Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00049
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/21/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9459 SW WASHINGTON SQUARE RD A14
Project: Footlocker /House of Hoops Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Data telecommunications system.
Contractor: CACHE VALLEY ELECTRIC COMPANY Owner: PPR WASHINGTON SQUARE LLC
6200 SW ARCTIC DR. BY THOMSON PROPERTY TAX SERVICES
BEAVERTON, OR 97005 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 -431 -6600 PHONE:
FAX: 503 - 624 -1436
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 03/21/2012 $75.00
12% State Surcharge - Electrical 03/21/2012 $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 forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By. — - / 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.
03/20/2012 14:19 FAX 425 424 9 � CACHE VALLEY ELECTRIC C�j001
Electrical Permit Application � ° j V ED FOR OFFICE USE ONLY
City of Tigard MAR 2 2 o1 z E W 13125 SW Hall Blvd Tigard OR O ived '
C •' Phone: 503.71.3.2439 Fax: 50 5 OF i atei Other Permit:
: 4 / • y
T I CA It D Inspection Lint: 503.639.4175 0 U / Tin
LD/p G 4 pn Date Ready/By: Emit ® Page 2 for
Internet: www.tigard-or.gov [Y 0/ , otified/Met : SupP enta Information
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❑ New construction ® Addition /alteration/replacement Please check all that apply (submit !r sets of pleas 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.
- :IX�s �G" 'ati � A'�• ' -- :..t�:. _ _ - i ; S, +;:- ;�i' - ^ijr!? 50 vol
_ , -..A , r.! � "�.'!r = . �� ` ! "r :Ss,.. exceeds amps 8t to or ❑Floating buildings.
::rr .� TE 5ti R�(z`T2�SN.,
,,,.:::. r, � , - : � . �.. L :.. .:... .. ... .. . ;.. ..... z;vX rcial -use agricultural
> :-l:zr:V:. ..:.:.. . >_, . - ;.,:. �;'.: .. ,.:: . . , ,: •:� : .,�a's�;!:;> +;.., ;( ^';� � , less to groun4 or exceeds 14,000 ❑Comma
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all otherinstaltations. buildings.
❑ Multi - family ❑ Master builder CI Other: pum m
: : tr ...'=r.,. „ Y „-::.: �:.,,:;... X„:: .,�4 ,. Y T.ka' ;.:;r;r ergeney syate
❑ Fire Installation of 75 KVA or
- ..';ern ra,� - ” -,: '-l� ''s:" I�"L+t ^':: i�� ❑Em m larger separately derived ate
T. ,.,. '�:, . :':� ``30Bs �f1�> M�1�YoN�':Al� ortr ;>` ':,f`?'s %!�`` ition of new motor load of ❑ °A ". "E", 2 ", "1
a..;_ r� �:::, :1' >:::� :: . , .� ..:. ::::,.�.:: ... ., � ::..: .......... r- :�.4. .:..lY "'::' ❑Add
Job no.: 43864 - 13 Job site address: 9459 SW Washington Square Road . 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 94234 ❑ Health-care facilities. ❑ Supply voltage more than
❑Hazardous locations. 600 volts
Suite/bldg. /apt. no.: Project name: Foot Locker ❑ Service or feeder 600 amps or more.
OM
Cross street/directions to jcb site: Description 1 Otc. I Fee. 1 Total I •
New residential single- or multi- family dwelling unit.
_ Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft, or less 168.54 4
Es. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: tial 75.00
,: ..:........... �-, -, -... ,. / .: ::.. , ':.: ,�:,...,. , .... -. : h,>. ,:=; :�<% _ ;::, m residential erl
:cd. ::� -�- ld +: t l \' :- �7 -iJ�• :
r �fi; „I�ti :. ,r:�'1,'.�::Sf'.� � t (with above �l 2
Limited energy, multi family 7500 2
voice /data installation - residential (with above sq. ft)
Services or feeders installation, alteration, and/or relocation
Master Permit# BUP2011-00247 200 amps or less 100.70 2
w•. ^.: Lq ar. f , s , - 201 amps to 400 ems 133.56 2
t:`x�'” ,PR � R'CY!i�>I)� . % � 1 e . „ N`':' ;:.. ��:•:':F;ai[
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
Temporary a services or feeders installation, alteration, and/or
City /State /ZIP: relocation
Phone:( )
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 circuits— new, alteration, or ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
:,, ;•. � <�:;�:�, ;';; - "• - e „�, ° °�� •�'w' abo service o r , 4 2 2
"'i isa °r- "•:n;,'b:�.,l,41 :` ::L,:.! - .. ONE: r.PthSUN.;;; `;': 7
_ S `EI-i1CC
, ::,_x .....:..:::.:...::... . .:.. ,....; :..:. -: � ,_ �;, ` .�.;:: ,, -'�, : ,_,_.. - . ......... ,,......_, ,., -..- _.,..... .. - ., ..„ each ve brlufch cvcuit feeder fee
Business name: Cache Va Iley Electric B. Fee for branch circuits without
service or feeder fee, first
56.18 - 2
Contact name: Vanessa Martin branch circuit
Each add'I branch circuit 7.42 2
Address: 6200 SW Arctic Drive Miscellaneous (service or feeder not inc luded)
Ci /State/ZIP: Beaverton, OR 97005 Each ing, service manufactured or modular
ty 67.84 2
dwelling, service and/or feeder
Phone: (503) 431 - 6600 Fax: : (503) 624 - 1436 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: van essa.martin@cve.com 67,84 2
-�..; ;��r•�r s �. � ,•c: {cc.' =r r _ .,H., _ � Sign or ou met lighting
.
> !: . _ � },,,., :`cam'.. ;',CID , � 'f�JiOlt' - -n :;:,r; •t.=... .:i' >"'t���I:`��`:.. +,.: ......... or limited-
...: ,�,,,,:
»:,s,:::::r:�:,.1 <: 1:.Y.e,1:::,,r "'...,.._,: T,..,_,.... i. ..sY..,..,i;'.. ..:::::....:::.. ... •.' -r,:, ,.:::;;::; Signal limited-energy
Business name: sames as above panel, alteration, or extension. 1 Page 2 I 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 6625/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( f ) Inspections for which no fee is 90.00 / hr
specifically listed rmm
CCB Lic.: 148222 Electri Lic.• 4 1 3 uprv. c.: 5000S `'` "' e - .,.
Suprv. Electrician signature, requi ed: A.4 „. � - a Subtotal: 75.00
Plan review (25 /o of permit fee):
Print name: Jody Jenkins l
_ Date: 3/20/12 State surcharge (12% of permit fee): 9,00
TOTAL PERMIT FEE: 1 84.00
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: • Number days after it has been accepted as complete.
er of inspections allowed per permit.
[: KBuiding %Pernits'ELC-PcrmitApp.doe 07/01/10 440- 4615T(ll/OS /COM/WEB
03/20/2012 14:20 FAX 425 424 9966 CACHE VALLEY ELECTRIC 002
Electrical Permit: Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for a 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.
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 - -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clo ystems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
:18uildi Termits\ELc- Rermit App.doc 07/01/10