Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 . : , COMMUNITY DEVELOPMENT Permit #: ELR2010 -00152
I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/13/2010
T
Parcel: 1S1260000300
Jurisdiction: TIG
Site address: 9755 SW WASHINGTON SQUARE RD D03
Subdivision: Lot:
Project: T- MOBILE
Project Description: Installation of low voltage for data.
FEES
Owner:
WASHINGTON SQUARE LLC Description Date Amount
BY THE - MACERICH COMPANY, 9585 SW Restricted Energy Permit 08/13/2010 $75.00
WASHINGTON SQUARE RD 12% State Surcharge - Electrical 08/13/2010 $9.00
PHONE:
Contractor:
SERVICE COMMUNICATIONS INC
4120 SE INTERNATIONAL WY A -109
MILWAUKIE, OR 97222
PHONE: 503 - 723 -6415
FAX: 503 - 723 -6416
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: y Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
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 done in cordance wi approve. • -ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A I NTION: Oregon - -quires y• . to follow the rules adopted by the Oregon Utility Notificat • • - r titer. Those rules are set forth in OAR
952 -001- 010 through OAR 952 -0t 0100. o may obtain a copy of e rules or direct questions to OUNC_by calli 03: ' •.6699 or 1.800.332.23 . •
Issue By: PermitteeSig •ture: / ..., (4.4---/
/ 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 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 FOR OFFICE USE ONLY
Iiih City of Tigard Date/I3y. t to P ermit No.: Il aep l et0 —00 %5.,
r 13125 SW Hall Blvd., Tigard, OR 97223 I'Isn Review
2 '
Phone: 503.639.4171 Fax: 503.598.1960 Date /By. Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Jutis: 0 See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
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❑ New construction Please check all that apply (submit 2 sets of plans w /items checked below):
, { �ddition/altcration/rcplacement
❑ Service or feeder 400 amps or more ❑ 13uilding over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
ti buildings.
volts Floating exceeds 10 000 amps
50 t lts or f l
exc ❑
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P
GA#` EE, fi# 1d#::: Gf311� 4 .... .............:..::... .. :. : : : : : : : : : : : : : : : : : : : :. : : : :.: • .
less to Bound, or exceeds 1x,000 (.ommerctal -use agttultural
❑ 1- and 2- family dwelling ELCommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder , ❑ Other: ❑ lire pump. ❑ Installation of 75 KVA or
❑ Fsrtergency system. larger separately derived system.
.......................... :;;;? ; :;
:: : : : : : : : : : : : : : : : : : ::i'r : : < : ::< : : :101k$f1`0:)II?fI RM. FAY` IONV10:: LOCAT; O .............. ................... : : : :.. : : :. :: Addition of new motor load of ❑ "/\", , "1-2", "1-3",
100I1P or more occupancy.
Job no.: S C''' Job •site address: (] ❑ Recreational vehicle arks.
l .O %0 LU 1 1 5; `jw W t� an `xp 1 ❑ Six or more residential units. P
City /State /ZIP: - 7 - LO2k ra + o (� 22:5 ❑ Health -care facilities. ❑ Supply voltage for more than
vll 1� C 1.1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: _ M o 6 I ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description I Qty. 1 Fee. 1 Total 1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. it or less 168.54 4
Ea. add'l 500 sq. ft or portion 33.92 1
Tax map /parcel no.: Limited energy, re
75.00 2
with
abo v s . It
q )
Limited energy, multi-family 7500 2
residential (with above sq. ft)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
o am Ps
133.56 2
t s t 400
2
Ol an
P
W
401 amps to 600 amps 200.34
Name: _L---� ( 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: 'Ibis installation is being made on property that I own which is not 401 amps to 599 amps 168s4 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee
7
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1r'�C!1T1�
.❑:::::::::::::::::::::::::::.: :::;::: : : : : : : : : : :.: : : : : : :.� : :. > :.; : :, : .: o :; : :; :.;� : :;;; : : :.. :;;; :<.; : :;: each branch circui .42 2
t
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit _
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or nodular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) I Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: . ., Sign or outline lighting 67.84 2
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panel, alteration, or extension. 1 Page 2 1 . OD 2
Business name: c V ACc' C j..lM1\Uf\
Y\enth 6fl.3 ` IIp (' Each additional inspection over allowable in any of the above
Address: IA lZV 5E T1 It1 A.1 M,rkl W Al A (OC1 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr ntin) 66.25/ hr
City/State/ZIP: \
� W (= .... 1 �� 222_ Industrial plant (1 hr nun) 78.18/ hr
( - ` r Inspections for which no fee is 90.00/ hr
Phone: ( 03> Z. _ Fax: (563 )1 Z3 Cpc l (p c p
..ecifically listed '/: hr min
Electrical . • S rv. Lic.: - >:::»»: : : : > : : :: : ::: ::: : ::: > ::: ::: :::>l C 1f TCxt: 1ZMl€'#':: ; 5::::>::::>: : : :z; : » : >a:: : : : : : > : : > : : : : : : >:
CC13 Lic,.. p l b I' 5 1 Lic.. .1'....,4e15 ' up 5 3f�cc� ........ .............. :...:
Subtotal: 75 d0
Suprv. Electrician signature, required: i� Plan review (25% of permit fee):
Print name: 1 , fyt 0 w Date: q — \23 k - b State surcharge (12% of permit fee): 9 • 06
TOTAL PERMIT FEE: $ y , 00
Authorized signaturC: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Print name: \\ '("Pit 1 1)ate: Qj t 1-- I 0 * Number of inspections allowed per permit.
1:\[ 3uil ding\l'ermits \EL.C- PemtitApp.doc 07/01/10 440- 4015T(11/05/COM/W1/B
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
............. ...............................
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:
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
❑ N urse Calls
❑ O utdoor Landscape Lighting*
111 P rotective Signaling
❑ Other
Total number of commercial systems: /
*No licenses are required. Licenses are required
for all other installations
1:\ Building \PcmiittUil.C- PcrtnitAppdoc 07/01/10