Permit p r
_ °e CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
m COMMUNITY DEVELOPMENT Permit #: ELR2010 -00033
r Date Issued: 02/17/2010
T [ G AR L): 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9483 SW WASHINGTON SQUARE DR A06B
Subdivision: Lot: 0
Project: Pac Sun
Project Description: Low voltage for audio /stereo cabling.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 02/17/2010 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 02/17/2010 $8.14
PHONE:
Contractor:
SAFE TECHNOLOGY GROUP INC
6400 NE HWY 99 SUITE 375
VANCOUVER, WA 98665
PHONE: 360- 699 -2130
FAX: 360- 719 -1527
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Y 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: N
Other Desc:
This permit is i :. - - •>ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done • accordance with approve ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. . TTENTION: Oregon la quires y• to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 601 -0010 through OAR 952 -0 -0100 Y. y obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1.800.332.2344.
ssued By: 62_(/(_41&
Permittee Signature: �/ lilt - Cv/
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.
Cali 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.
Electrical Permit Application ` -
FOR O FFICE US E ONLY i.
C . , . � Yii City of Tigar Date /B p 2 f.,7 ,0 ( T.
PermitNo.: e 0 8033 .
1 '" 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
: ' C Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
T 1 G AR D`: Inspection Line: 503.639.4175 Date Ready/By: Jas — El See Page 2 for
, ,Lr: ∎.:+� _a,,:,. , .c Internet: www.tigard or.gov Notified/Method: l/ t 6 Supplemental Information
.. TYPE OF WORK PLAN REVIEW - • • .
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 ICV A or
. ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
•
Job no.: 1044 Job site address: 9483 SW Washington Square Dr Six or or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard OR ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: AO6B Project name: Pacific Sunwear #1212 AC 54 lc ❑ Service or feeder 600 amps or more.
FEE SCHEDULE • .
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
Audio/Video cabling residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY: OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name:
401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, , er panel
Owner signature: Date: A. Fee for branch circuits with
. . . ® APPLICANT ❑ CONTACT PERSON a service or feeder fee,
each branch circuit 6.65 2
Business name: Safe Technology Group Inc B. Fee for branch circuits
Contact name: Jason Sweet without service or feeder fee .46.85 2
first branch circuit
Address: 6400 NE Hwy 99 Suite G375 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Vancouver WA 98665 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (360) 699 - 2130 Fax: : (360) 719 - 1527 Reconnect only 66.85 2
E -mail: sales @safetechnology.net Pump or irrigation circle 53.40 2
. CONTRACTOR . . Sign or outline lighting 53.40 2
Business name: Safe Technology Group Inc. Signal circuit(s) or limited- — Y
energy panel, alteration, or / g
Address: 6400 NE Hwy 99 Suite G375 extension. Describe: 1 Page 2 `�' 2
City /State/ZIP: Vancouver WA 98665 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (360) 699 -2130 Fax: (360) 719 - 1527
Investigation per hour (1 hr min) 62.50
CCB Lic.: 173731 Electrical Lic.: CLE79 Suprv. Lic.: 4272LEA Industrial plant per hour 73.75
:ELECTRICAL . P ERMIT 'FEES ..
Suprv. Electrician signature, required: f Subtotal: !' 7 Q
Plan review (25% of permit fee):
Print name: Jason Sweet Date: 2 - - State surcharge (12% of permit fee): S If
Authorized signature: •5' / TOTAL PERMIT FEE: 7$4 9 e &
T his permit application expires if a permit is not obtained within 180
Print name: Jason Sweet Date: 2 -17 -10 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I: \Building \Permits \ELC- PermitApp.doc 05/23 /06 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information l " O 201 £ c O J 5
LIMITED ENERGY PERMIT FEES:
r- RESIDENTIAL: WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
r COMMERCIAL _WORKONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
® Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits \ELC- PermitApp.doc 03/23/06