Permit IN a CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00047
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/12/2009
PARCEL: 1512600 -00300
SITE ADDRESS: 09348 SW WASHINGTON SQUARE RD W14 ZONING: MUC
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: GAP KIDS /BABY GAP
Project Description: Limited energy for air handlers.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC DC HEATING & AIR CONDITIONING INC
BY THE MACERICH COMPANY 7110 NE 157TH AVE
9585 SW WASHINGTON SQUARE RD VANCOUVER, WA 98682
TIGARD, OR 97223
Phone: Contact #: PRI 360 - 254 -5062
FEES Reg #: ELE CRE2
LIC 166355
Description Date Amount
[ELPRMT] ELR Permit 2/12/2009 $75.00
[TAX] 12% State Surch 2/12/2009 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: ,' p). )4�AA 0 a Permittee Signature: 1 i II, / 71,"
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 503.639.4175 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.
L Iectrktal Permit Application RECEW' FOR OFFICE USE ONLY
City of Tigard 1 Permit N o • *" .`
g
q
13125 SW Hall Blvd , Ti ard, O 97223 FEB 1 20 Plan Review ' _ - - a '
Ill y� „
�: Phone. 503.639.4171 Fax 503 598 1960 „ -.teBy Other Permit I V �
.
T I C'. A R D Inspection Line 503 639 4175 CITY OF TIG ' date Ready /By Jun ® See Page 2 for
Internet: www ttgard -or gov BUILDING DIVI' I�ed/Method - (CI Supplemental Information
E OF WORK PLAN REVIEW
❑ 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 ❑ Mannas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
n th ' less to ground, or exceeds 14,000 ❑ Commercial -use agncultural
❑ 1 - and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Addition system larger separately derived system
❑ Awon of new motor load of
❑ "A ", "E ", "I -2 ", "I -3 ",
c �0 1 4 , n 100HP or more occupancy
Job no.: Job site address: ? 1�/ f " 7 /(
9 ❑ Six or more residential units ❑ ecreauonal vehicle parks
City/State /ZIP: 7 Qe ��2, z ❑ Health -care facilities ❑ Supply voltage for more than
❑
Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 145 15 4
Ea add'I 500 sq ft or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
Limited energy, multi - family 75 00 2
residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106 85 2
Name: Y C ,r-/- 6 1 ,(/C 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240 60 2
Address: `�/ 9 /t, /I-7)- / .4 / ^ r ' ( �r L ^ � j (// Over 1,000 amps or volts 454 65 2
- ET W
City/State /ZIP: 3 /1–A/ CVO U /q_ %Q / crz Temporary services or feeders installation, alteration, and/or
relocation
Phone: (3 4..:0) 6 f -- 9�,- Fax: (W6O) 9t!j4 030 ,2- 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
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits ti'ith
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6 65 2
each branch circuit
Business name: j, B Fee for branch circuits
Contact name: without service or feeder fee, 46 85 2
first branch circuit
Address: Each add] branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90 90 2
Phone: ( ) Fax: : ( ) Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRALTO Sign or outline lighting 53 40 2
Business name: A e X 171, Signal circuit(s) or limited -
/�� energy panel, alteration, or
Address: 2-I /O /t/ g---)-71„A--0-t, extension Describe Page 2 2
City/State /ZIP: V &t1? ( 6 U E 2 1A./. f Q/6•1'2-- Each additional inspection over allowable in any of the above
( Q _ ' ~I !� Per msga 62 50
Phone: ( > t ) r , Fax: ( ) lnvestigation uon per hour (1 hr mm) 62 50
CCB Lie.: .463 e r_( — Electrical Lic.: CEE Suprv. Lic.: C-2 c 0 2, Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: C 6, `'Y %I '-- Subtotal
Print name:
2 /2 /� D 9 Plan review (25% of permit fee) -
t?(�iZ�t I �/ Date:
,�/�c State surcharge (12% of permit fee)
Authorized signature:e t '� / TOTAL PERMIT FEE
// /� This permit application expires if a permit is not obtained within 180
Print name: op / t / (f EL 6 /L �„ ()/ Date: 02 ty, �1 � 0� days after it has been accepted as complete.
* Number of inspections allowed per permit
I \Bwldmg\Permns\ELC- Permit App doc 05/23/06 440-4615T( I I /05/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELRjO01.'00li'i
13125 SW Half Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 � '
Inspection Requests (24 Hrs.): (503) 639 -4175 ...'_� Zit"
INSPECTION WORKSHEET FOR DATE: 41 1110 9 TIME: PAGE:
SITE ADDRESS: q 3 A % 6 Ui S 1 JQ &. W I t4 CLASS OF WORK:
SUBDIVISION: 4 LOT #: TYPE OF USE:
PROJECT NAME: % .
DESCRIPTION:
1 - 51015
OWNER: PHONE #:
CONTRACTOR: b G t'io 4 p1( PHONE #:
Inspection Request Scheduled For: Date: 14 ( f ®f oQ[,.. Pour Time:
Code # Inspection Description Confirm # Contact # Message
1rif\ V,64e----
Corrections /Comments/ Instructions:
SOLI SQieR,RE 1-0w xj_sz,akork F
w1c0.1 \I'm:Thy aice, ' i 0 ,,u,
Au, 1)0,5 CAN Nr 4,S
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Gm 4\14( *L‘ Date: ES 1 Phone #: (503) 718 - VIA
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
rRESIDENTIAL WORK'ONLY: _ . _ Y _~
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:
: WORK- ONLY: , • -77
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:
*No licenses are required. Licenses are required
for all other installations
I \Buddmg\Permits\ELC- PermiApp doc 03/23/06