Permit �' .�� CITY OF TIGARD � � '� ELECTRICAL RESTRICTED ENERGY PERMIT
d �
rs s.. COMMUNITY DEVELOPMENT Permit #: ELR2010 -00035
.fi Date Issued: 02/24/2010
TIGAKL7•• 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9483 SW WASHINGTON SQUARE DR AO6B
Subdivision: Lot: 0
Project: Pac Sun
Project Description: Low voltage for T -stat.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 02/24/2010 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 02/24/2010 $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:
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
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This perm' ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be a in accordance with a proved p This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
da s. ATTENTION: Oregon law r • es you to follow the rules adopted by the Oregon Utility Notification Cen - os rules are t forth in OAR
992- 001 -0010 through OAR 952 -001 -0 r I. You — stain a copy of the rules or direct questions to OUNC by calling 503.246 • • .800.:3 344.
Is ed By: ■ = � � _� . � �m- � Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property 1 own which is not intended for sale, lease or rent
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
CaII 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 ApplicativrraL'i‘ 1r. .
.i: .
FOR OFFICE USE ONLY . .
r‘ r.,!`,, ',; 'f, ''', ,! T.• .. - •
City of Tigard Phone: 639,4171 D R I c e e . i /B -..x , i , , ....,w No.: E
cyp ,„ .
,,,,, Permit j2_,; pv
o
p • " , 3125 SW Hall Blvd., Tigard, OR 97AVB 2 4 2010 Plan Review
a .. 503. Fax: 503.59 Date/By: Other Permit: Ng t AOC)? -.00 510
- - - - Inspection Line: 503.639.4175 Date Ready/By: inns:
"FIGA
la See Page 2 for
Internet: www.tigard C 071
ITY - trii1A20 No, i lieAl/Met hod: Supplemental Information
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F . ,:.::: L'z'..' .: : iiAja4101. '::.:: :'. '.....:: :,..', i.;.:.:.!.: ';':: .. --, !-,.: , .!' :.' :',:, .,. - ,,,. , F , , , iii , ; - A1 4 ,, R g***. - .4.
X j New construction 0 Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other:.
where the available fault current 0 Marinas and boatyards
640 fi;JI-.0,1*iiatioti-,V:`:;--:?..';i;::(;:-S.v ' ''J'.' ' ::'' ' ` ' ; ' : : ,. ;:': exceeds 10,000 amps at 150 volts or 0 Floating buildings
less to ground, or exceeds 14000 0 Commercial agricultural
III I- and 2-family dwelling ;K Commercial/industrial 0 Accessory building amps for all other installations. buildings
0 Multi-family 0 Master builder 0 Other: El Fitt pump. CI Installation of 75 KVA or
jiiii.,ti;ittititr.i.ri El Eme.rencY sYstem. load of larger separately derived system.
Job no.: 362.z 1 Job site address: 1 9 , OR, 10011P or more. occupancy.
El Six or more residential units. El Recreational vehicle parks.
City/State/ZIP: 'T i j A i a 0 b le 0 Health-care facilities. ID Supply voltage for more than
0 Hazardous locations 600 volts nominal
Suite/bldg./apt. no.: A 0 1 Project name: p ,.,,,... 0 Service or feeder 600 amps or more.
44:**tOtOr': ',."...:,•;:a -,';:','."':',
Cross strect/directions to job sitc:
Description I Qty. I Fee. 1 Total I *
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. R. or less 168.54 4
E. add'I 500 sq. fl.. or portion _ 33.92 I
Tax map/parcel no.:
I zimited energy, residential
67.84 2
. 1*.,: .8. C.P.R74'PrNYPRIC'='; '.:;:':,:':',:':,::";':.:'''.:";',`, ; :';.: ',.,..::'''''i. (with above sq. ft.)
Limited energy, multi-family
67.84 2
1, 0 ■ot VC 1TAO 1. 1 - .7 residential (with above sq. fl..)
Services or feeders instillation, alteration, and/or relocation
200 amps or less 100,70 2
fikeiiOf*,*001.",;:, .•::,:1'.:)";[;' ; :::; •I''.;4':- 201 amps to 400 amps 133.56 2
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 552.26 2
City/Slate/71P : Temporary services or feeders Installation, alteration, anther
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 i
Owner installation: This installation is being made on property that 1 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
. . , . „.. . ., : y '' ' g::1006 '' .. , l :+;;:■':'::"':,;'' 1, 4 :.,: CI;;!.f00 ::;;::; above service or feeder tee,
7.42 2
each branch circuit
Business name: A e o .......i Th. e I L.,, I B. Fee for branch circuits
without service or feeder fee,
Contact name: ic II
first branch circuit 56.18 2
Each addi branch circuit 7.42 2
Address: j 0 3 0 1/4.itt 1 A „.„ ,,d
Miscellaneous (service or feeder not included)
City/State/ZIP: .-- i
I 1 4.1A7 - 14-1 0 i el 19 ea Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( ) 61 2___ i 6-6,c- I Fax: : (5 gq g __ 1 8 7 q
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
':' , ' ' ," •. •'' '. , '.' . ''. '.:. 7. . , '''•? , ,: . ..':: : `3. ,-, ;001i'rtik.:6COAC' ' ' . .,: . . : ;,,':';': ,.,::''::,,:.' ::. Z, ,:' . ;,::, Sign or outline lighting 67.84 2
.. .., • . . . ,, . ,, , ,..,, , - . , . , ., . ,, , , . .. . . , ... ,
Signal circuit(s) or limited-
Business name: AA le , , 0 ...,„ I; tti AAA i c ", i
energy panel, alteration, or
extension. Describe: 1 Page 2 2
Address: to 33 0 6) -- TbAlAT),... a
/ CityState /ZIP:
- 7.171.2.4A1-71.4 em el 76 ,6 7 _ _. _._ p Eath . i
additional ns pection over allowable in any of the above
r ----- ------
pection 66.25 '
Phone: (5 ) pi 7 -jct., C _
1 Fax: (5 ) 6g 1 9 7q Investigation per hour (1 hr min) 66.25
CCB Lie.: 51613 Electrical Lic.:51/ LI 7/4 c Suprv. Lic.: 93 L 0 Industrial plant per hour 78.18
' . '•." ::•"'•-•'•''': ,,
Suprv. Electrician signature, required: k eta
j
Su
Plan review (25% of permi 0 °
Li
67
Print name: ft 5 - , at - Date: 21 3 / 2e , 0
State surcharge (12% of permit fee):
Authorized signature: 2%
TOTAL PERMIT FEE: 7 5. q g
This permit application expires Ira permit is not obtained within 180
Print naineVe 1.,, c/..19irk Date: 2„/i a/2N 0
days after it has been accepted as complete.