Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
o COMMUNITY DEVELOPMENT Permit #: ELR2010 00234
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/26/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9416 SW WASHINGTON SQUARE RD K08
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: GNC
Project Description: Low voltage for HVAC
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 10/26/2010 $75.00
CARLSBAD, CA 92008 12% State Surcharge - Electrical 10/26/2010 $9.00
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: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in acco nce with plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT ON: Oregon law re• • re •u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 thro gh OAR 952 -001 •100. • may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu By: I/ Permittee Signature: ��
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application --1 --K- FORpOr1•I E USE O \L)
City of Tigard �� Rey fo - _. fL,e Ay, -00,.
Permit No.:
e 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
= .* ; Phone: 503.639.4171 Fax: 503.59$,}9¢0 2O1O D : Other Permit:
Inspection Line: 503.639.4175 U 1, I Date Ready/By: ions: 0 See Page 2 for
TIGAD R ° 8
• Internet: www tigard- or.gov � � yD7� Notified/Method: Supplemental Information
- y< qln , 3 N �1
• �r 3 rnx.-. ' ,r :i « .Y";X -',", i kt ' • • . t � '� @'l - , A. 2'n :j" - ,�? r_:d:..:;;,*: . t „. : }w' Ei,i.i
j all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ®Adtiiti s � . ration/replacement Please duck
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current ❑ Marinas and boatyards.
f -. 0t z 4 4 1 a '' tngtr ' ,v' ei'd ,tit' fit... a x, y ¢ x : .i' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
r 6 ' { ;^ _ ' 1 .ai ,,.?" . - N i1F „1.� . k. s .*. s _. ,4;,,;`„ 5 `{`�' t...: <rj'
Commercial/industrial ❑ Accessory building l mn amps oral other a exceeds alga 14,000 ❑ commercial-use agricultural
❑ 1- and 2- family dwelling ❑ Commercial/industrial
amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
t ` �� w y l ��
. ❑ Emergency system. larger separately derived system.
.,,F' , li r V; YY '"li.. *i7Fr l'11f Q)2 i41t `' � ... �` � . , * 4a s "''2"r ❑ Addition of new motor load of ❑ "A ". "E ". "I 2 "1 3
Job no.: I Job site address: 9 v .//L 6 ,,,) ��'( / AX T � ( � gw44,E` loom °r more. occupancy.
❑
i' fr ❑ Six or more residential units. Recreational vehicle parks.
City/State/ZIP: 'Tr� n , J ` 9 7 Z � ❑ Health -care facilities ❑ Supply voltage for more than
/ 'r'/e- r✓ L ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: 14_ pt I Project name: c N C ❑ Service or feeder 600 amps or more.
' f ; r w gt D 3 ti } >rvl
job site: Des _ `` `� Fe.. "'� "�`' 1
Cross street/directions to
J t>e=�pmn ► tom. f ' Rea. � total 1
New residential single- or multi- family dwelling emit_
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 I
- t,: < 4 i a'r ri li r s �` ; a to ` F e5-r Limited energy, residential 67.84 2
.,.? WP. u. O y ;,, S ,3 N c } a' -. y �'+3 q p , ,n (with above sq. ft.)
K T u ra >Y. _ Limited energy, multi - family
/ Oa - J re" P ,fZ" ` f (2- residential (with above sq. ft.) 67.84 2
Services feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
? "} - Y+Y •vn ]., W.aiR' t`C? -;. .-n ,fa!y �236-�.ti '' U. H �Ni ,>
.. < t;: a . ,- » KN k , s � ,x ti >_ , z...4� 7z s 201 amps to 400 amps 133.36 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/State/ LP: Temporary services or feeders installation, alteration and/or
relocation
Phone: ( ) I 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 drains - new, alteration, or extension, per panel _
Owner Slgnattue' Date. A. Fee for branch circuits with
' µ, ' ; ? - above service or feeder fee,
' ..� .v9='1 • i4 -- .k, ` N. �1 - � - `.. `> • , :. . • „ . 7.42 2
each branch circuit
Business name: A_R(Zjw /,, 1,/.070, 4-L ej,,) 7 4 frd S /#J C, B. Fee for branch circuits
Contact name: ' service or feeder fee, 56.18 2
1Cii4.J / KfL. .J 5 Z. 6 1L[ first circuit
Address: /U . 33® •���- . /� gd Each add'I branch circuit 7.42 2
l Miscellaneous (eservlee or feeder not included)
City//State/ZIP: V y A, t ,1 , 0 ,7‘....46 T Each manufactured or modular 67.84 2
1
dwelling, service and/or feeder
Phone: ( 573) 6, 2 _ / gL - - I Fax:: (5 �) 6q / ' ! �71 Reconnect only 67.84 2
E -mail: • r: AU G. ''Reb ,ZiZ- • eryyr■ Pump or irrigation circle 67.84 2
�' i 1 ;,. ` a,, .' a , a a f';:;' •? 's' Sign or outline lighting 67.84 2
A/ � g�� � ��I"`� 7 2 5 /Ne_ energ c a er limited -
Business name:
/`r►Vt`►�^�' d+•4tt1�'A- JI('1°{� c f1t� r energy Panel, akeratior>, or
Address: /0 31e> J ra , �77/3 R0144> extension Describe: ( Page 2 �t 2
City/State/ZIP: -7°0 / O 9 7e6 z_ Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone:
SSG3 ) c v L- / . 5 - S' I F ax: ( 5 0 3 ) 9 / - / Es 7 7 Investigation per hour (1 hr min) 66.25
CCB Lic.: 57 9 Elec trical Lic.3 • .. £ /7eL/ Suprv. Lic.: In dustri al plant per hour 78.18
3 `l 93o 1. �B �
�L �o' �f A ?} , t ; :7,-, '. .'Re_ . '; mo t ,,i5 - , et l1?_,�,9' ✓r ' � i
Suprv. Electrician signature, required: ` AZ"? /�`'{// Subtotal:
Plan review (25% of permit fee): j
Print name: R o B per ri LA SALGE I Date: /e): 7 � / �
/ //II State surcharge (12% of permit fee): 4A aD
Authorized sign,/ e ,. / .' TOTAL PERMIT FEE: g 4.00
/ / This permit application expires if a not obtained within 180
Print name��,.� d/ //� � ,r 7 ,, f> // Date. e7 �/ days after it has been accepted as complete.