Permit CITY OF TIGARD 'ELECTRICAL RESTRICTED ENERGY PERMIT
6 ! N
... COMMUNITY DEVELOPMENT Permit #: ELR2011 -00009
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2011
TIGARD Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9530 SW WASHINGTON SQUARE RD H10
Project: Apple Store Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: HVAC system for breakroom.
Contractor: ARROW MECHANICAL Owner: PPR WASHINGTON SQUARE LLC
10330 SW TUALATIN RD 2235 FARADAY AVE STE #0
TUALATIN, OR 97062 CARLSBAD, CA 92008
PHONE: 503 - 692 -1565 PHONE:
FAX: 503 - 691 -1879
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/26/2011 $75.00
12% State Surcharge - Electrical 01/26/2011 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N •
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
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 rul- ••o•ted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through O • 952- 001 -0090. You may obtai - • • • the rules or • ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By f Perm ittee Signat !� % ✓lc���l �'
i 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 the next available inspection date.
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 = �oRciF>; c,E s -o�L%
� It O� TI I' � Rece ivod - ga ' Date/B y: I i /i/ Permit No.: ( Y 1312 SW Hall Bivd., Tigard, OR 97223 J
Phone: 503.639.4171 Fax: 503.548'1 �60P r \ \\ Date/By:1eW
Other Permit: Qjj — U
Ti G R � Inspection Line: 503.639.4175 ~ %' � O Date Ready/By: >: H See Page 2 for ✓ "
-- — Internet: www.tigard or.gov 0 �� / �Notified/Method: ."7" Supplemental Information
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• ' a *� P - check all that apply (submit 2 sets of plans w /items checked below)
'Pl ease c
❑ New construction ti_. Addition /alteration/replaceirient .
%‘,' V' 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: C�
-4n '.:x. ? ' - "r -,:;::�. c- ; , -� - ;,«;-u: ;,;;�, :; - 'K ,. :, .�,., : - where the available fault current 0 Marinas and boatyards
��> � fi ,3 -s�• �;;.,; � : �yws�:;�,� R , ; .,,K t;?� y : - ,,�;�;� � exceeds 10,000 amps at 150 volts or ,, ❑ Floating buildings.
,x:3... .. ... :� :.. ...•S's�:y!�- e>_i. ° :k.•q :LEA :F -.�.ir i-, ,pA�.. :w ^i �' ig+'.,s.`- Y��h'- F^.`.�+f.�... :L� �?'�:Y� :n�s's"�.x. :..�i`'.3 C,
less to ground, or exceeds 14,000 Q Commercial -use agricultural
0 I- and 2- family dwelling ® Commercial/industrial 0 Accessory building
amps for all other installations. buildings.
0 Multi- family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
;,;;s i s fi 3 ;;r ;..< , = r :, :a ' ° v _ » -.. ,.� , :; m x{ acs. CI Emergency system. larger separately derived systi
f "l ,A l-;° 4 $ , d - , . :e a 1, `'' t 1 . , - 5 0 Addition of new motor load of
er
Job no.: Job site address:. 5,,,; 4.44 - - , /Joy Six or or more r est R occupancy.
• 0 or more residential units. ❑Recreational vehicle parks.
City /State/ZIP: % J G 1?� j 62— y 7 7
El Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: iefrpfrig: 0 Service or feeder 600 amps or more. ay"
Cross street/directions to job site: Description . p .e. , . - - F � ' ' ala Qts•
New residential single- or multi - family dwelling unit.
• _ . Includes attached garage. _
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54
Tax map/parcel no.: Ea: add'l 500 sq: ft..or portion 33:92 1
3 ern Limited energy, residential 67.84
- i c � 1 i G R ` h _ & - > t. . z ,. ,° g V , , ". M : 4 (with above sq R.)
Limited energy, multi - family
Al If \ 7 5— residential (with above sq. ft) 67.$4 ,
r.
Services or feeders installation, alteration, and/or
_ t 200 amps or less 100.70
l amP 201 amps to 400 amps 133.56
no s- '`''S4 4. y w_ <:. �w4 ` ` ` �..r i d v - -, ,,,,, > (�G' ` s ' ,� a y <x
P '
Name: 401 amps to 600 amps 200.34
601 amps to 1,000 amps 301.04
Address: Over 1,000 amps or volts I 552.26
City/State/ZIP: Temporary services -or feeders- installation; atteratior_ 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A Fee for branch circuits with
= ^ zvom c - , gi p; t �::xti+kskeyY. ^,Z > w A; xrnr w�5 t ;•• `' ,':`�'' ; ;i ^ -W' :; c`.:_ s'a,Tw''" .'" +s�b.•i..a; : ^ i > ... - a.;e t -
c,, 4 ` ;f it " : �� r .x 41f a a. ! P F- ,s
.. ;,.- r: �_• �` ��=:: � . , - ,xw:�¢<�%�� >7;- °�- »�;f�� - �i :w3 ._ -�:;� - ,.? :. •� �� : :...- ,���}�` :zs 7.42 above service or feeder fee,
" ' '� each branch circuit 2
Business name: • . B. Fee for branch circuits
Contact name: fH ut service or feeder fee, 56.18 2
sir, :: 'ranch circuit
Address: Each add'l brancli,eicuit 7.42 2
Misc'ell tr eous ei'vite feeder not included)
. City /State/ZIP: Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone:.( ) , Fax: : (, ) - Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
*<:�x Lysyc„>�,= a•7x-, �, u € �.- �..>.,,� - ��,• �. Yom,: - gr'` °= .°3'.=, ..
- a r M .MS's 1 • 5 h , m Qr Wi t- r . Si or outline lighting 67.84 2
.c'`�` �:�= � �..'�sa� ,�� �' ,s � � " �"�_. �-_ �� .rte; Sign
Business name: k , ms-
Nrie / e � L l �, hi c + Signal circuit(s) e r limited -
energy panel, alteration, or
Address: 3c., J extension. Describe: Page 2 2 •
City /State/ZIP: / / TZbj o ,7Z Each, additional inspection over allowable in any of the above
,=j ell_ / j ( / / J3) 6` � - / ,.7,, Per inspection 66.25
Phone:
(�'G ) � � � FaX: � Investigation per hour (1 hr min) 66.25
CCB Lie.: S (1- I Electrical Lie. 374 —'1 ?C Suprv. Lic.: yi 0 1. a Industrial plant per hour 78.18 I
aH a r'?� _ M-
Suprv. Electrician signature, required l . jaa Subtotal: '
` / ` permit-fee):
Print name: Ro86 , tr . r, j SAL Ge. Date: -I/ e / Plan review (25% of perm
// c�
State surcharge (12% of permit fee): ' q _ -
Authorized signature: � TOTAL PERMIT FEE: O ' c f, ^ This permit application expires ifs permit is not obtained within 180
Print name: ,S 4J.V J /k(—' Date: I /l/ // days after ft has been accepter as complete.