Permit
n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2010-00010
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/21/2010
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9451 SW WASHINGTON SQUARE DR A16
Subdivision: Lot: 0
Project: Vans
Project Description: Install restricted energy for burglar alarm.
FEES
Owner:
PPR WASHINGTON SQUARE LLG Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 01/21/2010 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 01/21/2010 $8.14
PHONE:
Contractor:
AMERICAN VETERANS SECURITY LLC
4420 SW 110TH AVE
BEAVERTON, OR 97005
PHONE: 503-808-9010
FAX: 503-808-9018
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom/Paging: N Landscape/Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: Y
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do47ma ans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. s you to follow the rules adopted by the Oregon Utility Notification C enter. Those rules are set forth in OAR
952-00ou may obtain a copy of the rules or direct questions to OUNC by calling 6.6699 or 1.800.332.2344.
Iss Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Jan 20 2010 1:09PM HP LFISERJET FRX p,1
DECEIVED
Electrical Permit pplicatio
City of Tigard t1 Raeived ;
1312$ SW Hall Blvd., Tigard, OR 97223 JAN 2 U 2010 Dm~ ' Permit No.; e- o0u
M' phone: 503.639.4171 Fax: 503.598 ¢ Dian Review
Inspection Line; $03,639,4175 1~Y OF TIGARD Dato Ready.By- Other permit:
Set Page 2 for i~
Internet; wwrr w,tigard-or.gov BUILDING DNIS NotifitrldMlothad: 1 ' r;- I Sup lemental LilormeNOp
'jo
1Va m '
iii ,
119 I••.~. ~''1.I u,, ,
ew construction ❑ Addition/alteration/replacement Please check all that apply (submit I rata of plane wlitams ahaaked below):
❑ Demolition ❑ service or feeder 400 amps or more ❑ Building ever three stories.
❑ Other: where the available fault current ❑ Marinas and boAtyards.
e><ccoda 10,000 , h, ' . ' If ia.' ~ ~"~11~4, I t,; amps at 150 volts or
❑ Flawing buUAlnas,
less to around, or exceeds 14,000 0 Commeroiat-use agricultural
❑ 1- and 2-fi mily dwelling e'tornmercial/itidustrial ❑ Accessory building amps fbr all other InnAllatians, buildings.
❑ Multi-fhmil ❑ Master builder ❑ Other; ❑Firepump, ❑loatallatieaor75xv.aor
pp r" 1 ❑Emer encY aYatom. larger separately derived systctri1~
qr d~4t ~~1~i { • n ~ '.n iy
'14 III I 1~G ❑ Addidon of new motor load Of ❑ "A" "E",''t-2 "1 c"
Job no.: ' f J Job SitC address: I00HPormere. occupancy,
f
❑ Six or more residential units. ❑ Racreational vehicle parks. 1
City/State/ZIP: ❑ Health-care facilities. ❑ Supply voltage far more than
❑Hazardous locations. 600 volts nominal.
SuitObldgdapt. n0,; Project n e, LI Service or feeder 600 amps or more, 4
Il,il :r
Cross street/directions to job site: n I Fro 1
New residential single- or multi-family dwelling unit. I.
Includes attached earage.
Subdivision; Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 s q, ft, or portion
33,92 1;;
c { I Limited energy, residential
;ir',? tl it F i li . I~t! Wilt above . R. 67.84 2
Limited energy, multi-farnily 67.84
2
residential with Above E q. ft.
Services or feeders Installation alteration and/or relocation
~ 1( ~ 200 amps or less
ELI Zs Q V- t..i 0! 1 100.70 2
a.
m ~`r ta~u,•(tll 1 ~,-1if"r Ui R 201 amps t0 400 amps
133.56 2.11
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 Amps 301,04 2
Address: Over 1,000 amps or volts 551,26 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 ems or loss 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, tease, rent, or exchange, a.ocording to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature:- _ pate; aranch circults - new alteration or extension er panel
r`~i " d 'InF I ' pll A. Fee for branch circuits with
above service or feeder fee,
eaoh branch circuit 7,42 2
Business name: H. Fee for branch circuits
Contact name: without service or feeder tie, 56.18 2
first branch circuit
Address: Each a4d'1 branch circuit 7,42 2
bfiscel[aneoue (service or feeder not Included
City; StateJZIP; Each manuNctured or modular 67,84 2.11
dwelling, service and/or feeder
Phone: ( ) Faz:: ( ) Reconnect only 67.84 2-
E-mail: Pump or Irrigation circle 67.94 z :
t,:rl,..^s• . r1.y. t~'F iltl, rv 1...~m 1. p•' ril'l'= Sign or outline lighting 67.84
Business name: Signal olrouit(s) or limited-
ti energy panel, alteration, or
Address; 1.+2 t,~ extension, Describe: < Page 2 2
City/State/ZIP: (j Each additional inspection over allowable in an orthe above
cy^ Per inspection 66.25 I
Phone: (cam `Oc - clo Fox: 05C5 ItFr Investigation per hour I hr min) 66,25
GCS Lic.: ~~"j Electric ic,: Suprv. Lic.: = 1 Industrial Iant per hour 78.18
Suprv, Electrician signature, req
Subtotal:
Print name, CA) ry 1 p M) Plan review 25% of Permit &e):
State surcharge (12% of permit fee);
Authorized signature" TOTAL PERMIT FEE.
PTInt name: Date; 1 This permit application expires If a permit Is net obtained within 180
C~ days after It has been accepted as eomplets. I'
' Numbcr of inspcctioas allowed per permit, ;I
t:v3uldiag>PCrmitrlELCPsrml p,dac IM'Ol/o9 440-4615T(1Vos(C0_WWEB !