Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 4 °. COMMUNITY DEVELOPMENT Permit #: ELR2009 -00114
T [GARO 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 04/27/2009
Parcel: 1 S 1260000300
Jurisdiction:
Site address: 9724 SW WASHINGTON SQUARE RD F06 & F07
Subdivision: Lot: 0
Project: GAP
Project Description: Install restricted energy for (4) thermostats.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, Restricted Energy Permit 04 /27/2009 $75.00
2235 FARADAY AVE STE #0 12% State Surcharge - Restricted Energy 04 /27/2009 $9.00
PHONE:
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062
PHONE: 503 - 692 -1565
FAX'
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo Boiler Controls:
CCTV. Clock Systems:
Data & Telecommunications Fire Alarm:
HVAC: Y Instrumentation: Total $84.00
Intercom/Paging: Landscape /Irrigation:
Landscape Lighting Medical:
Required Items and Reports (Conditions)
Nurse Calls: Protective Signal:
Security Alarm: Other:
Other Desc:
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 do n accordan . ith ap• t•ved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 ays ATTENTION Or - ji .n la - • ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 thro gh OAR 95 !My ay obtain a copy of the rules or direct questions to OUNC by calling 503 246 669 . 1 800.332 234
Iss ed By: �� .tom. _ 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 603.639.4175 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.
Electrical Permit Application RECEIVED i _ i , i ,. , I •,
City of Tigard APR 17 2009 y LI II, Oct gb Permit No : €I r jz,2 .00 114
: 1 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Floc 503.598.1 �, O F T IGARD Date ' Other Pe}IDit V 'w ' 44 `
I . I _ , Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Ws. et SeO Page 2 for
Internet www.tigard- or...gov Fy J1���pp�y Notifiad/lvie I 1n Supplemented Information
j Y 'E :PE;QF.' TWORK o rT ., - _'....'..r ° i. '• �..`�,.�r ` '• :. /.. '{(
❑ New construction ddition/alteaation/replacement Please dmck all that apply (submit 2 sets of plans wlitems enactor' below)
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current D Marinas and boatyards
- ( rago � CONSTRITCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
Less to ground, or exceeds 14,000 D Commercial -use agricultural
❑ 1- and 2- family dwelling ,Commercial/industrial ❑ Accessory building amps for all other installations buildings
❑ Mltlti-family ❑ Master builder ❑ Other: ['Fire pump ❑ Installation of 75 KV A or
$ S ,' � flON' AND ,LOCATION - ❑ Emergency Addition o new motor "A", 1", "1 de-3 system
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
{ - 7 ?i-i 100HP or more.ttP�cY•
Job no.: i Job site a / d / d�ess: � /� ; ❑Six or more residential units. D Recreational vehicle parks
City/State/ZIP: / L _ y ` R ❑ Health -care facilities ❑ Supply voltage for mote than
/ ��""��cc t J
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: A Project name: • ❑ Service or feeder 600 amps or more
Cross street/directions to job site: ' e ' ';� •'�, r
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision I Lot no.: 1,000 sq. ft or less 145.15 4
1 no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map/parcel Limited energy, residential
DRSGRIPTiOPP OF WORK (with above eq. ft.) . 75.00 2
�� L imited energy, multi - family 75.00 2
-�,.�I residential (with above sq. S)
Services or feeders insfafatlon alteration, and/or relocation
200 amps or less 80.30 2
0 PROPERTY OWNER , 'El TENANT 201 amps to 400 amps 106.85 2
Name: g #P 0 / 4 / ° i 20 401 amps to 600 amps 160.60 2
Address: / I C 1 /� � � ( k�, 601 amps to 1,000 amps 240.60 2
/ ,5c). C � 71� Over 1,000 amps or volts 454.63 2
City/State/ZIP: ! E-9,. (7 Temporary services or feeders installation, alteration, and/or
relocation Phone: ( ) ax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A Fes for branch circuits with
I APPLI • I -Pt CONTACT PERSON above service or feeder fee,
• " each branch circuit 6.65 2
Business name: A i t R he , r ytA14 I cm I B. Fee for branch circuits
Contact name: without service or feeder fee 46,85 2
first branch circuit
Address: 10330 1»4 `fop! /ram R.d Each add'i branch circuit 6.65 I 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: - T0Ati4..I.tm elit% 47661 Each manufactured or modular l 90.90 2
dwelling, service and/or feeder
Phone: (,6'p5) 44/ 2- 1666" I Fax: : (e'o:S) 441-1671 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CQ CT0R Sign or outline lighting 53.40 2
Business name: • Signal circuit(s) or limited-
Kbt..A M&rfif4ArM f dAi energy panel, alteration, or
Address: rC! �vh 6W " I bATyoi fa. extension Describe: Page 2 2
Cit / State /Z1P: 7"vA oK 4 Each additional inspection over allowable to any of the above
& 42 -- I Fax: (( p!) Mt 1874 Per inspection 62.50
Phone: (
6 C 56 8 Investigation per hour (1 hr min) 62.50
CCB Lic.:6 1 3 Electrical Lic.: '3q . spL/,61 SupJ r vv . Lic.: 130 Lap Industrial plant per hour 73.75
Suprv. Electrician signature, required: C .0(.4 Subtotal: 4 7
Print name: Roie e r G. 4 . 4 � i . c` Date: Plan review (25% of permit fee): '
/6 State surcharge (12% of permit fee): L { • 00
Authorized signature: TOTAL PERMIT FEE: s t4.0 0
Print name: Date:
This p ermit application expires if • permit Is not obtained within 180
day/ after it has been accepted as complete.
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