SE BUSH BY J C PENNEY 0288-1
PORTLAND, OR 97236 TAX SERVICES
PO BOX 10001
DALLAS,TX 75301
PHONE: 503-761-5156 PHONE:
FAX: 503-760-7501
FEES
Quantity Description Date Amount
Specifics: 1 ea Restricted Energy Permit 08/10/2016 $75.00
1 ea 12%State Surcharge- 08/10/2016 $9.00
Electrical
Type of Use: COM 45 Misc Administration Fee 08/16/2016 $45.00
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $129.00
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. ATT 0.• Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0s -0010 through 0•- 952-0. -00.0 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
g �5--0-6-iG t. i
Is ued By: _ _ Q/�� Permittee Signature: G(
OWNER INSTALLATION ONLY `J
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 ..
., 1.OR OPI 1C1.i fsE 011.1
City of Tigard 9�„ ( Received (4 G
Date/B �� Permit#: G G0
11 13125 SW Hall Blvd.,Tigard,OR 97223 i i
■ Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
1 t Date/B ; Related Permit#:
Inspection Line: 503.639.4175 AUG 2 01 h Ready Date/By: ,naris;
1 I G A R D See Infoformation Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF % i t:� FLAN REVIEW
❑New constructionAddition/a1(13#141/F:411'Y 9 ON
E. �'��,! Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0Building over three stories.
❑Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or
121-and 2-family0 Floating buildings.
dwelling IS, ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-
agricultural
agricultural
❑Multi-familyamps for all other installations. buildings.
0 Master builder 0 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: V 3 5 Si )Cr/4�/� ./�) /�/� 0 Addition of new motor load of system.
t !�� �r �C�, IOOHP or more. ❑"A","E","l-2","1-3",
Clty/State/ZIP: ❑Six or more residential units. occupancy.
��� 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than
Cross street/directions to job site:
❑Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
t�0'70 1,000 sq.ft.or less 168.54 4
Tax map/parcel#: 15/26 CA.
DESCRIPTIONi OF WORK Ea.add'I 500 sq.ft.or portion 33.92 1
`� Limited energy,residential 75.00 2
Y l A" rA 044if s h#4:cP " _? (with above sq.ft.)
Limited energy,multi-family
!s—
residential(with above sq.ft.) 75.00 2
❑ PROPS Y O R 0 TENANT
Name: Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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
❑ APPLICANT 0 CONTACT PERSON
A.Fee for branch circuits with
Business name: above service or feeder fee,
Contact name:
each branch circuit 7.42 2
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
Phone: Miscellaneous(service or feeder not included)
( ) Fax: :( ) Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:
( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(/2 hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
Subtotal:
Print name: j. ate: 0 Plan Review Required(25%of permit fee):
4) State surcharge(12%of permit fee):
Authorized si nature �' TOTAL PERMIT FEE:
/` `� �� r This permit application expires if a permit is not obtained within 180
Print name: VX: / f �' Date:g-j�---j days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe 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:
RESIDENTIAL
WORK ONLY: ^'. FEE SCHEDULE
Description
I.QtY• I Each Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved: 5.01 to 15 kva 133.56 2
❑ A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n B• urglar 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
>100 kva—no additional charge 0.0 3
n Vacuum Systems*
Each additional inspection over allowable in any of the above:
El
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('h hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WOW(ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
I-1 B• oiler Controls
TI Clock Systems
Fl D• ata Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELCPermitAppPLRERE.doc Rev 06/17/2015
IIIIICITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
8.''- COMMUNITY DEVELOPMENT Permit#: ELR2016 00197
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/10/2016
Parcel: 1 S 126CD00300
Jurisdiction: Tigard
Site address: 9500 SW WASHINGTON SQUARE RD i
Project: JC Penney Subdivision: None Lot: None
Project Description: Data telecommunications system.
Contractor: BRY-COM Owner: PPR WASHINGTON SQUARE, LLC
14244 SE BUSH BY J C PENNEY 0288-1
PORTLAND, OR 97236 TAX SERVICES
PO BOX 10001
DALLAS,TX 75301
PHONE: 503-761-5156 PHONE:
FAX: 503-760-7501
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/10/2016 $75.00
12%State Surcharge-Electrical 08/10/2016 $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: 1 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 -nter. Those rule :re set f• h in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a py orti4krules or direct questions to OUNC by calling 503 987 or 1.:••.332. .4:.
Issued By: Permittee Signature: A '
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 1012 OFFICE: ISI. 0M1.v
-< �' ' 1 V 81
CityofTigard , Received �1
IP/ g t Date/B : 4 / ,') Permit#: .� i c t ....00 "t
- 'I 13125 SW Hall Blvd.,Tigard,OR 972 ki_!` Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: Q-
Inspection Line: 503.639.4175 7 O 16 Ready Date/By: 0 See Page 2 for
T I G A R D Internet: www.tigard-or.gov ��� Notified/Method: i Supplemental Information
TYPE OF WORK-.,10 fit ,l6, PLAN REVIEW
❑New construction Addition/alteratr Please check all that apply(submit 2 sets of plans w/items checked):
I' I 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: �,
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling gi Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other:
0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
r- _ ❑Addition of new motor load of system.
Job#: Job site address: 9.`7 s td W I J( _Q-Q. 100HP or more. ❑"A","E","1-2","I-3",
City/State/ZIP: j f L ( 0 ❑Six or more residential units. occupancy.
��q ❑Health-care facilities.
0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: .S-C- k�N tY 0 Hazardous locations. 0 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#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
7 4`-z- /0(1 i�} ) Q I A .A A/ pJ�, (with above sq.ft.) 75.00 2
i'r�� �` V 1!t 1 C !r !W t- Limited energy,multi-family
P1/t�L T-t -/JC el Po(f. -
t SA-LF residential(with above sq.ft.) 75.00 2
❑ PROPERTY OWNER ❑ TENANT Renewable Energy 0 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
0
APPLICANT ❑ 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
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP: Each add'l 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: ) ic't_cc3z4/( Sign or outline lighting 67.84 2
� // Signal circuit(s)or limited-energy ,
Address: 1 LI? /7 y st • uW panel,alteration,or extension. Page 7��2 2
City/State/ZIP: P.j L 7 2)4 Each additional inspection over allowable in any of the above
7N Additional inspection(1 hr min) 66.25/hr
Phone:( -le1 - ) Fax:(S03) 76D-73_3/ Investigation(1 hr min) 90.00/hr
Email: hitt J 7,&(t'C77 41/6a- . Industrial plant(1 hr min) 78.18/hr
"vInspections for which no fee is 90.00/hr
CCB Lic.:(?if c/3 Electrical Lic.: f/ 5C up .Lic.: 7L,`\- specifically listed('A hr min)
� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: fiP 64,crt Subtotal: 75)
Print name: f ►N( ,3 , 41 �'g/'/ Date: g`, —1.6 0 Plan Review Required(25%of permit fee):
):).T
,T State surcharge(12%of permit fee):
TOTAL PERMIT FEE: `1"
Authorized signature: ?q.t.
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_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:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description
*
Fee for all residential systems combined: $75.00 Qty. Each ToTOWI
3' 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 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
n 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('h hr min)
ELECTRICAL PERMIT}FEES
COMMERCIAL WORK ONLY:
SubtotalEnteron Page 1):
Fee for each commercial system: $75.00
�' * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
V.pata Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
El Protective Signaling
El Other:
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitAppELR_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
9350 SW WASHINGTON SQUARE RD, TIGARD,
OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2016-00197
Jeff Grove
Violation Summary:
Inspector Contractor