Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2015 00098
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/08/2015
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9451 SW WASHINGTON SQUARE RD A16
Project: Vans Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Low voltage for data,back office.
Contractor: INSTALLATION&SERVICE TECHNOLOGIES INC Owner: PPR WASHINGTON SQUARE LLC
8340 MISSION RD STE B4 PO BOX 847
PRAIRIE VILLAGE, KS 66206 CARLSBAD, CA 92018
PHONE: 913-652-7000 PHONE:
FAX: 913-381-2819
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/08/2015 $75.00
12%State Surcharge-Electrical 04/08/2015 $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 i ' • ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don: accordance w approved • -. . 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 •w quires ,.0 to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 001-0010 through OAR 952-11-0090. ay obtain a copy of the rules or direct questions to OUNC by calling 503.2 2.1987 or 1.800.33 . 44.
•
I-sued By: ' 4_ Perm ittee 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 Application FOR OFFICE USE ONLY
City of Tigard RECEIVED Date/By:: "7 61. / Permit No.. �j 4.:.d0,5
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' 8 Phone: 503.718.2439 Fax: 504,4%196n- Date/By: Other Permit:
Inspection Line: 503.639.4175 v I` 2015 Date Ready/By: Juris: HI See Page 2 for
T It„ARD B
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
L°�I n1vISION ;
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATE RY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 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 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","1-3",
4f, u (�.l '.`, 100HP or more. occupancy.
Job no.: l5,y Gy Job site address 9 75 k.) �Vl1S . M a ❑Six or more residential units. ❑Recreational vehicle parks.si
City/State/ZIP: �` e OQ ❑Health-care facilities. ❑Supply voltage for more than
r1 J� ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: a► Project name: A Y,Is ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I •
I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 . 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
A- pp/��DESCRIPTION OF WORK (with above sq.ft.)
i�.l' Ll.� Renewable Energy multi-family ft.) ❑ See Pa e 2
St Qs L1 O,sk� residential with above s ft. 2
► ID.Wilee, Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
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: Date: Branch circuits—new,alteration,or extension,per panel
,:.,:??,,,,:,4,-T,,,-4 ,,,,,g-Ja 4 p ..`, A.Fee for branch circuits with
",7-,m,1,1- ,-',727'777-777-7,4v- "A- above service or feeder fee,
each branch circuit 7.42 2
Business name: ,
B.Fee for branch circuits without
Contact name: /� ..A R IL (P e� service or feeder fee,first 56.18 2
V t'�r\ /'S 1 branch circuit
Address: g3 q 0 ll vl i55iio h ct Each add'I branch circuit 7.42 2
City/State/ZIP:WA t� l/l 1t A e V fGGG1S���� Miscellaneous(service or feeder not included)
Y ` ►7 Each manufactured or modular 67.84 2
7 ( ) dwelling,service and/or feeder
Phone:(�l • 5 D a Fax: Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
-, ...; .. .:?,r= 4 Sign or outline lighting 67.84 2
Business name: /ern,.Z 9 Ai r j�f�� igAjC�/€j Signal circuit(s)or limited energy I See
I/ panel,alteration,or extension. Page 2 7 5- 2
Address: /1'4; - Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP: Investigation(1 hr mm) 66.25/hr
Phone:( ) ///do Fax:( 7�h /0/,/i7 Industrial plant(l hr min) 78.18/hr
1 A 7O1 wz 3 I p Li 434 specifically for which no fee is 90.00/hr
CCB Lic.: M{ Electrical Lic.: /L� Su rv.Lic.: s cificall listed('/:hr min)
�cm ,.14 ELECTRICAL PERMIT FEES 7�
Suprv.Electrician signature,required: • W cdt-.. Subtotal: °c a
Print name AyQ,t` �,to
eate:r ..g. ' Plan review(25%of permit fee):
`V State surcharge(12%of permit fee): d7e,
Authorized signature: .A ,j Q ) TOTAL PERMIT FEE: �,Cr)
V �'V� I
Print name: 10 Mvt A p�` Date: g r 5 This permit application expires if a permit is not obtained within 180
y g ` days after it has been accepted as complete.
" Number of inspections allowed per permit.
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i
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY:. FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qn• I Fee I Total I
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑I Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
OAR 918-309-0040)
Heating, Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
• • Each additional kva over 25 7.42 3
❑ Vacuum System * ; >100 kva—no additional charge 0.0 3
' Each additional inspection over allowable in any of the above:
❑ Other: • • •t • Each additional inspection is 66.25/hr 1•
• charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%z hr min)
COMMERCIAL WOgic L 3 ., , 1;,, EttotoC4 , now l
Fee for each commercial system •$78.00 Subtotal:
(SEE OAR 918-309-0000) •. • • Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
' Number of inspections allowed per permit.
❑ Boiler Controls
2/
Clock Systems
Data Telecommunication Installation •
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ InterFom and Paging Systems
•
❑ Landscape Irrigation Control*•❑ Medical • • •
❑ Nurse Calls • •
❑ Outdoor Landscape Lighting*
. ❑ Protective Signaling
• ❑ Other •
s Total number of commercial systems: l
•
•*No licenses are required. Licenses are required
for all other installations
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