Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN a .' COMMUNITY DEVELOPMENT Permit #: ELR2013 -00170
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2013
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9618 SW WASHINGTON SQUARE RD 005
Project: Helzberg Diamonds Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Low voltage for data
Contractor: SAFE TECHNOLOGY GROUP INC Owner: PPR WASHINGTON SQUARE LLC
6400 NE HWY 99 SUITE G375 PO BOX 847
VANCOUVER, WA 98665 CARLSBAD, CA 92018
PHONE: 360 - 699 -2130 PHONE:
FAX: 360 - 719 -1527
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/17/2013 $75.00
12% State Surcharge - Electrical 07/17/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape /Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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 day of issuance, or if work is ended for more the 180
days. ATT = . • - .on law requires you to follow the rules adopted by the Oregon Utility No i on Center. Those ru s e set forth in OAR
952 -001 -' 010 through OAR • -001 - : ' 0. You may obtain a copy of the rules or direct questions to OUNC by calling 0 . 2.1987 or 1.800.332.23 .
Issu d By: 1 t7 � v 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' 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 ApplicatiJECEIVED FOR orn i E 1 SE ONE ,
11, 41 City of Tigard 2� L 17 DSICIB d v / 7 Permit No.: EL 4o�Ol3 -0170
97
13125 SW Hall Blvd., Tigard, OR 2013 Date/ ' 3
Phone: 503.718.2439 Fax: 503.5 Plan Review Other Permit: r e p 1 3 -12 a (7 I
Date/H :
TI G A It D Inspection Line: 503.639.4175 OF TI GARD Date Ready/By: lulls: ® See Page 2 for
Internet www.tigard -or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction et Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w• /hems checked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current ❑ Marinas and boatyards.
• CATEGORY OF CONSTRUCTION - exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1- and 2- family dwelling ®CommereiaVindustrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Accessory building
F ire for all other installations. buildings.
❑ Multi - family ❑ Master builder atio
❑ Other: 0 pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SUE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A ", ` E'', "I - 2 ", "1 - 3 ",
Job no.: Job site address: 9618 SW Washington Square Road 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health - care facilities, ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Helzberg Diamonds ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description 1 Qty. 1 Fee. I Total I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00
DESCRIPTION "OE WORK (with above sq. ft) 2
��Tt� L energy, multi- family 75.00
residential (with above sq. ft.) 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 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: ( ) F ax: ( ) 200 amps or less 59.36
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Branch circuits– new alteration, or extension, per panel —
Date: A. Fee for branch circuits with
. ® APPLICANT . I 0 CONTACT PERSON _ above service or feeder fee, 7.42 2
each branch circuit
Business name: SAFE TECHNOLOGY GROUP INC. B. Fee for branch circuits without
service or feeder fee, first 56.18
Contact name: JASON SWEET branch a invit 2
Address: 6400 NE HWY 99 SUITE G375 Each add'l branch circuit 7,42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: VANCOUVER WA 98665 Each manufactured or modular 67,84 2
dwelling, service and/or feeder
Phone: (360) 699 - 2130 Fax: : (360) 719 - 1527 Reconnect only 67,84 2
E - mail: SALES@SAFETECHNOLOGY.NET Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited-energy
Business name: SAFE TECHNOLOGY GROUP INC. panel, alteration, or extension. 1 Page 2 75.00 2
Each additional inspection over allowable in any of the above
Address: 6401) 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
CCB Lic.: 173731 Electrical Lic.: CLE79 Suprv. Lic.: 4272LEA specifically listed ('AA hr min) 90.00 / hr
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: -95,4°
Plan review (25% of permit fee): ---
Print name: JASON SWEET Date: 7 - 16 - 13 State surcharge (12% of permit fee): 9 - °°
Authorized signature: • ,/ TOTAL PERMIT FF � C / I (x.
This permit application expires if a permit is not obtained within 180
Print name: JASON SWEET Date: 7 -16-13 days after it has been accepted as complete.
Number of inspections allowed per permit.
1 : 113 uildingTe rmitsELC- PermitApp.doc 07/01/to 4404615T(tu05/CO..M(WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
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
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
[:1Buildiug\Pe mits\ELGPermitApp,doc 07/01/10