Permit i p ry CITY OF TIGARD
` ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00123
13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2010
T1GA RD ; g Parcel: 1 S1 260000300
Jurisdiction: TIGARD
Site address: 9771 SW WASHINGTON SQUARE DR D08
Subdivision: Lot: 0
Project: CCS
Project Description: Audio /stereo system.
Job No. 3597
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 07/14/2010 $75.00
CARLSBAD, CA 92008 12% State Surcharge - Electrical 07/14/2010 $9.00
PHONE:
Contractor:
TRITON COMMUNICATIONS, LLC
PO BOX 1091
HILLSBORO, OR 97123
PHONE: 503 - 615 -5800
FAX: 503 -628 -5689
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 $84.00
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Al ,. , dt7 /7z/ c 19-770 .
Issued By: � � P ermittee 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 clay.
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.
07/12/2010 13:34 535285b9,. _; TRITON COMMUNICATION PAGE 01/03
Electrical Permit Application] " FOt UFFi1'•: LSE ONi.V
IN I City of Tigard JUL 13 2010 Date/8 E�,¢�O /0 �Ol?
DateJB : / i t ■ Permit No.=
w 13125 S50 F.63 503.639.4171 Fax: 503.598.1460' , Tigard, OR 97223 plan Ravie • ' /�, , ryo /0 _DOO , 0
Phone: 503.639 "4171 V , ` r • i DateB : Other permi • ' l
Inspection Line: 503.639.4175 .. a ��, Date Rr: rd y/By;
- I I ( ; ,� t I.) El See rage 2 for
Internet: wsvw.tigard- or.gov 'v. t.. .;. Notified/Method: Supplemental Information
T`Y'PE OF WORK .: ,. S I4'Crww :
• ❑ New construction ddition/alteration/replacement Please check all that apply (submit 2 sets o 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 .' . .. -: . ;: ..:.: ry
g `' ' .. exceeds 10,000 amps at 150 volts or ❑ Floating buildings- •
less to ground, or
❑ 1- and 2- family dwelling Cormnercial/industriai ❑ Accessory building exceeds ❑ Commercial-use agricultural
e rc amps for an ether installations. ns� buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fin pump. 0 installation of 75 KVA or
Ern eney system, larger separately derived system.
JOB S1TE :1N;F0 N . ` OCA TION G1g
❑Ad dition of new motor load of ❑
1001-1P or more. Recreation.
Job no.: 5581- Job site add s :7 [ 5k r
ltrZ�.Q ❑ Six or more rcsidetitial units, ❑ Recreational vehicle parks.
City/State/ZIP: 7. ,,,, (� (� � t� �.a D ❑ Health -care fac;lities,
El Supply voltage for more than
1:3, Proj ect n . t' - : '
\-.3- i J t� El HA7Ard0n9 1°eati°ng 600 volts nominal.
Suite/bldg. /apt. no.: feeder 600 amps or more.
J El or fe . 'FEE 3 :: .
Cross street/directions to job site: ueseriptiso 1 sty" I ref_ Toes I •
New residential single- or multi - family dwelling unit.
includes attached garage.
-
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
FA, add1 500 sq. ft, or portion 33.92 ■
Tax map /parcel no.:
:DESCRIPTION; OF WORK Limited with above sq. ftresidential
75.00 2
" \ Limited energy, multi family 75.00 2
1 i\ Al 0 ( residential (with above sq. ft-)
Services or feeders installation, alteration, and/or relocation
.
200 amps or less 100.70 2
O PROPERTY' OWNER ', 0 T EN,A,NT. :::::;::::j:;::.:::1; 201 amps to 400 amps 133.56 2
" 401 amps to 600 amps 200.34 2
Name;
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552,26 2
- Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I
Owner installation: 'This installation is being made on property that I own which is not 201 amps to 400 amps 125,0$ z
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 - sew, alteration . or extension, p er panel
Owner signature: Date: A. Fee for branch circuits with
. ': ❑ APPLICANT; ON above service or feeder fee, .42 2
�"� each branch circuit 7A2
Business name; B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'1 branch circuit 7.42 - 2
Address: Miscellaneous (service or feeder not included)
Cit /Blaze /ZIP: Each manufacmredor modular 67.84 r 2
Y dwelling, service and/or feeder
Phone: ( ) I Fax :: ( ) Reconnect only 67.84 2 J
pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR : , — -
Si gna l circuit(s) or limited -energy l
Business name: '1 ' �� C � C fl > (��� )gel, a l insp ion. ` page 2 � 2
� -�7 Each additional inspection over allowable In any of the above
Address: 70 , (Da t Additional inspection (1 hr min) 66.25/ hr
- )� k,S �) 1 (:)\ O�" `'? Investigation (1 hr min) 66.25/ hr
City/State/ZIP:
Industrial plant (1 hr min) 78,18/ hr
Phone: (5 (0( 5 9, J " (00 I Fax; ,� )�DS .- 56 g ✓ Inspections fbr which no fee is 90.00/ hr
` � s specifically listed ('A hr min)
A y CB Lic,: 1 L (9 lectrical Lic.:331(_ ( ,j Lic,: 4 ('F,4.. : ;: . EL CTItIC L .PERM•r :: F.;EE$ •. Suprv. Electrician signature, required: Subtotal; ,i ye'1, �, Plan review (25% of permi t fee): . ): _-.r
Print name: D ate: State surcharge (12% of permit fec): C\
A�o,.. lrc��n \I �l e.Q.�r � /�alt� .
M TOTAL PERMIT FE ��� �' . '�} 1
Authorized signature: fZ This per application expire%if a permit is not obtained within 180
days after it Sao been accepted as complete.
Print name: y , ( \JO-V 42-Q.-* Date: ft -/ (O • Number of inspections allowed per permit.
1: 1Dulldiroormits\6LC- PormitApp.doc 07/01/10 IA' ' 440-4.15T(1 MS /CO 4/WEB
07/12/2010 13:34 5036285689 TRITON COMMUNICATION PAGE 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL W( RKONLY ..;.......;:;:.
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Aix Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY;
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved!
►❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Insttallation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
LI Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other _
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:1$ wilding 1PermitAELC.PermitA00.400 07/01/10