Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
0 ' COMMUNITY DEVELOPMENT Permit #: ELR2010 -00199
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/28/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9477 SW WASHINGTON SQUARE DR A07
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Best Buy Mobile
Project Description: Low voltage for security system.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 09/28/2010 $75.00
CARLSBAD, CA 92008 12% State Surcharge - Electrical 09/28/2010 $9.00
PHONE:
Contractor:
VISION SECURITY SERVICE
10874 SW ROLAND CT
WILSONVILLE, OR 97070
PHONE: 503- 502 -3909
FAX: 503 - 200 -2907
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 $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: Y Other: N
Other Desc:
This permit is • ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other appli = • - =w , , ork will
be done ' accordance wi p plans. This permit will expire if work is not started within 180 days of issuance, or if w• • is su =nded 7 more . e 180
days. TTENTION: Oregon law, re re you to follow the rules adopted by the Oregon Utility Notification Center Th• -e ru -s ar- , fo in OAR
952- 01 -0010 through OAR 952 -00 100. ou a obtain a copy of the rules or direct questions to OUNC by calling 503.246. • • • • or 1.: %0.3 '344
�� Permi e Signature:
. -
I sued By: Permit tee S g /� _
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 Applicati EC I E FOR 01:1:1(:1 H S I.. ON 1.1
Received ��l/ /D ` D it - .a _oo
City of Tigard 2 E P `� 8 2010
01 n Date/B : Permit No.: /C.pfO
° 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
' C Phone: 503.639.4171 Fax: 503.59 Date/B ' : Other Permit: j , /Q •—e0/t {,
1.1 1z I Inspection Line: 503.639.4175 �� TY OF TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental lnformation
TYPE OF WORK PLAN REVIEW
❑ New construction . .ddition/alteration/replacement Please check all that apply (submit a 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 .151.kommercial/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.
�1 �^NA, �,�,�, ID Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: 7 1 Job address:�:Fdp D ✓ '5u f . i1 TOO S 100HP or more. occupancy.
,.,n l ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ( f/ Q ?.9-3 ❑ Health-care facilities. ❑ Supply voltage for more than
1 ���+ (� ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name' .e [." . M I ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
r �� +,a Limid energy, multi-family
(� G • . J d� residential above (with above e sq. . ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
h 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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
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
ty 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 2
CONTRACTOR Signal circuit(s) or limited- energy 1 ° Business name: \,[‘k 0\3 ._.C,1.10)-1‘_ 3 e -�.)v e , panel, alteration, or extension. Pa 2 2
Each additional inspection over allowable in any of the above
Address: `OVit- Svc f ;::tJ _ Additional inspection (1 hr min) 66.25/hr
City/State /ZIP: �11 ) 1 , CO 00 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/hr
Phone: ( 6 ( : ) , ..5i(:) Fax: p O 0 Inspections for which no fee is 90.00 / hr
specifically listed (%: hr min) _
CCB Lic.: VII a' Electrical Lic. 014 Supry Lic: ELECTRICAL PERMIT FEES
Su rv Elect ciah fl ature, required: 7/t 4 Subtotal: 75.00
p .....)& Plan review (25% of permit fee): -,gam
Print name:.. p'; (if o Date: Q State surcharge (12% of permit fee): c (. 00
TOTAL PERMIT FEE: gY. OD
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
I:\ Building \Pennits\EI.C- PermitApp.doc 07/01/10 440-4615T(II /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
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 Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling •
i4f- Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10