Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• • • COMMUNITY DEVELOPMENT Permit #: ELR2010 -00025
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/05/2010
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9677 SW WASHINGTON SQUARE DR CO5
Subdivision: Lot: 0
Project: Aeropostale
Project Description: Install anti -theft antenna.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #0 Restricted Energy Permit 02/05/2010 $67.84
CARLSBAD, CA 92008 12% State Surcharge - Electrical 02/05/2010 $8.14
PHONE:
Contractor:
3 GUYS ELECTRIC LLC
2062 NW 15TH CT
GRESHAM, OR 97030
PHONE: 503 - 729 -1522
FAX: 503- 661 -7378
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: N Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom/Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: y
Other Desc:
This permit is i • =• s • - 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 : ordance with a — • oved 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. AT ' NTION. Oregon law e ' = you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 ' 010 through OAR 952 -001 00 Y • alli
y obtain a copy of the rules or direct questions to OUNC b can! 46.6699 or 1 800 332 2344
ii A
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Issu • • By: _ • �' ' V
' • Permittee Sig ature: �
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 INSTAL .ATION ONLY
SIGNATURE OF SUPR. ELEC' C j'�-- Date:
1
LICENSE NO. •
Call 503.839.4175 by 7:00 a.m. for an Inspection that business day.
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.
-- Feld 04 10 11:00a mult. county attorney (5031988 -3377 p.1
Electrical Permit Application RECEIVED FOR OFFICE USE ONLY
Received
City of Tigard Received - q /o )4 Permit No EXAC/o/O qX>.2
I : . 1 3125 SW Hall Blvd., 1'igard,UR 97223 FEB 0 4 2 P lfl Plan Review _
Q n !Y7
Phone 503 G39A 17 t Fax. 503,598 1960 FEB Othci Perini': t,„,1 4ee -dO
TIGA1tO Inspection Li ne: 503 4175 Datc Rcady /By tuna I Id Sec Page 2 for
Internet: www tigard or CITY ®FTIGAR Noufeti/Melhud J Supplemental Iitfsnniiivn
,; ', ,!1 PPE' : I , Dl1!1 ION , , .
PLAN ,REVlli;W
® New construction ❑ Addition /alteration /replacement Please check all that dpply (submit 2 sets of plan; whim, checked below)
❑ Service of tocdei 400 aiips in more ❑ Building ova thrce sixties
❑ Demolition ❑ Other: where the available fault =win ❑ Marinas and boatyards
' '" "" " " ''': '' CA'I'ECO'lf`fi „ Y r' rCONSTRUfwi'YON 5 S: 5 '' '' ' "' " ,. "' exceeds. 10,000 mum at ISO milt Ili ❑ l•lnatuip hml,6ngv
loss to ground, Si exceeds 14,000 0 Commercial-use agticullui al
❑ I- and 2- family dwelling ® Commeicial /industrial ❑ Accessory building ditlpSfJT dll other installations buildings,
❑ Mulct- lamely ❑ Master builder ❑ Other ❑ Fnc pump ❑ installation of 75 kVA of
JOB Si "L'E; INI ORMATION AND• LOCATION ❑ limrruettcy �.yctnn Iar8er sepruately dauved ayaten,
d. ' ❑ Addition of new motor load of ❑ "A" "h' "I.2" "t •i'
lob no.: Job site addicss: 9677 Washington Square Rd. 100RPrn more otciipd "cy
❑ Six or more residential units ❑ Recreational vehicle p,uha
City /State //•I1'' Tigard, OR ❑ lietdil,.c;u facilities In Supply vnlrage In mote. Ilia°
T ❑ Hazardous locaunns 600 volts nominal
Suite /bldg - /apt no ' Project name: Aeropostale ❑ service or feeder o00 snips of more.
-`-" - 'is; " ' .. ' .FEE SCHEDULES
Cross strcct/dircctions to job site: Washington Square Mall i. ,uci _ I QC) I rcr. I lout I -
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 map /parcel no - -- ha. add'l 500 sq 11 or portion 33.92_ I
- • Limited energy, tesideuual
w • DESCRIPTION OF WORK„ ' ; '' (with above sq tt) 67.84 2
Limited energy, multi - funnily
Install anti -theft antenna. +� residential (with about its, 1L) 67 84
Services or feeders installation, alteration, and /or relocation
200 amps or Icss -� __ 100 70 2
' ❑ PROPERTY OWNER „ ' " U''TENANT,'',' ',` „ 201 amps to 400 amps 133 56 2
Name 401 amps to 600 amps 200 34 2
Address. M� 601 amps to 1,000 amps 301 ,04 — 2
Ovcr 1,000 amps or volts 552,26 ' - an
Cily /Stale /ZIP,
Temporary services Or feeders installation, alteration, and /or
relocation
Phonc: ( ) Pax ( ) 200 snipe or leis 59 36 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125 08 7
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owns!! \IS'nlfllUrC. Date: Branch circuits - new. alteration. or extension. ler panel
- •• . A Fee for branch circuits with
®. APPLICANT " • ',,,,,' ,'" ' „❑ CONTACT iPERSON ,,. above service or feeder free, 7 42 2
Business name: 3 Guys Electric, LLC each branch branch circuit
y ' R. Pee for brm,ch cia rcuits
Contact name: Wade Hadley u'tlliaut service or I't t dt r I'x, 56 18 2
first branch circuit
•
Address: 2062 NW 15th Court Each add'I branch circuit 7,42 2
— - Mrscellalleous (service or 1 @edcr not included
City /Stole /ZIP. Gresham. Or 97030 Each manufactured or modular
dwelling, service and /or feeder 67 84
Phone. (503) 729 -1522 I Fax' : (503) 661 -7378
Reconnect only Ell 67,
E wadc3267 r(,aol.com
Pump of arlgation circle 67.84
- :CONTRACTOR';' ; ■,,,,;;;;{ d . ',,,, , ° ', ' Sign or outline lighting 6714
7 84
Signal cucutt(s) or limited -
Hucinrcc name. 3 f:uyc Fieetrie, L,LC WS energy panel, alteration, or
Address: 2062 NW 15th Court extension, Describe: Page 2 67 84
---• »... Install Antenna _
City /Statc / /_IP• Gresham, OR 97030 Each additional iii ection over allowable in any of the above
Per inspection 66 25
Phone • (503) 729 -1522 Fax: (503) 661 - 7378 Investigation per hour (1 hr 66 25
CCI3 Lie.: 177242 Electrical Lic.: CLE 120 Suprv. Lis..: 5161 EA Industrial plant per hou 78 18
• t' ' - ELECTRICAL,' 1 ERMIT FEES
Supry Electrician signature, required: j 4.96, ' / � /— ^W Subtotal 67.84
Print name: Wade Hadley UU Date: 2/04/10 Plan review (25% of permit Ice)
- State surchaigc (12% of permit fee)• }(,yr' q./
Authorized signature TO PERMIT FE F 15.8$"? • '
q
'this permit application expires if a permit is not obmined n ithnt ISU
Print name lane Hadley �� _ Date: 2104 /10 drys Om it ha., heco „«<trrs,f aa,,vngtctc. l ► 1'
• Number of inspections allowed per pcmmut /v
Imeikintd \i'enuiik11.C- i4nuitAppdv,• 10/01/09 440-- 46)5T(I1 /05 /COMAvp11
-- Feb 04 10 11:OOa mult. county attorney (503)988 -3377 p.2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK,ONLrY:' : „,i;
Pee for a tl residential systems combined .. $67.84
Check Type of Work Involved:
Audio and Stereo Systems*
❑ Burglnr Alarm
❑ Garage Door Opener*
❑ I Icating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918 - 309 - 0000)
Cheek Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Ti Data Telecommunication Installation
❑ Fire Alarm Installation
fl 1-IV AC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
H Protective Signaling
Other Install Anti- Thc•ft Anrgon
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I;\F3ujLJin rnuts \GI C -' fl LApp.doc IW