Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I: , COMMUNITY DEVELOPMENT Permit #: ELR2012 -00145
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/12/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9681 SW WASHINGTON SQUARE RD C06
Project: Tesla Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (1) low voltage for Audio/ Video
Contractor: ADVANCED COMMUNICATIONS SERVICES INC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 231196 BY THOMSON PROPERTY TAX SERVICES
PORTLAND, OR 97281 -1196 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
•
PHONE: 503 - 598 -7082 PHONE:
FAX: 503 - 598 -7320
FEES
• Description Date Amount
Specifics: Restricted Energy Permit 07/12/2012 $75.00
Type of Use: COM 12% State Surcharge - Electrical 07/12/2012 $9.00
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 -0 90. 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:
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.
Thls 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 FOR OFFICE USE ONLY
City of Tigard RECEIVE. PemutN O0- 00
1111 " 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 JUL 1 2 2012 Dat- : : Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: H See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF'WORBUILDlNG DIVISION PLAN REVIEW
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /itetns checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
qie / JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
` ❑ Addition of new motor load of ❑ "A ", E ", "1 - ", "1 - ",
Job no.: Job site addresw-9 95-SW Washington Square #C06 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Healthcare facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: C06 Project name: PRS Tesla ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description I Qty. I Fee. I Total
. New residential single- or multi- family dwelling trait.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'! 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
audio /video residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
' 200 amps or less 100.70 2
❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
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 I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, fast 56.18 2
Contact name: branch circuit
Each add'! branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Ci /State /ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy I
Business name: Advanced Communications Services, Inc panel alteration or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: PO Box 231196 Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Portland, OR 97281 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 598 - 7082 Fax: (503) 746 - 4384 Inspections for which no fee is 90.00/ hr
specifically listed (%z hr min)
CCB Lic.: 179445 Electrical Lic.: CLE139 Suprv. Lic.: 4578LEA ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: t OD
Plan review (25% of permit fee):
Print name: Brian Kunishige Date: 7/12/12 State surcharge (12% of permit fee): R ipt)
TOTAL PERMIT FEE: 4 6 4 s Qa
Authorized signature: This permit application expires If a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number o f inspections allowed per permit.
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: j
Fee for all 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:
i 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
❑
HVAC
❑ Instrumentation
❑ Litercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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