Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
.71 e COMMUNITY DEVELOPMENT Permit #: ELR2010 -00240
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/02/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9669 SW WASHINGTON SQUARE DR CO3
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Express
Project Description: Low voltage for anti -theft system.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 11/02/2010 $75.00
CARLSBAD, CA 92008 12% State Surcharge - Electrical 11/02/2010 $9.00
PHONE:
Contractor:
3 GUYS ELECTRIC LLC
2062 NW 15TH CT
GRESHAM, OR 97030
PHONE: 503 - 729 -1522
FAX: 503 - 661 -7378
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N Total $84.00
Vacuum System: N Required Items and Reports (Conditions)
Other: Y
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 ' accordance • = •proved 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 la c • ' es you to follow the rules adopted by the Oregon Utility on Center. Those rules are set forth in OAR
95. 001 -0010 through OAR 952 -0• r 00. Y. • ay obtain a copy of the rules or direct questions to OUNC_bl .111•1••• -' 6.6699 or 1.800.332.2344.
Iss =d By: 1 // ( J - L - � Permittee - '• nature: tC.N`
- ��
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.
NOV- 1 -2010 06:41P FROM:3 GUYS ELECTRIC (503)661 -7378 TO:50359131960 P.1'3
Electrical Permit A licatio ECE/ I (,It e 1F I I(I 1 'I e,.\I.1
C1 of Tigard 000 ��� �� , Received i N .: /]/1J/1
2S g DatcIB . // �/D �! e Permit o , _ i • , ,,a
13125 550 Hall Blvd., Tigard, OR 9 8.1960 V 2 ' 101 PP I n Re ew 1311rer Permit. • � �WQ ��d�S,
Phone: 503.7182439 F ax: 503.598.1960 0
i i t. ‘ It t r Inspection Line: 503.639.4175 CIT OF Date Ready /By: Aida ® See Page 2 for
Internet www.tigard- or.gov BIIILD D ARO Notified/Method: upplemenhl Information
TYPE OF WOR N PLAN REVIEW
® New construction ❑ Addition/alteration/replacement Please check all that apply (submit 3 acts of plans w /dons checked below):
❑ Demolition 0 Other: ❑ w Service the la 400 a cuneennttwre ❑ Building over o stories
❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating building&
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 and 2 family dwelling ® Commercial/industrial ❑ Accessory building amps for all other in;lallatioas. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
0 Addition of new motor load of ❑ "A" "E" "1.2" "1 -3"
Job no.: I Job site address: 9669 SW Washington Square IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: Project name: Express ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Dnrriatioa 1 Qtr. I ere. 1 Total I • .
New resldentlal single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. R. or portion 33.92 I
Limited energy, residential
15.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Install Anti - Theft System
Limited residential (with above sq. ft.) 75.00 2
Services or feeders installation 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: 'rem o ,n s or feeders installation, alteration, and/or
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 1 own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168,54 2
Branch elrcuits new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT 1 ❑ CONPACr PERSON above service or fuxsiva• fee, 7.42 2
each branch circuit
Business name: 3 Guys Electric, LLC B. Fee for branch circuits without
_ service or feeder fee, first
56.18 2
Contact name: Wade Hadley branch circuit
Each add'I branch circuit 7.42 2
Address: 2062 NW 15' Court Miscellaneous (service or feeder not Included)
City/ State/ZIP: Gresham, OR 97030 E�h srviceeland/� feeder 67.84 2
Phone: (503) 729 - 1522 1 Fax: : (503) 661 - 7378 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: wade3guys®gmail.com
Sign Or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: 3 Guys Electric, LLC panel, alteration, or extension. _ 1 Page 2 75 2
Each additional inspection over allowable io any of the above
Address: 2062 NW IS"' Court Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: ire ham, OR 97030 Investigation (1 hr min) 66.25 / hr
Industrial plant (1 hr min) 78.18/ fir
Phone: (503) 729 - 1522 I Fax: (503) 661 -7378 Inspections for which no fee is 90.00/ hr
specifically listed eh hr min)
CCB Lic.: 177242 Electrical Lic.: CLE120 Suprv. Lic.: 5I6LEA ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required/ I 1;;M �� r-- Subtotal:
Plan 75.00
required/1) Plan review (25% of pe:ttnit fee):
Print name: Vinton Wade Hadley I Date: 11/01/10 State surcharge (12% of permit fee): 9.00
TOTAL PERMIT FEE: 84.00
Authorized signature:
TIM permit application expires Ica permit is not obtained within 100
Print name: lone Hadley I Date: 1 1/01 /10 days after 11 has been accepted as complete.
y • Number of inspections allowed per permit.
i. lBuiWing Wermits\ELC- PermdApp.doc 07/01/10 440461ST(I IPo5/COM/WCR
NOV-1-2010 06:41P FROM:3 GUYS ELECTRIC (503)661 -7378 TO: 5035981960 P.2'3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for pa 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
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
® Other Anti -Theft System
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I\ Huilding \PertnitssELC•PermitApp.doe 07/01/10