Permit CITY OF TIGARD ELECTRICAL PERMIT
1114 ° PERMIT #: ELC2009 -00037
COMMUNITY DEVELOPMENT DATE ISSUED: 1/27/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S126CB-00500
SITE ADDRESS: 09300 SW WASHINGTON SQUARE RD ZONING: MUC
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
PROJECT: MACY'S
Project Description: (2) branch circuits for furnace upper mezzanine over dock.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
MAY DEPT STORES COMPANY, THE MACY'S NW INC
ATTN: PROPERTY TAX DEPT , 12100 SE 82ND AVE
611 OLIVE STREET HAPPY VALLEY, OR 97086
ST LOUIS, MO 63101
Phone: Contact #: PRI 971 563 - 6932
FEES
Description Date Amount Reg #: ELE C 172
[ELPRMT] ELC Permit 1/27/2009 $53.50 SUP 324IS
[TAX] 12% State Surchar 1/27/2009 $6.42
Total $59.92 REQUIRED ITEMS AND REPORTS
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 1:.: = . ;TTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in
OAR 95 .01 -0010 throu• OA '52-001-0100 You may obtain copies of these rules or direct questions to OUNC at • 2 :. ;'•99 or .:'0.332 2344.
Issue. = 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:
CONTRA • ' INS LLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE: f /_?
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.
'Elec'trical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By Permit No E.t.d. /W + _ V 3 7
• 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
C . Phone 503 639.4171 Fax 503 598 1960 Date/By. Other Permit
TI G A R D Inspection Line 503.639 4175 Date Ready /By ions RI See Page 2 for
Internet www tigard - gov Notified/Method Supplemental Information
TYPE 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 ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ 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 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system ❑ Addition of new motor load of ❑ "A ", "E ", "1 - 2 ", "I - 3 ",
Job no.: — Job site address: C 7390 S/v 175( , g /P4 100HP or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: 7/ L----190,0 ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: 004(e / f i- / ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: .$ v.
t, ,&Li � ^�L4 -
Deuriptioa I Qly. I Fee I Total I •
' QO ej, /� /� New residential single- or multi- family dwelling unit.
`' O �" 7 T`Per 1 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
DESCRTION OF WORK (with above sq 11) 75 00 2
IP
^O f/�C _ � �� � Limited energy, multi- family 75 00 2
J G/ j2 n' / 7 /" t t G residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106 85 2
Name: / V ` R c y S 401 amps to 600 amps 160 60 2
nn n 601 amps to 1,000 amps 240 60 2
Address: /mac /00 Se 8 O� A ✓6 / Over 1,000 amps or volts 454 65 2
City/State /ZIP: / � `r .' ' c'/ D' ` /� 7 7 v $.6 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (9 ) Sb3 ' v,_?a Fax: ( ) 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, i er panel
Owner signature: Date: A Fee for branch circuits with
❑. APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6 65 2
each branch circuit
Business name: 5 /f " /`] $ ed.e B Fee for branch circuits
Contact name: without service or feeder fee, 46 85 , / 2
first branch circuit
Address: Each add'I branch circuit 6 65 0 / 2
Miscellaneous (service or feeder not include i
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
CONTRACTOR '' \\,,�� Sign or outline lighting 53 40 2
Business name: /M/9 C 1 1,—.< is. IL) 1 Nv.--- panel
' Signal t(s) or limited -
energy panel, alteration, or
Address: / /DO S 6 gp9 / t, extension. Describe Page 2 2
City/State /ZIP: U"'X- f`i/fi'f2) (/( of >" ai e 7 dg 6 Each additional inspection over allowable in any of the above
Per ga
(q7() 3 t 3 t' o z Fax: ( ) stition 62 50
Phone: /
^ /1 Investigation per hour (1 hr mm) 62 50
CCB Lic.: OVh Electrical Lic.: C / 7a Suprv. Lic.:.O —/ �S Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �� Subtotal. J..4, 57)
Print name: D ait, 9 ` 3 £ ' 3 G LC > Date: / /'j X7 /0 9 Plan review (25 %of permit fee) -t9-
State surcharge (12% of permit fee). , /{�t
Authorized signature: i ' ' TOTAL PERMIT FEE: L .9'
Print name: 0 c \ i/1' -t) d' i 67 Date: //Z 7/v 9 Th'g permit application aspires ita permit rs not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit
I \Budding\Permits\ELC- PermitApp doc 05/23/06 440- 4615T(1 I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: •
PRESIDENTIAL 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 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
n 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 \Buildmg\Permits\ELC- PermttApp doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC 000 7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2712009
Phone: (503) 639 -4171 qi�l�
Inspection Requests (24 Hrs.): (503) 639 -4175 ':� __� C O ECTION WORKSHEET FOR DATE: 1/2W/009 TIME: 01AM PAGE: •
SITE ADDRESS: 09300 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: 1MMACV'S
DESCRIPTION: (I branch circuits for furnace upper rneczanine over dock.
OWNER: MAY DEPT STORES COMPANY, THE, PHONE #:
CONTRACTOR: MACY'S NW INC PHONE #: 971 - 663 -6932
Inspection Request Scheduled For: Date: 1/28/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 080071 -01 971-663-6032 Y
Corrections /Comments/ Instructions:
SS ❑ PARTIAL APPROVAL ❑ CANCEL • ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 74Je("► Date: / -2.;1' - Phone #: (503) 718-
,