Permit CITY OF TI GA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
42 40 4 DEVELOPMENT SERVICES PERMIT #: ELR2001 -00066
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/16/01
SITE ADDRESS: 09569 SW WASHINGTON SQUARE RD B -4 PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Data/Telecommunication
Job No. 50 -03772
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PPR WASHINGTON SQUARE LLC CHRISTENSON ELECTRIC INC
P.O.BOX 21545 111 SW COLUMBIA
SEATTLE, WA 98111 STE 480
PORTLAND, OR 97201
Phone: Phone: 241 -4812
Reg #: LIC 000458
SUP 3289S
PLM 2468S
ELE 26 -34C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 3/16/01 $75.00 2720010000 Wall Cover
Elect'l Final
5PCT CTR 3/16/01 $6.00 2720010000
Total $81.00 EXPIRED
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the• Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
•
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'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
ke40A1-41:61
A ,
`Electrical Permit Application
H L C:.: pate Tceived: - -... Permit no. - 2OD t Moro
l ,' ;:�j h � City Of Tigard Pro no.: - Expire date: ' - .
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 , ,.' `_�„ ., `1h�tagastied: By: "' Receiptno.:
Phone: (503) 639 -4171 .
Fax: (503) 598 -1960 Crf " %J ". ,;,_ Case file no.: -- - • - Payment type: --- -
• Land use approval: = — .
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory CI Commercial/industrial ❑ Multi - family 0 Tenant improvement , ' i
❑ New construction , , O Addition/alteration/replacement ❑ Other. ❑ Partial
JOB SITE INFORMATION
Job address: 9569 SW WASHINGTON •SQ' :RD 'TIGARD Bldg. no.: • — Suite no.:, . : Tax map /tax lot/account no.:. ; , :
Lot: Block: Subdivision: , a _- _.,- _, :..
Project nam - : • ' ` ` IN, ' Description and location of work on premises: L'il DATA /- TELECOMMUNICATION: -
Estimated date of completion/inspection: QUESTIONS? CONTACT_ JIM HARDISON ' " INST - LL' , I;) -
-: ,..CONTRACTOR: :, -- .: - .. ..- - .J , 4 r :-; ' FEE-SCHEAULE. -, --
Job no: 50 -03772 _ , -_ Fee NM
Business name:CHRISTENSON ELECTRIC, INC. - Description Qty. (ea) Total no. (Lisp
New residential - single or multi per
Address: 1 1 l SW COLUMBIA, SUITE 480
dwelling curt. Includes attadted garage.
City: PORTLAND State: OR ZIP: • 21 _ — :: • cetacluded:
Phone503 2414812 Fax503241051'• 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof __
CCB no.. 58 � c. bus. lic. no: 26 -34C Limited energy, residential ___ 2
City /metros o.: 5 46 ' Limited energy, non- residential _EMI _ 2
/;�'�� Each manufactured home or modular dwelling ■■
Signa ' of supervisin a =trio : required) Date 3/14/01 Service and/or feeder 2
Sup. elect name (print): BRIAN CHRISTOPHER License no: 873S Seera feeders — installation, .e
2erationorrelocation:
PROPERTY OWNER
2000 amps or less 2
Name (print): 201 amps to 400 amps ___ 2
Mailing address: 401 amps to 600 amps Mme_ 2
601 amps to 1000 amps ___ 2
City: State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: E -mail: Reconnect only ___ 1
- Owner installation: The installation is being made on property I own Temporary services or feeders - - -
which is not intended for sale, lease, rent, or exchange according to installation ,alteration,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps ___ 2
Owner's signature: Date: 401 to 600 amps __— 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name' It. Fee fcr branch circuits with purchase of
Address: service or f.. ■ - each branch circuit 11111 2
City: State: • ZIP: B. Fee for b 1 °' •.sl: )+aw, ,
of service or feeder ■■. 2
Phone:
Fax E -mail: _ B'
"
5i.
Each additional branch circuit: l'__ PLAN REVIEW (Please check all that apply) misc. (Service or feeder not lncluded):
❑ Service over 225 amps-commercial ❑ Health -care facility Each pump or irrigation circle ■■ ■ 2
❑ Service over 320 amps - rating of l&2 ❑ Hazardous location Each sign or outline lighting ___ 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, IIIIIII
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 75 • 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Descri . Lion: DATA TEL I Au 1 ti ■
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 7 5
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 6 -
Expires accepted as complete. TOTAL $ R1 00 f
Name of cardholder as shown on credit card '
$
Cardholder signature Amount 440 -4615 (6/00/COM)
OCT.2000 +FEES ON BACK OF FORM
Electrical Permit Fees: Limited Energy Fees: r -- - . •
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
P Restricted Energy Fee $75.00
- - Number of Inspections per permit allowed (FOR ALL SYSTEMS) - -,
Service included: — - Items Cost - -: Total 4. Check Type of Work Involved:
Residential - per unit •- -- - -- --- ••- ------- -- -- - -- L__________
'
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or - - - ---- •__ - - - -- - - -- -- _ __ -. _ • I • , -C : , F• -
• — portion thereof --- 7 --r, • .... •• . $33.40. . - 1 -O- -Burglar Alarm .. -.. ____• . -. _.' - , .';'2.::: .._
■ Limited Energy ... " - - .$75.00- - - • - - '2" . ..,.., .. - ,. ; 4,-, * : - ,, , e ms,; :';- ::''• �, ,r .1
' Each Manufd Home or Modular ❑ 7 • .•s
Dwelling Service or Feeder -- $90.90 • -• 2 Garage Door Opener' • , -, :, - , -
Services or Feeders - -` -- • • . ❑ Heating, Ventilation and Air Conditioning System' '
Installation, alteration, or relocation -
200 amps or less - $80.30 ' 2 ❑ Vacuum Systems 201 amps to 400 amps '-; s _: ' ' $106.85 - ' • 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps -- - — - `— - - $240.60 - - 2 : - -- El Other
-
- Over 1000 amps or volts - -• -- .- - - - - -- $454.65 2 - - - -
Reconnect only .. $66.85 2 •
r •s . •.. •�• w.. • TYPE OF WORK INVOLVED - COMMERCIAL ONLY • Temporary Services or Feeders ' - _ Fee for each system $75.00
Installation, alteration, or relocation
200 amps or less $66.85 2 (SEE OAR 918 -260 -260) .-
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee. .
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits •
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40 --
Signal circuit(s) or a limited energy '
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over -
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50 ❑
In Plant $73.75 Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ ' No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # •
8% Surcharge $
' Total Balance Due $
i:\dsts \fomu\eic- fees.doc 10/09/00 ++OVER FOR PERMIT FORM