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Permit (173) lmF IIIICITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT a COMMUNITY DEVELOPMENT Permit#: ELR2016-00257 Tf GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/14/2016 Parcel: 1 S 1260000300 Jurisdiction: Tigard Site address: 9585 SW WASHINGTON SQUARE RD Project: Washington Square Mall Subdivision: None Lot: None Project Description: CCTV system for roof surveillance throughout mall. Contractor: HUSER INTEGRATED TECHNOLOGIES Owner: PPR WASHINGTON SQUARE LLC 1313 NW 17TH AVE PO BOX 847 PORTLAND, OR 97209 CARLSBAD, CA 92018 PHONE: 503-227-6688 PHONE: FAX: 503-227-5941 FEES Description Date Amount Specifics: Restricted Energy Permit 11/14/2016 $75.00 Type of Use: COM 12%State Surcharge-Electrical 11/14/2016 $9.00 Class of Work: ALT Total Number of Systems: 1 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 Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a c•• of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.23 77 Issued By: K--.---.":""'...E Permittee Signature: �,1�/ t�C 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 oil lC►: I:S1.oy 1.1 City of Tigard 1 received 'iu � 'sate/B ifrommrizmnffingsgim lig13125 SW Hall Blvd.,Tigard,OR 97223 ,*.y� ' _ Phone: 503.718.2439 Fax: 503.598.1960 1 Plan • Review Related Permit#: Date/B : Inspection Line: 503.639.4175 A r,‘b Ready Date/By: ® See Page 2 for I I G A R D Internet: www.ti and-or. ov (U Notified/Method: g g ��"��� �, � IMSupplemental Information TYPE OF WORKirt 'P�}I`giJ t� PLAN REVIEW Please check all that a I 2 sets of w/items ❑New construction a Addition/alteration/reC e gIcifISapply(submitplanschecked): VS(' 9 +? 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition ❑Other: $� where the available fault current �J ❑Marinas and boatyards. CATEGORY OF CONSTR ION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling g'Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 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 ❑Addition of new motor load of system. Job#: Job site address: ?..5 85 5 J �� _ r 10OHP or more. ❑"A","E","1 2","1-3", City/State/ZIP: d,� X72 Z �"" ❑Six or more residential units. occupancy. 0 Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 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: AI iti 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 75.00 2 �»/� � (with above sq.ft.) V c f,-�044 -4r roCri RAY-ec I l ictk _ Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Af Mt%�i(` Renewable Energy 0 See Page 2 (8 PROPERTY 0 TENANT Services or feeders installation,alteration,and/or relocation Name: ifecze /1__ 200 amps or less 100.70 2 Address: 4�f QlG61 �fJ 201 amps to 400 amps 133.56 2 ` S 401 amps to 600 amps 200.34 2 City/State/ZIP: 5444,4. ii10 ' pow 601 amps to 1,000 amps 301.04 2 Phone:(3/0 ) 3?L/ 4cO 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 0 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: /4uf ��l 4 Sign or outline lighting 67.84 2 C Signal circuit(s)or limited-energy ,� Address: l�(3 4G4/ /7A /ivy _, panel,alteration,or extension. 11 See Page 2 ��t' 2 City/State/ZIP: ��� © ,�Ovi72o9 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(3 03 gilt' 't 27 �'f. 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.: /1722 Electrical Lic.: Ca-13 prv.Lic.: 36 e t. A specifically listed('/hr min) 90.00/hr "711 1 y / ELECTRICAL PERMIT FEES Suprv.Electrician slgna re,required: —/� k t ii/ Subtotal: __ Print name: �G ate: //i7../(� 0 Plan Review Required(25%of permit fee): -- ` State surcharge(12%of permit fee): ciC= Authorized signature: TOTAL PERMIT FEE: Y. 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. 1:\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 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 ❑ 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 n 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(Vz hr min) Mr. fECTRIC PERMIT EELS COMMERCIAL WORK ONLY: i: Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): 3r * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC n Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling 13 Other: 71/ Total number of commercial systems: 1 *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 9585 SW WASHINGTON SQUARE RD, TIGARD, OR, 97223 Record Type: Record ID: Commercial - Electrical Limited Energy ELR2016-00257 Inspection Type: Inspector: 198 Low voltage final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor