Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
13 • COMMUNITY DEVELOPMENT Permit #: ELR2010 00177
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/08/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9779 SW WASHINGTON SQUARE RD D11
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Champs
Project Description: Data telecommunications system.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 09/08/2010 $75.00
CARLSBAD, CA 92008 12% State Surcharge - Electrical 09/08/2010 $9.00
PHONE:
Contractor:
CACHE VALLEY ELECTRIC COMPANY
6200 SW ARCTIC DR.
BEAVERTON, OR 97005
PHONE: 503 -431 -6600
FAX: 503 - 624 -1436
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: y Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
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 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 m- • • • •- • • of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued 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.
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.
09/08/2010 13:10 FAX 425 424 9966 CACHE VALLEY ELECTRIC C j001
RECE
Permit Application FOR ol OFF IC USI otil,v _
City of Tigard SEP $ �� 1` ':" , PcnnitNe.: 2 /:,„*- o- - 1
4 i a 13125 SW Hail Bivd., Tigard, OR 97223 naReviaw Otherpermit:
Phone 503.619.4171 Fax 503.598.1960 �F T ' • ,
pxdiion Line: 503.639.4175 :
r l c n x i lnl ernct two/lipid-anger -anger CI DI NG DIV amd bo V1GI '
2
fki„wn :hti .$ .cl,,;}•�re': -x L4;c'`.470 "�_r 6Y.°r- A-Z.� °. i
0 New construct I .: Addition/alteration/replaoement Phrase chat as amt apply > • ;pm o[pla
sob. oa Wheels ohedscd • o4 r
O Service or fader 400 amps or mare ❑ Building over throe stor I
❑ Demolition 0 Other: ,rlmra the nvaitabto Oudt current OW= and boatyards.
fi bs° •_- , s�, t ,,, T iT r � aucctis 10.000 =Pool 150 volts or ❑ Floating bondings. i
c .2 .. i t • , a ,:v� fl � A i.. Y- w -- -- ....- ,• less to grand, m exceeds 14,000 CI Commercial-use wisdom!
0 1- taxi 2- ftlmilydwelling t ommercial/indusulal ❑ Accessory building amps Ibr alt other instanatioas. boadinp.
❑ Multi- family _ ❑ Master builder ❑ Other: Ci Fire pomp. a I7t ton. KVA o 1
�� g r tr- . -• ❑ Bmhugdmy syat a separately derived r
an ; 15 % 0 6: -I r li,. i, V .S k!i c k;, . ,,ii - e5 €-' . 0 Addition anew motor load of ❑ "A "."E.. , 1_2 .. ..1-3", i
10011P or more. OttlipaItCy.
Job no.: fob site address: 41 A CI Six or meta rmidasaial melts. ❑ Recreational vehicle parks. j
❑Heatlb •cans facilities. CI S y voltage rot morn !ban City/State/ZIP: 'ride, . ) ( q 1O C pltoratdons locatiooa.. 600 votes aamioal.
Suite/bldg apt, no.: -1 1 I roject name: 0 ( „ 9C)('a•� - CI Service or feeder 600 amps a moo. i
P l 0 ',. - n '''t „ice 1 i'' rt71, J : i s q.:71:''. ZA�- 4; +, a
Cross street/directions to job site: DUMP on rxv. Fee TM •
New residential single or multi -family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft or less 16854 4
1 Ea. add'I 500 sq. it or portion 33.92 I ;
fax map/pareel no : _ Limited march residential 75.00 2
741.4. k igr".'1. µWei t iE . a , :��� a 4 . :- Limited ergy
IM Mir , 1 i MI . 1 t .' / ^ 6 ` 1 - residential (with above sq. ft) 7 2
' 1ot' , tL 41 Services or feeders instaliarlou, alteration, and/or relocation
200 amps or loss 100.70 2 i
r� �` " x -` s . .. IVoa'o i ` e �j Y- 201 amps to 400 amps 133.56 2
�4 Fa '�+ ?�' 'a J 'v*- '`r•`h!�... - d u.,.. •'' -�`� - ,� ,.t.s�i � •& fie.
401 amps to 600 amps 200.34 2 f
Namur 601 amps to 1,000 amps 301.04 2 !
Address: Over 1,000 amps or 552.26 , 2 i
Temporary services or feeders installation, alteration, and/or ,
City/State/ZIP: relocation
Phone: ( ) 1 Fax ( ) 200 maps or less 59.36 1 1
201 amps to 400 amps 125.08 2 !
Owner installation: The: installation is being made on property that 1 own which is not 2 0 1 amps to 599 amps 168.54 11 2 1
Intended for sale, lease, n :nt, or exchange, according in ORS 447, 449, 670, and 70l• 'Branch circuits - new, alteration, or extension, ner paod 1
Owner signature: Date; A. Fee for branch circuits with ,
f'0•- x-2-4"' '`i'3 t 7'
�! 4 3.'. M4 - " t -f P I S Fi i ` . almvesarvice�fceder 7.42 2 !
s�; sects m - • z� s� __a la .,� -� ° each btauch &mail
Business name: � � a B Fee for branch chvuits without l
service o r r e a l e r fee, that 56.18 2
Contact frame: V u frobac, a in branch circuit I Bads add' I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included) I
Each manufactured or =Mar
67 2 1
City/State/ZIP: dwelling, service and/or Rieder i
Oeconneetonly 67.84 2 I
Phone: ( ) Fax:: ( ) Pump or Irrigation circle 67.84 2 i
E - mail: V W eve e . 31.. Sign or outline lighting 67.84 2 i
/�
e ._�
. ,. ,� `.,. � . signal circuit(s) or Ilmim�at
dergy OD
Business name: C` i ` . Va panel. altewtlon, or extension ` Page 2 • 15 AD s
�' i11 C C'� 1( Bach additional inspection over allowable in any of the above I
Additional inspection (1 hr min) 66.251 hr ' 1
Address �a f Mir , CI -ht, �j p � .- 1/� investigation (I lirmin) /M 1
City/State/71P: i / (1A1GI , `l /005 Lsdsmtria[piant(l hrndn) 78.1.8i ly
Pte: (549 , ` 1 1 ` I Fax /,�r�) m /1- Inspections for which no fba is
s sal listed A hr min 90.00/ In' `i ✓ /0n O 1 ?iZ�J' 1
,I /(� Su Lie. � � -' -: dn,,e. y ' i ;t. ii�,-'ka : !• -Ebb
CCB L{c. `►ct�/�'!J► Electrical Llo . , - ' Pn, �rJ doD S �= - �l� _''i �.,� � �; �
�� Subtotal: 1 , I
Suprv, Electrician signature, requ ; . ^.' /. �! w Plan review (25% of . omit fee):
P[Ltt name: ,..1011Ir -— '� Date: State surcharge(12%of permit fee): DO _ i
� 'DOTAL PERMIT FEE: L OQ s
Authorized signature: Uhl perndt appueatba oxplres Ka penult Is not ob within 180 1
days attcr it boa bean accepted as complete.
Print name: 1 Date: 4 } rwsbcraf impactions allowed par permit.
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09/08/2010 13:10 FAX 425 424 9966 CACHE VALLEY ELECTRIC IJ002
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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 Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial $75.00
system
(SFR OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Steno Systems
❑ Boiler Controls
❑ Clock Systems
,Data Telecommunication Installation
❑ Fire Alarm Ins :allation
❑ HVAC
❑ Instrumentation
❑ Intercom and ?aging Systems
❑ Landscape Irrigation Control*
❑ 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
L•\ Building lPcrmits\ELC- PermitApp.doc 07/01/10