Permit • t, CITY OF TIGARD ELECTRICAL PERMIT III ° K PERMIT #: ELC2009 00069
° COMMUNITY DEVELOPMENT DATE ISSUED: 2/23/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09563 SW WASHINGTON SQUARE RD B02 A & B ZONING: MUC
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
PROJECT: GYMBOREE
Project Description: Sign lighting only.
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: 1
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: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
WASHINGTON SQUARE LLC MARTIN BROS SIGN INC
BY THE MACERICH COMPANY 3165 COMMERCIAL ST SE
9585 SW WASHINGTON SQUARE RD SALEM, OR 97302
TIGARD, OR 97223
Phone: Contact #: PRI 503- 364 -2211
FAX 503 - 364 -4315
FEES
Description Date Amount Reg #: ELE 24 -23CLS
[ELPRMT] ELC Permit 2/23/2009 $53.40 LIC 64761
[TAX] 12% State Surchar 2/23/2009 $6.41 SUP 399SIG
Total $59.81 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 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: i..Qj n k t , Q X Az Permittee Signature: S...k 0 S y, (
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.
MART PAGE 01
02/24/2009 11:09 5033644315
CITY O F TI G A CS 11 ELECTRICAL PERMIT
TY
n o 1 V,Mi�1.�
of ` COMMUNITY DEVELOPMENT PERMIT M: 1 aS•40069
DATE ISSUED: 2123121)09
l `` "" n 13125 SW Hall Blvd., Tigard, OR 9722 603.639.4171
PARCEL: 1S12800-00300
SITE ADDRESS: 09563 SW WASHINGTON SQUARE RD B02 A a B ZONING: MUC
SUBDIVISION: WASHINGTON SQUARE L0T: JURISDICTION: TIG
PROJECT: GYMBOREE
Project Description: Sign lighting only.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 • 200 amp: PUMP/IRRIGATION
EACH ADD'L 500SF; 201 400 amp: SIGNIOUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC( FOR: 601 +anips -1000 volts: MINOR LABEL. (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: WISERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1 at WID SRVC OR MR: PER HOUR:
401 - 600 amp: EA ADD'L ERNCH CIRC: IN PLANT;
901 - 1000 amp: PLAN REVIEW SECTION
1000+ ampfvolt: a=4 `ES UNITS; , 600 VOLT NOMINAL:
Reconnect oni : SVCFDR ›= 225 AMPS: CLASS AREA/SPEC t0CC:
Owner. C4ntrabtor:
WASHINGTON SQUARE L1.0 MARTIN BROS SIGN INC
BY THE MACERICH COMPANY 3165 COMMERCIAL ST SE
0595 SW WASHINGTON SQUARE RD SALEM.' OR 97302
TIGARD, OR 97223
Phone: Contact #: PRl 503364 -2211
FAX 503 - 3644315
FEES
Description Date Amount Reg 0: ELE 24 - 23CLS
rELPP -MTI ELC Permit 2/23/2009 $53,40 LIC 64761
(TAX) 12% State Surohar 2/232009 $6.47 SUP 39951G
Total $59.81 REQUIRED ITEMS AND REPOR
This Permit Is Issued subject to the regulations contained in the Tigard Municipal Code. Sic of OR. Specialty Codes and all other a - - Ilaabie laws. All
work will be one in accordance with approved plans. This permit win expire If work Is not �tartod within 180 days of issuance, or if wdrk Is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center, Those Pules are set forth In
OAR 052.001 - 0010 through OAR 952 - 001.0100, You may obtain copies of these rules or direst questions to OUNC at 503.246.6829 Or 1.000,3323344,
Issued By: Perntittee Sl nature:
OWNER INSTALLA "•N ONLY
The installation is being made on property I own which Is not intended for sale, lea e, or rent.
OWNER'S SIGNATURE:
DATE:
CONTRACTOR INSTALLATION ONLY _
SIGNATURE OF SUPR. ELEC'N: _ - DATE: o7A4 k g
LICENSE NO:
Call 503.639.4175 by 7 :00 a.m. for an inepect�on that business day. .
This permit card shall be kept in a conspicuous place an the job site until completion of the project.
Approved plane are required on the jeb site at thr time of each inspection.
/ 2,, R ECEI ♦ ED
Electrical Permit Application rc)li c)rrl�a USE c)N1.Y
Received 11
III City of Tigard FEB 2 3 2009 Date /B • • .. • •• 2 Permit No.. €1 70 `
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Other Permit: 6 r ezgoq .0:50S O
Phone: 503.639 4171 Fax: 503.598.19 Date /B .
- r I c n It D Inspection Line: 503.639.4175 Y OF TIGARD Date Ready /By• WM HI See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method. Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ❑ Addition /alteration/replacement
,�,� ./ ) ❑ Service or feeder 400 amps or more ❑ Building over three stories.
I O
❑ Demolition ther: . 6A where the available fault current ❑ Mannas 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 ", "I -2 ", "I -3 ",
Job no.: Job site address: ',net,: �p IOOHP or more occupancy
S i . ..) d . J - SE • l ❑ Six or more residential units. ❑ Recreational vehicle parks
City/State /ZIP: p •J _ ❑ Health -care facilities ❑ Supply voltage for more than
�I� a /� t �T� 1 '� .Z:� 3 ❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.:.*. (IQ. Project name: � yVV+ b 0 ❑ Service or feeder 600 amps or more
FEE SCHEDULE •
Cross street/directions to job site: f ort, i 7 5 C.h O ((s -°rr �1 Description I Qty. I Fee. I Total I •
1 1. -
4...) New residential single - or multi - family dwelling unit.
"�� S 11 t ' , S6t) a. Q Yl � u Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add] 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
k .Q4) 1'V
, ■ 1 60 e e . (, c i r,� I• ,' S t , rn residential (with above sq. ft.)
1 _ ✓ ' l L Services or feeders installation, alteration, and/or relocation
6.Qti '1A K a t._ "QlP La. . 200 amps or less 80 30 2
IlL- PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Q C i2 r 1 CA — �'I't, yy - 401 amps to 600 amps 1 60.60 2 -
601 amps to 1,000 amps 240.60 2
Address: 114 (1 A) . 7...}14t.,.. g' ti A Over 1,000 amps or volts 454.65 12
Y Z S3 6 a g Temporary services or feeders installation, alteration, and/or
City/State /ZIP:
iPhOe K' relocation
Phone: ax: 200 amps or less 66.85 1
( 6oaJ 9 S 3 - (. s'7 Fax: ((�� 9 S 3. 5 Y 9 201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
- - APPLICANT [�EONTACT PERSON ab ove service or feeder fee, 6.65 2
each branch circuit
Business name: ''') ^„ et( 3 � 5 K B. Fee for branch circuits
Contact name:Jcti j ei V - n. ,
without san crvice or feeder fee, 46.85 2
l W 4- "�� first branch circuit
Address: 3 / 5 L 3 Each add'I branch circuit 6.65 2
b J �C Miscellaneous (service or feeder not included)
City/State /ZIP:` - 30 a� Each manufactured or modular 90 90 2
v e.� dwelling, service and/or feeder
Phone: (� 3 y , a s ` 1 Fax:: ( ,353) 34 1_4,43/s- Reconnect only 66.85 2
E -mail: JfiltAt I. i S ,p____Y ■ a r-f'l #% - 1 Y"ll .s . C 010%, Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting I 53.40 53. f 2
Signal circuit(s) or limited -
Business name: — ' Q � ��� energy panel, alteration, or
Address: 31 is S Can.. J • extension. Descnbe: Page 2 2
4r. el.... r A..o
City/State /ZIP: S 4 7 3 6 _ Each additional inspection over allowable in any of the above
, Per inspection 62.50
Phone: (..9,.) 310c1 ( )
3(o C( a ! 1 • 3 6, i/ - y 3!S` Investigation per hour (I hr min) 62.50
t r7 to
CCB Lic.: / ' Electrical Lic.:Qii. a ch_s Suprv. Lic.: 399 _ SI G Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES.
Suprv. Electrician signature, required: Subtotal: <3 , 4
Print name: , r t� p� u uA S Date: a /jq /Q Plan review (25% of permit fee ! State surcharge (12% of permit fee): (Q , • _ r _
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete. 1
. Number of inspections allowed per permit 5 k• S
1 \ Building \Pernins \ELC- PermnApp doe 05/23/06 440- 4615T(I 1 /05 /COM /WEB
02/24/2009 11:09 5033644315 MARTINBROS PAGE 02
. . — CITY OF TIGARD
COMMUNITY DEVELOPMENT
r i k i 13125 SW Hail Blvd., Tigard, OR 97223 503.639.4171 I v/
FEB 2 4 2009
Electrical Signature Form
Bu
CITY O TIG
D
IMPORTANT PERMIT NOTICE
MARTIN BROS SIGN INC
3165 COMMERCIAL ST SE
SALEM, OR 97302
Permit #: ELC2009 - 00069
Date Issued:
Parcel: 1512600 -00300
Site Address: 09563 SW WASHINGTON SQUARE RD B02 A 8. B
Subdivision: WASHINGTON SQUARE
Lot:
Jurisdiction: TIG
Zoning: MUC
Project Name: GYMBOREE
Description; Sign lighting only.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate Individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mall the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd , Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical Inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR;
WASHINGTON SQUARE LLC MARTIN BROS SIGN INC
BY THE MACERICH COMPANY 3165 COMMERCIAL ST SE
9585 SW WASHINGTON SQUARE RD SALEM, OR 97302
TIGARD, OR 97223
Phone #: Phone #: 503464.2211
Reg #: LE 24 -23Cr s
LIC 64761
SUP 399SIG
digio AN INK SIGNATURE IS REQUIRED ON THIS FORM
grta ure 0 upervising ec clan
Elie (printed) SUP LIC ;x