Permit 0 :', CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00055
T I GAAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/01/2010
•. Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9483 SW WASHINGTON SQUARE DR AO6B
Subdivision: Lot: 0
Project: Pac Sun
Project Description: Low voltage for EAS system (loss prevention).
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 04 /01/2010 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 04/01/2010 $8.14
PHONE:
Contractor:
INTEGRATED WEST TECHNOLOGIES LLC
38751 DUBARKO RD
SANDY, OR 97055
PHONE: 503 - 476 -2106
FAX: 503 - 826 -0926
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 done in e fiance wi proved 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. AT NTION: Oregon la re res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 010 through OAR 952 -00 100. Y m y obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.80 .332.2344.
Iss d By: 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.
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 # 'i ,i . I () (� I * I \ " ' ru?E � '"� i
`•4 ',' '' C of Tigard Received 4/ /0 � Permit No.: EL/Up/0 -ODds
Date/By: 7
ip
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Ill " Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit:
1 ) Inspection Line: 503.639.4175 Date Ready /By: :furls: ® See Page 2 for
41 f..1 ' K 191
1: , Internet: www.tigard or.gov 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
' JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: 9 ` "9 J� S (I 5 ,� S I ix or or more. occupancy.
4_ ❑ Six or more residential units. ❑Recreational vehicle parks.
City /State /ZIP: / ❑ Health -care facilities. ❑ Supply voltage for more than
Gli / C/ 9 ` ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ` ^ / _ /7 Project name: j>4 � ❑Service or feeder 600 amps or more.
� G � FEE SCHEDULE
Cross street/directions �to�j site: 6'
e: i 1 s i Jr- l S� A ei % (' Description 1 Qry. I Fee. I Total 1 •
� J ( 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
/ A Limited energy, multi - family
-� S yC� .`/ r S s f .� residential (with above sq. ft.) 67.84 2
J � � y ) Services or feeders installation, alteration, and/or relocation
/ .f: ft eV kIv�A) 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
Name: (G ( ( v� / 601 amps to 1,000 amps 301.04 2
Address: t 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
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, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 .CONTACT. PERSON , above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
Y dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 4,7. 2
•CONTRACTOR Signal circuit(s) or limited - energy • 41 ` 7� - / 7d (' j panel, alteration, or extension. Page 2 2
Business name:
'L/1 ✓k (j Y S G Y C S Each additional inspection over allowable in any of the above
Address: ' - 73 � Ice 6 G .,,i Additional inspection (1 hr min) 66.25/ hr
'7 6T-7--- Investigation (1 hr min) 66.25/ hr
City /State /ZIP: v.\ 2) �� £ ' / Industrial plant (1 hr min) 78.18/ hr
Phone: SQ 3) v G -Z {_ Fax: ( 5-03) 2 6 __ e Z 4 Inspections for which no fee is
tP specifically listed (%s hr min) 90.00 / hr
CCB ,"ic.: /20/ 1 Electrical Lic.: ix, r 4/ Suprv. Lic.: ELECTRICAL. PERMIT FEES • s
•. it( 7 / /r( 10 if If Subtotal: 07• FF'
Suprv. ectrician signature, required: -
C ' Plan review (25% of permit fee): . �i9
Print name : C 4,11/ C � f Date: / f // 4 0 State surcharge (12% of permit fee): g. 1 f
. 'V TOTAL PERMIT FEE: 77-9
Authorized signature This permit application expires if a permit is not obtained within 180
� �/ days after it has been accepted as complete.
Print name: (21., /A1l j`sS Date: V / / 0 * Number of inspections allowed per permit.
1:\Building\Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05/COWWEB
Electrical Permit Application - City of Tigard
Page . 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
'RESIDENTIAL WORK ONLY: . .
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
H HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
H Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
H Protective Signaling
K Other 7A-
Total number of commercial systems: f
*No licenses are required. Licenses are required
for all other installations
1: \ Building \Permits\ELC- PermitApp.doc 10/01/09