Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
* COMMUNITY DEVELOPMENT Permit #: ELR2011 -00033
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/10/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9355 SW WASHINGTON SQUARE RD T19
Project: VERIZON WIRELESS Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Data telecommunications system.
Contractor: TECHNOCOM INC Owner: PPR WASHINGTON SQUARE LLC
7929 SW BURNS WAY STE. F 2235 FARADAY AVE STE #0
WILSONVILLE, OR 97070 CARLSBAD, CA 92008
PHONE: 503 - 682 - 4195 PHONE:
FAX: 503 - 682 -2781
FEES
Description Date Amount
Specifics:. Restricted Energy Permit 02/10/2011 $75.00
12% State Surcharge - Electrical 02/10/2011 $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: Y Fire Alarm: N
HVAC: N 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 rules adopted by the Oregon Utility Notification Center. Those rules are set fokth in OAR
952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of thdirect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B . /` _� _ 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 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 "-- t °°`d FOR OFFICE USE ONLY
14 ,. City of Tigard ? 9 2011 Received
13125 SW Hall Blvd., Tigard, OR 97223 tilt* : 2 i n= Permit No.; J I - [1(b
Plan Review Phone: 503.718.2439 Fax: 503.598.1960 i is =tht� Date/H Other Permit:
.,,, 6ARLJ p eC 3.639 �t i • O��.r, n - °s
, d 7S rjulL ' lln l t Date m,y, goo age ter
Internet: e(; www ti otiftedJMeththod: '.II
S upplem Information
Information
on Line
P�
TTirtr. OF WOR]((
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 cots of plans w/itcliis checked below);
111 Demolition ❑ ❑ Service or feeder 400 amps Or more ❑ Building over three stories .
where the available fault current LI Marinas and boatyards.
CA ° E0RX' 101E C .4,i,�1„IXTIOS exceeds 10,000 amps at ISO volts or EJ Floating buildings,
Other:
uiv
Y g El Accessory building loss to ground, or exceeds 14,000
El 1- Master builder A th !] Comntereial• use agricultural
1 - and 2 -femil
❑ Multi-family �-•� amps for all other installations, buildings.
LJ e Q Rife pump.
, }' hutellaf n 4f 75 KVA w
' !JOB: SITEs. I mON. AND ° d A *'i [] Emergency system, larger separately derived system.
O ❑ Addition anew rooter load of
Job no.: I14007 j Job site address; VERIZON WIRELESS 100t1P or more. occupancy.
Cl Six or mere residential units, ❑ Recreational vehicle parks,
City / State/ZIP: PORTLAND, OREGON 97223 ❑ Health -care facilities, ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: TI 9 Project name; VERIZON WIRELESS ❑ service or kcdcr 600 amen w *WIC.
bacriotiu .:, .p SG l Qty. - 1 F ao. To :: - - ■
Cross street/directions to job site:
1g1?ll
n Q ton
New residential single or multi family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168,54 4
Tax tune /parcel no.: Ea, add'l 500 eq- il. or portion 33,92 1
Limited energy, residential
11ESCll�1F'TION ;Qp WbRIC (with nbovc sq. ft.) 75,00 2
VOICE/DATA CABLING Limited energy, multi family 75,00 2
residentiml with above sq. ft.)
Services or feeders installation. alteration, and/or relocation
200 amps or less 100.70 _ 2
❑ PROPERTY OWNER ❑°, TENANT :.: ` r, 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps in 1 non amps 201,04 2
Address; _ Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /o
relocation
Phone: ( ) 7—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 crops 125,08 — 2
intended fur sale, lease, rent, Or exchange, sceara2ng to ORS 447, 449, 670, and 701. . 401 d,upa to 599 amp lols,y4 ' 2
Branch circuits - new, alteratio or ex tension per panel
Owner signature: Date: A. Fee for branch circuits with
„
-
. 1 NT 12 .
A GUIVTACT P)�2SO1V above service or feeder foe. 7.42 2
each branch circuit
Business name: TECHNOCOM, INC B. F eireuita uhoor
service ee for or branch feeder fee, first w 56,10
Cotltact unrue: JEI' F SANDNER branch circuit =
Address: 7929 SW BURNS WAY, STE 1R Each add'! branch circuit 7,42 2
Miscellaneous (service or feeder not it eluded)
City /State/ZIP: WILSONVILLE, OR 97070 dwelling. m.9rrutaewrrn or moaular 67 84 2
dwelling, service and/or feeder _
Phone: (503) 682 -4195 Fax: : (503 ) 682 -2781 Reconnect only 67.84 2
E- mail: Pu,np or irrigation circle 67.84 2
CONTRACTOR' Sign or outline lighting 67.84 2
CO Signal circuits) or limited-energy 1
INC _pail, alien:Mon, or extension. rage 2
Business name; TECHNOCOMI 75,00 2
• Each additional ins eP e tio n over allowable in an of the abov
Address: 7929 SW BURNS WAY, STE F Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: WILSONVILLE, OREGON 97070 InvestignUOn (1 nr mm) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 682 -4195 Fax: (503) 682 -2781 Inspections for which no fee is
Specmncally listed l's hr min) 90.00/ hr
CCB Lic.: 73872 1 Electrical Lic.: 34 -269CL Suprv. Lic.: 228 ILEA ELECTRICAL, 'PERMIT Ft)r, _ ,
Suprv. Electrician signature. required: i ��
Subtotal: 75.00
Plan rev (25% o permit fee);
Print name: JEFF SANDNER Date: 02/09/11 State surcharge (12% of permit fee): 9.00
TOTAL PERMIT FEE: 84.00
-
Authorized signature:x �_.,•■ This permit application expires if a permit is not obtained within 280
Print nine; JEFF SANDNER Date: 02/09/11 • days after it has bees accepted as complete
. ,._ • Ntemhrr tiro
fu' a allowed per permit.
1: 1Building1ParmitsI ELC.PermitApp.doe 07/01/10 410 1/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
T.TMITED ENERGY PERMIT FEES:
.t, WQRX ONLY:
Fee for all residential systems combined ... $75.00
Check T of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ I eating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
CO.MMERCItl,' ' .b :ONLY,
Fee for each commercial S7;.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
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses arc required
for all other installations
1; Mudding \Permits1ELC,PermitApp,doc 07/01/10