Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2012 -00051
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/23/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9573 SW WASHINGTON SQUARE RD B06
Project: The Limited Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Audio system.
Contractor: SAFE TECHNOLOGY GROUP INC Owner: PPR WASHINGTON SQUARE LLC
6400 NE HWY 99 SUITE G375 BY THOMSON PROPERTY TAX SERVICES
VANCOUVER, WA 98665 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 360 - 699 -2130 PHONE:
FAX: 360 - 719 -1527
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/23/2012 $75.00
12% State Surcharge - Electrical 03/23/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Y Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N 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:
/7
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 A licatio ' t a 1 VII 1 t `Y. (441.‘
7� � � � I'i )It
� Received
Cizs ;I dd Tigard, `l ^O P D l atte/1 3 Review
'` ?� PermttNo. y [�dvld � (X -b bl
Phone: 503.718.2439 Fax: 5 .598. �.v DaWB : Other Penn.
i i; I Inspection Line: 503.639.4175 ! '\\ Date Ready/By: tans. W Sat Page 2 for
Internet: www.tigard- or 0 \ , Q Noll/led/Method: � Supplemental Info ;nation
❑ New construction ® Addition /alterati'replacement Please check all that apply (submit 2 se. • of plans w /uems check.• i below):
O Service or feeder 400 amps or more CI Building over three ncs,
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyn. • I:.
r . exceeds 10.000 amps at ISO volts or C] Floating buildings.
❑ 1 -and 2- family doe leas to ground, a exceeds 14,000 CI Commercial -We at:,','u d
(ling ® Commercialindustrial ❑ Accessory bu ilding amps for ell giber instillations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire Pump. O installation of 75 K' t or
O Emergency system. larger separately del ad system.
❑ Addition anti motor load of ❑ "A ", ••E ", "1.2" .. 1. .
Joh no,: Job site address:4118S SW WASHINGTON SQUARE RD Io0HPormore. o' c
9� 73 ❑ SIX Of more residential units. ❑ Recreational vehiel, narks.
City/Star e/ZIP: TIGARD OR 97223 ❑ MeaMh-ease facilities. ❑ Supply voltage for r,,,re than
0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 800 I Project name: THE LIMITED ❑ Service or fader 600 amps or more
Cross streeddirections to job sift: WASHINGTON SQUARE MALL . t R .
t>arriptroe ;„ . ' '1.4.1 M •
New residential single- or multi -'' .icily dwelling unit.
Includes attached garage.
Subdivision; I I.ot no.: Ow sq. R. or less 168.54 4
Tax map /parcel no.:
Ea. add'I 500 sq. ft. or portion 33.92 1
Limited mere, residential 75.00
(with above sq. ft.) 2
Limited energy. multi - family
AUDIO CABLING residential (with above 59. ft) _ 75.00 2
Services or feeders ioatatlatlon iteration, and/or relit :talon
200 amps or lea 100,70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to boo amps
— 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /Statc/ZIP: Temporary services or feeders iii :tallatioa, alteration. And/or
relocation
Phone: ( ) Fax ( ) 200 amps or less 59.36 l
201 amps to amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. - 401 to 599 168.54 2
Branch circuits — new, alteration. or extension . er nrl
Owner signature: Date: A. Fee for branch circuits with
above spryiee or feeder ices, 7.42 2
each branch circ
Business name: SAFE TECHNOLOGY GROUP INC. B. Fee for branch circuits waken/
service or feeder fee, first
56.18 2
Contact name: JASON SWEET branch circuit
Each add'I branch circuit 7,42 2
Address; 6400 NE HWY 99 SUITE G375 -- Miscellaneous (service or feeder .114 Ineloded)
City /State/ZIP: VANCOUVER WA 98665 Fach manufactured or modular 6784 �'-
dwelling, service and/or feeder �1?
Phone: (360) 699 -2130 I Fax: : (360) 719 -1527 Reconnect only - 67.84 2
• E -mail: SAI. Pump or irrigation circle 67.84 2
E S@aSA FETECHNOLOGY.NET •
�r. .: �,�, Sign o r outline lightin 67.84 2
Signal cucuft(a) or limited-encrgy
Business name: SAFE TECHNOLOGY GROUP INC. panel, alteration, or extension. ( Page 2 7'• 2
_ Each additional Inspection over ;r�luwable In an of tilt. above
Address; 6400 NE HWY 99 SUITE G375 Additional inspection (1 hr min) 66.25/ hr •
City /State /ZIP: VANCOUVER WA 98665 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) .. 78.18/ hr
Phone; (360) 699-2130 Fax: (360) 719 -1527 Inspections for which no fee is —
a. - iftcall listed 'h hr min 40.00/ hr
((B Lie.; 173731 _ Electrical Lic.: CI .l "79 I Suprv. I.ic.: 4272LEA -- ,, 7 7( ' ''' f• . 1'; ; , t.. • :�
Suprv. Electrician signature, required: 1. v Subtotal:
P lan review (25% u ;runnit Ice): •
Print name: JASON SWEET Date: 3 -22-12 State surcharge (12% 0. permit fee): q.dzio
: . t, �-
TOTAL PI
Authorized signature: �/� -- MIT FEE:
This permit eppliicadoa mire. if a , ref is not obtained vo,thia 180
Print name: JASON SWEET _J Date: 3 -22.12 _ days after It has been a• , opted as complete. • Numbtx of inspections allowed pal 'resit.
t:Wvilding\PermiuV?LC.Paruiotpp oc a7/Ot/IC 4046157(1I/05/COat/W5e
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�_ ItESIDENT:xi��yoR `
Fee for all residential systems combined $75.00
Check Type of Work Involved;
O Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ I Ieating, Ventilation and Air Conditioning System*
❑ V acuum Systems*
❑ O ther:
CO .12 1a >0r'" k
Fee for ugh commercial $75.00
system
(SEP. OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ IIVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
•
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other -
'1'otal number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
•
I: WuiIdlnYsp..itaLC- PermitApp.doc 07/0