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Permit (82) CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2019-00065 Tf GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/06/2019 Parcel: 1S 1260000300 Jurisdiction: Tigard Site address: 9339 SW WASHINGTON SQUARE RD T11 Project: Amerisleep Subdivision: None Lot: None Project Description: Adding(23)branch circuits and limited energy,for data telecommunication installation for Ti. Contractor: ADVANCED WIRING SERVICES INC Owner: PPR WASHINGTON SQUARE LLC PO BOX 644 PO BOX 847 CLACKAMAS, OR 97015 CARLSBAD, CA 92018 PHONE: 503-310-3655 PHONE: FAX: 503-698-6372 FEES Quantity Description Date Amount 1 ea Restricted Energy Permit 02/06/2019 $75.00 Specifics: 23 crt Branch Circuits wo/Purchase 02/06/2019 $219.42 Service or Feeder Type of Use: COM 1 ea 12%State Surcharge- 02/06/2019 $26.33 Class of Work: ALT Electrical Type of Const: Occupancy Grp: Total $320.75 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 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the les adopted by the Oregon Utility Notification Center. Tho rules are rth in OAR 952-001-0010 through -001-0090. Y. _ .. '4 a copy• .-rules o .' -ct questions to OUNC by calling 503.232. .8. . Issued By y--y — ` 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 Application l'',-..:-' FOR 01:1 R I: 1 1 oy►.l City of Tigard -d Received /,, � FE-,---, 0o Date/B : 13125 SW Hall Blvd.,Tigard,OR 97223 ` r�" Plan Review r _ Phone: 503.718.2439IIIII _, Date/B : Related Pe y r iIll Email: TigardBuildingPermits@Tigard or god° Ready Date/By: 7aris: El See Page for I WARD Inspection Line: 503.639.4175 Internet: www tigard-oi gov ., !y Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑New construction ix Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more 0 Building over three stories. El Demolition El Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling 51 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amp0 Multi-family ❑Master builder ❑Other: Fire for all other installations. butngs. 0 Fire pump. Installation❑ of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: J©i 1 or Job site address: 61351 4 a 1, /_Q, n 6 ❑Addition 0Hof new motor load of system. `7w r. 100HP or more. ❑<`A„ "E„ "1.2„ "1.3„ City/State/ZIP: '`((Y A eri Dk. �' z7,/ ❑ x more residentialunits. 0 occupancy. Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: "f' Project name: HAS re l4 L,�l!(� 0 Hazardous locations. 0 Supply voltage for more than ��rr//�+ ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential eo/,s°�^ (i (1i ' 72C(A-L �2 �� giec/� n i7- (with above sq.ft.) 75.00 2 o/KLimited energy,multi-family , bjresidential(with above sq.ft.) 75.00 2 u,`.i f r `" ' 1// `�p VI-77 /T-z`0 Renewable Energy 0 See Page 2 0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 _ 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 PPLICANT ACT PERSON r Branch circuits—new,alteration,or extension,per panel am/ A.Fee for branch circuits with Business n e: above service or feeder fee, each branch circuit 7.42 2 Contact name: B.Fee for branch circuits without p service or feeder fee,first I 56.18 5.4./6 4+ 0 2 Address: branch circuit City/State/ZIP: Each add'l branch circuit ?02,. 7.42 /6 4.4 2 Miscellaneous(service or feeder not included) Phone:( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: jA/A,kat id lefAli,. ;E.pi 'e6‹ 4jc , Sign or outline lighting 67.84 2 �t2 4 Signal circuit(s)or limited-energy See Pae 2 2 Address: panel,alteration,or extension. g 9749`6' Each additional inspection o er allowable in any of the above City/State/ZIP: ei,de, .�l i Additional inspection(1 hr min) 66.25/hr Phone:(5'3 ) ?it) 44.5 Investigation(1 hr min) 90.00/hr q Email: ` ar ' 204,A/14/L. Industrial plant(1 hr min) 78.18/hr rInspections for which no fee is 90.00/hr CCB Lic.: aZ51/\,L\-)\Electrical Lic.: La Suprv.Lic.: 447c$ specifically listed(1/2 hr min) ELECTRICAL PERMIT'FEES Suprv.Electrician signature,required: Subtotal: Print name: SMO illt/Vj 41/ a Date: i l&.'t q 0 Plan Review Required(25%of permit fee): / / State surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: - FEE SCHDULE * Fee for all residential systems combined: $75.00 Descriptioterm I Each 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 El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) El Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 El Vacuum Systems* >100 kva no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr s.-cifically listed(Vs hr min) r t CAI, k CO f=.' IAL s Subtotal(Enter age 1): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls El Clock Systems Data Telecommunication Installation ❑ Fire Alarm Installation El HVAC ❑ Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* El Medical El Nurse Calls El Outdoor Landscape Lighting* ❑ Protective Signaling El Other: Total number of commercial systems: , *No licenses are required. Licenses are required for all other installations 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 9339 SW WASHINGTON SQUARE RD T11 , TIGARD, OR, 97223 Record Type: Record ID: Commercial - Electrical ELC2019-00065 Inspection Type: Inspector: 199 Electrical final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor