Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
:91 c ;'' COMMUNITY DEVELOPMENT Permit #: ELR2009 -00199
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 07/22/2009
Parcel: 1S1260000300
Jurisdiction: TIG
Site address: 9724 SW WASHINGTON SQUARE RD F06 & F07
Subdivision: Lot:
Project: GAP
Project Description: Install low voltage for data, POS /EthernetNOX
Owner: FEES
WASHINGTON SQUARE LLC Description Date Amount
BY THE MACERICH COMPANY, 9585 SW Restricted Energy Permit 07/22/2009 $75 00
WASHINGTON SQUARE RD 12% State Surcharge - Electrical 07/22/2009 $9 00
PHONE
Contractor:
CASCADE UTILITIES INC
PO BOX 189
ESTACADA, OR 97023
PHONE: 503 - 630 -8985
FAX • 503 - 630 -6638
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 Required Items and Reports (Conditions)
Landscape Lighting. N Medical' N
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 ac • - • approved plans 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 ' TION Oregon - • . • res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 .010 through OAR 952 -01 { -0100 Yo. ay obtain a copy of the rules or direct questions to OUNC by calling 503 246 6 0 332 2344
`x /
Issue By: / ` Permittee Signature: k I : 4�1.111. .__
MI) •O/
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
City of Tigard U CEIVED Received 7 29 Q9 Permit No / / �+
13125 SW Hall Blvd , Tigard, OR DateB – /A "/ l7
II
g Plan Review Other Permit
•
▪ Phone 503 639 4171 Fax. 503 598.1960 Date/B
TI GARD Inspection Line 503 639 4175 JUL 2 Z 2 009 Date Ready/By _____________ See Page 2 for
Internet www tigard - gov Notified/Method Will Supplemental Information
E jQ I[ kUl i�' t'LGARD PLAN REVIEW
❑ New construction Addition /al[lrRf011TrCPAdYt JRYN Please check all that apply (submit 2 sets of plans w /uems 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
❑ I- and 2 - family dwelling [G ommercial/tndustrial ❑ Accessory building less to grail other a exceeds ons ❑Commercial -use agricultural
Y g 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
S 7 ❑ Addition of new motor load of ❑ "A ", "E ", "1.2 ", "1 - ",
Job no. / ,.p IT p 61 A Job site address: q 7 Ski t(,CLS .L)s$ S ix orm rmore occu
S dd A G ❑ ix or more residential units ❑ Recreational vehicle parks,
City/State /ZIP: --7 5, t /-� Q G7 -� 0 Health-care facilities 0 Supply voltage for more than
f J K f -79,13 ❑ Hazardous locations 600 volts nominal
Suite /bldg /apt. no • Fr) Project name. - , [� ❑ Service or feeder 600 amps or more
'-1 / l C3' FEE SCHEDULE
Y
Cross street/directions to job site. l 1 _ t0 i ^� '/ Description I Qty. 1 Fee. I Total I •
l New residential single - or multi- family dwelling unit.
666 Includes attached garage.
Subdivision Lot no 1,000 sq ft or less 145.15 4
Tax map /parcel no . Ea add'I 500 sq. ft or portion 33 40 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq ft )
�` � / I Limited energy, multi - family
YC:1q AP /Vc )c' c — 1400 � I/d ®+O t,[p residential (with above sq ft )
75.00 2
Jl 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: 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240,60 2
Address Over 1,000 amps or volts 454 65 2
City /State /ZIP. Temporary services or feeders installation, alteration, and /or
relocation
Phone' ( ) 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, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT (]CONTACT PERSON • - above service or feeder fee,
each branch circuit 6 65 2
Business name: C , m 0...k( _` .'E , , ivC B Fee for branch circuits
7 without service or feeder fee,
Contact name -ao,b -6,351,1 first branch circuit 46 85 2
Address: Each add'l 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. 603 ) 6' 36)_- 0 M5 - Fax' : (5P3 ) 6 __C6 3g Reconnect only 66 85 2
E -mail' - 33 r) 8 Eq) RCGNA)C 7'-S , CdA\ Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 53 40 2
( Signal circuit(s) or limited-
Business name. a-5 CI C e 1 1i4 ; ' VO C. energy panel, alteration, or 7.09 Address: lJ 1 exte,as.54mbe Page 2 2 1 IF
City /State /ZIP: e,4 ,,,j, o i ef-7 09_3 Each additional inspection over allowable in any of the above
_ �+, Per inspection 62 50
Phone (S03) 636 ° S Fax ��) 6'3 7— ‘4 Investigation per hour (1 hr min) 62 50
CCB Lic • 1 1 Lik . /9ecciztr' aI Lic : b /- Supry Lic.3gy', j, j Industrial plant per hour 73 75
Supry Electrician sig r4tT ; •� ELECTRICAL PERMIT FEES
0 • Subtotal '71
1 Plan review (25% of permit fee) / ��
Print name. O b i. . Q us f _ Date: ' 7 , d� , Q 5 a
Pl State su (12% of permit fee) .DC)
Authorized signature: � 8, TOTAL PERMIT FEE s (a,e0 p This permit application expires if a permit is not obtain d within 180
Print name: b TTT &I A. L. B d s i Date _22 2 ...0=1 � days after it has been accepted as complete.
^
• Number of inspections allowed per permit
I \Building\Permris\ELC- PermitApp doc 05/23/06 440- 4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard n Other
Page 2 - Supplemental Information Total number of commercial systems:
LIMITED ENERGY PERMIT FEES: " -No licenses are required. Licenses are requir
for all other installations
RESIDENTIAL WORK ONLY:
Fee for all residential systems $75.00
combined
Check Type of Work Involved:
❑ Audio and Stereo Systems"
❑ Burglar Alarm
n Garage Door Opener ::
❑ Heating, Ventilation and Air Conditioning
System
❑ Vacuum Systems::
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ lock Systems
D ata Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control "'
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting"'
❑ Protective Signaling
I \ Buildmg\Permns\ELC- PermuApp.doc 03/23/06