Permit c,,
III
a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00048
DATE ISSUED: 2/13/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S12600-00300
SITE ADDRESS: 09348 SW WASHINGTON SQUARE RD W14 ZONING: MUC
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: GAP KIDS /BABY GAP
Project Description: Low voltage for audio /stereo.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: 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 OHM SYSTEMS LLC
BY THE MACERICH COMPANY PO BOX 86833
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97286
TIGARD, OR 97223
Phone: Contact #: PRI 503- 484 -5700
FAX 503- 258 -0382
FEES Reg #: ELE CLE6
LIC 166819
Description Date Amount
[ELPRMT] ELR Permit 2/13/2009 $75.00
[TAX] 12% State Surcha 2/13/2009 $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 . e 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...99 or 1.800.
Issued =y: I / � zA Permittee Si ature: (� -- L--- -
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.
,it S
Feb 12 2009 4:14PM HP LASERJET FAX p -1
c• l CED
'electrica Permit Application j 6 q MR O F F I C E
City of Tigard Receivea
13125 SW Hall Blvd ,Tigard, OR 97223 FEB 12 2009 DatdB t� Pamir No.: eta e /f
9 Phone: 503.639 4171 Fax: 503.598. Pao Review
r] t Internet. www tid BUILDING l� Inspection Line 503 6394175
IN
'Y OF TIGARD Da le R : Other Permit:
www.tigard-or.gov gov NG DIVISION Date Ready/By ,�; a•
D�VVSs N otified/Method: '�/ -i 0 See Page ) for
s� ak � , »
f ` ��' �f' z er'��� t W'3�i�l�y- = p a , ;p►F, c �.m r Supplemental Information
a x �. # [ i,f t- 4 d. ,M',� :9 a +.3 � � lri 1 ,Zi 'I. n.. 1 1 1 h!" i i fix, �.fi 7 c x".9.4 ";
r_„.. 1 `tl,. n47.• .. e.. ,. urn.. uls .. s.. ,. '!� II 9. t ! i `Ti a n a 3 i �'� A § 1 '' `- :',
t
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Iii�,f�m uOriO s.t.r ^ oisk.e , oe,.,e�,dh,?<� , Va'11au SE r.. � ':, t i s li n + u 'may 2.. awn- e plena h ck below): w f).... E
Please check all that apply (submit 2 eats of plena whims whims checked bel
❑ New Construction 2 Addition/alteration/replacement
El ❑ Other: 0 Service or feeder 400 amps or more ❑Building over three stories
� Demolition ( $R r e 1 r ,,� �. axau where the available fault current ❑ Marinas and boatyards.
i' ` t t i t',' �, e e # t , vii 1 s "" ' exceeds 10 amps at 150 volts o r ❑ floating buildings.
' Goa ' I N�f.s ix Ea...�a - igir skit iii a `a.�} th;fao+,' tlttt l , f B 8s
11 ommercial/industrial lass s ground, or exceeds 14.000 na. ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling
❑ Accessory building amps for all other installations. buadmgs.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
tf �� k} �t Farr Bpi r "t Kx tt +t pry w yz a t ¢ mf a ❑ Emergency system. larger separately system. ss. is 'p si € t 1 1 w1 t s � 1 , ,ei , d .. F. e . )j y den vod stem.
r . , n. w s1fc.. 61 n i1i: Pa.h.,itpi' � i ' : 17 : et.. -. .t . . i P3E t ❑ Addition of new motor load of ❑ .. ,. " -3 „
Job no.: Job site address: Q3 S ln/ IOOHP o< more. occupancy,
� - J �'" '' �S `M ❑ Six or more residential units ❑ Recreational vehicle pall e
City/State/ZIP: (,� ` J / d2 i — ea?. 3 ❑ Heahh -care facilthes. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: G R r „.) ❑ Service or fade 600 amps or morn
Cross street/directions to job site:
Description � ' 1 �a i ri j li 'i r r i,� � '" . u r , , l
Girl., Fee. Tota •
New resIdential single- or multi- family dwelling unit..
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 1 145.15 4
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
s�i ' o, v Limited energy, residential
tj, , k trq,, a w 112 Yj .yr ^ S S �, 75 00
"t '''' ?' -4/1' . 4''' �l t ,4^ «'5'''' n d '''''w° ' a _ rata' At "t¢ 4 '� ? Limited energy, multi-family (with above sq ft.) 2
t i
l D S4-•r -.--t I s g t, (141- ` r---) - residential (with above sq ft) 75.00 2
Services or feeders inatallation slleration, and/or relocation
i�t t 8 u i a rsn 200 amps or less 80.30
F fl i f i i ° <.` 1 3e r i t lP f , t17 ., rl tif', ie�fs v ��;. r ' !` i a ,' 201 a m s to 400 am s 2
tare, 2 P p 106 -SS
Name: 401 amps to 600 amps 160.60 2
Address: 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City/State /ZEP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) f Fax: ( ) 200 amps or less 66.85 I
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 snips 133.75 1 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
pima +a €� , � i?7ke,is -- k 6 7 '0 !{ v4 ,ac 0_,, duet , sv - , � , .. A. for branch circuits with zst„ r at . t Jll : `
x3.A�� > :�i above service or feeder fee,
Business name:
each branch circuit 6.65 2
B Fee for branch circuits
Contact name: wfthow service or feeder fee, 46.85 2
first branch circuit
-
Address: Each add'l branch circuit 6,65 2
City/51atelZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular
dwelling, service and/or feeder
Phone: 40 2
( ) I Fax: ( ) Reconnect only 66.35 2
E-mail:
Pump or irrigation circle
S f� ;j ,€' �.,E !�P> t']� pr t�' z . -;?nyr t.4�4 '� `r' t i ,. . , rsr 53.40 2
'` 5n ,�'
.1��,`..xL ". n. ��.� . !it„IUfE3 Yette „,,ut.,- ��.s:i�.�,,.y_,,,� i,,,�,,,.�����, � y, ne lighting
Business flame: (5 i....k �ST 1M y LLG S l e Sign rg or panel, anoutli,( e r alteration, , 53.40 2
or
/ energy pe alteration, or
Address: "PQ 3 ' RS e) extension. Describe: ` Page 2 --75 2
City/State/ZIP: (?,,, ^
.,) 0 1
78 Z
6 Each additional Inspection over allowable in an of the above
v Per inspection (5u3) �g'i4 c2v i Fax P ection
62.50
S7 � l, e. (�� ZS g t? Investigation per hour (1 hr min) 62.50
1141 %411CCB Lie.: t 64 %1 el I Electrical Lic.: GLE 6 Suprv. Lie.: Industrial plant per hour r _X73.75
g
Suprv. Electrician signature, required:
Subtotal: 7 •
Print name: C 3 U s r f . Date: Z -/11 y/ t, q Plan review (25% of permit fee): $-
ll�� State surcharge (12% of permit fee): 7.00
Authorized signature:
TOTAL PERMIT FEE: 8 y . cc)
Print name: 'Date: This permit application expires if a permit Is not obtained within ISO
days after it has been accepted as complete.
1 lauilding1PernetelEL e- Permitapp.dec 05/23/06 440 4615TOI/05/COMMEa a Number of inspections allowed per permit.
Feb 12 2009 4:14PM HP LASERJET FAX p.2
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:
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
r's ML�cS �ue .aaa ��,,.c:,rfad �.v�'S a�w T.•3�� i� &e ..4'a �o:, ,,: ,�'f S :i4Yra A .
Fee for each, commercial $75.00
system
(SEE OAR 918-309 -0000)
Check Type of Work Involved:
'<udio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ I ntercom and Paging Systems
❑ L andscape 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
11Buildingwamil AELC- PermitAyp.doo 0/23/06