Permit q
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
S,: COMMUNITY DEVELOPMENT Permit #: ELR2010 -00059
Al AREi 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/13/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9565 SW WASHINGTON SQUARE DR BO3A
Subdivision: Lot: 0
Project: Icing
Project Description: Low voltage for HVAC
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 04/13/2010 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 04/13/2010 $8.14
PHONE:
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062
PHONE: 503 - 692 -1565
FAX: 503 - 691 -1879
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: Y 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 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. ATTENT : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -00 through t5AR 95 01 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
s/ r
Issued A .fif - 40 - 1A
Permittee Signature: = /l -
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.
Electrical Permit Applicatifif FOR OFFICE LSE ONLY
j
City of Tigard Date/By: Received t/ J /0 ./ Permit No.: ek 0 /D,.QOQS7
II
Tigard, ARR 1 3 2010 y
• 13125 SW Hall Blvd., Ti OR 97 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 • Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 CITY OF TIGARD 1�� Date Ready/By: huts: t3 See Page 2 for
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Internet: ww.tigard- or.gov RIM DING DIVISION Notified/Method: 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 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A "E `I -? ", "1 -3 ",
Job no.: Job site address: Washington Square Space BO3A 1001IP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no: BO3A Project name: Icing ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I 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 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
Limited energy, multi - family
New thermostat /41/7/ residential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Nye 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Y relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, ter panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ® CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: Arrow Mechanical Contractors, Inc. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Kevin Kruszewski branch circuit
Each add'l branch circuit 7.42 2
Address: 10330 SW Tualatin Road Miscellaneous (service or feeder not included)
Cit / State/ZIP: Tualatin, OR 97062 Each manufactured s a or r modular 67.84 2
y dwelling, service and/or feeder
Phone: (503) 692 - 1565 Fax: : (503) 691 - 1879 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: arrowmech @verizon.net
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: Arrow Mechanical Contractors, Inc. panel, alteration or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 10330 SW Tualatin Road Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Tualatin, OR 97062 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 692 -1565 Fax: (503) 691 - 1879 Inspections for which no fee is 90.00/ hr
specifically listed ( %hr min)
CCB Lic.: 5193 Electrical Lic.: 34 -47CLE Suprv. Lic.: 930LEB ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: /_ _
Plan review (25% of permit fee): CP T
Print name: Robert C. La Salle Date: 4/6/2010 State surcharge 02% of permit fee): g- /
�° TOTAL PERMIT FEE: — Ft
Authorized signature: ,, (` S! j:4 This permit application expires if a permit is not obtained within 180
/ ���Y ' ^ days after it has been accepted as complete.
Print name: R a � (� A 5r� Date: L.` - L a ; j Number of inspections allowed per permit.
1:\ Building \ Penults \ELC- PemtitApp.doc 10/01/09 440- 4615T(ll/05 /COM/WEB