Permit Q
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CIT OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00096
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/16/2007
PARCEL: 1512600 -00300
SITE ADDRESS: 09502 SW WASHINGTON SQUARE RD J - 3 ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: CINGULAR WIRELESS
Project Description: Low voltage for T -stat wiring. Job No. 90085
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: 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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC JACOBS HEATING AND NC
BY THE MACERICH COMPANY 4474 SE MILWAUKIE
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97202
TIGARD, OR 97223
Phone: Contact #: PRI 503 -234 -7331
FAX 503 - 296 -5351
FEES Reg #: ELF 26 -807C RE
LIC 1441
Description Date Amount SUP 704LHR
[ELPRMT] ELR Permit 4/16/2007 $75.00
[TAX] 8% State Surcha 4/16/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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
issuanc- - . • is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utili otification Cen - T' •s • rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions t. •U' - 03.246.6699 or 1.800.332.2344.
■
Iss d By: . Permittee Signatur•W'iriM
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.
V Electrical P er mit A pplication , f , • , ., � ,()i l l( sl . i)N1 1 ._ ,? . _. >h ` ' �:'
Date received: 470 Permit no.: GI.��Q — Qr� ��
:i ' ,f f City of Tigard P roject /appl. no.: r_e date:
.:iii-- :..,:.
City of Tigarrl Address: 13125 SW Hall Blvci, 'Tiga OR 97223 Date issued: darer* eceipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
f r7 rFy W x'�, a t't ''. j' r 1 F °-i '� yf+�:, d ') * ml „ T. h � 31 1 ,,:. r . 15 it t . lf , p R,- •.� / r , ,p-',A1.:: . :442.2.- r ) 1 * : Y..� - -- - .0 ! 6 ",.. , > •:33�. 5 ...,..:,'n ... ; , r ;-.'r 3 h , ,T Y'P E .- R Nf I T S( t s ,i ' ` f {,,,: *�k 4 r , , sf r
I 9 I & 2 family dwelling or accessory 0 Commercial /industrial ❑ Multi - family O Tenant improvement
17 New construction It Addition /alteration/replacement CI Other: ❑ Partial
ex @ -1 v. •6 v r r. -,(a fA -4' �Y, , , �f n r s � '- a a '
xt° "4Argr::?Y-t`. F; ,-I.' ' .` ".a ?�.. -.Vi A� LJ 0 B .9I T'E I N U .. 1'yl O , s
N-ik � -. ;� `' x h �F'.� .c``.-�. F�`.. . ,4'`� 11.. h43 'f r i . : :ij '
Job address: • ���` _ Bldg. no.: Suite no.� Tax map /tax lot/account no.:
F Lot: Block: Subdivision: -- Q.4:$
lac$
I Project name ' m - oc Description and location of work on premises: --7_ v,,,...... f - —_
Estimated date of c 1pletion/inspection:
' ' • aelt)i'i : Nt AC'f, f Fj s `� ' ti SM s FEE SyCHEDUL'E' + � '
0 APPLJGATION
�?,r� ;! ,.. �•.+�h5?�Y.r�: =e�i a�r s+r..,:a:� ...� � �e7s3sitrr>�.�..i.i �r :"x�� -.� �r. j,-... .e_a� � _, • }r , �' ��? H - �,+ ,S : ti . _FS n�''z '�° , ^T•
Job no: C� t=ee Iwo
I Business name: A'�t Description NI (ea.)
Address: A err residential • single or malts -family per
�A ��.. M+i \,,.a la, i a�e dwellingunk .Iacludesattached
City: ' ...c...i \ard. . I State:tOr ZIP: - service Waded:
Phol,dar46i --133\ ,j . x E-mail: 1000 s.. ft. or less 4
CB lo.: �� Iec. bus. lic. no: F.ach additional 500 sq. ft. or portion thereof = = =
L.imited energy, residential 2
' CI • rnr c. no.: illr Limited energy, non - residential 2
i Each manufactured home or modular dwelling ...
21tettiire of - upery isin_ can (required) Date Service and /or feeder 2
' � w L 8ervaeasot feeders to iastellatloa, IIIII '
Sup elect. name (print) License no �, s I.
�� it �''!t 4 r -,.+ t f -.� ' r� � - y ,
al6etaUoner relocatloa:
� � � i `� �s r P R O PE R T Y;SO lift liVA _+ `xk s' . x °
O t k,, •=-�.- `. ... ,.� sue. _ _ A .,, _, . i �,.:,..r3s s,.� , ...va 200 amps or less
Name (print): 201 amps to 400 amps MI= 2
I 401 amps to 600 amps ■■
1000 2
Mailing address: 601 amps to 1000 amps 2
City: State: ZIP: Over 1000 amps or volts __ 2
Phone: I Fax: E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporaryserviceeorfeeders -
which is not intended for sale, lease, rent. or exehanec accordine to Inotallatioa, alter at oa,or relocation: I j I
ORS 417, 455, 479. 670, 701. 200 amps or less - -- I - 1
201 amps to ;100 amps I ' _
Owner's signature: Date: 401 to 600 amps _
1' •r' r 1, r ' , a • E II G IN />;E �± ' "; -; Branch circuits new, alteratio I
or extension per panel:
Name:
A. Fee for branch circuits with purchase of
Address: service or feeder fee. each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
I hone Fax E-mail:
* • � - a ; �c,� r Y tr Each additional branch circuit:
P L • R`E 1►, I - •. = • e a se chec al thatN apply� , I M sac. (Service or feeder notinclnded):
O Service over 225 amps - commercial O Health -care facility Each pump or irrigation circle 2
Service over 320 amps - rating of I &2 Li Hazardous location Each sign or outline lighting 2
family dwellings LI Building over 10.000 square feet our or Signal circuit(s) or a limited energy panel.
t:.) I ' j
System over 600 volt.., nominal more residential units in one structure alteration• or extension*
J
❑ Building over three. stories LI Feeders. 400 amps or more *Description: _� -�
a Occupant load over 99 persons rD Manufactured structures or RV park Each additional Inspection over thever the a l any of the above: •
f:_res:vlighting plan ,Other: — per ms lion 1
plc r —� �— — I
Submit ____ sets of plans with any of the above. Investigation fee. 1
The above axe not applicable to temporary construction service. Other
Permit fee $ `W.> '
'Not al! jurisdictions accept credit cards. please call jurisdiction for more information. Notice: This permit application
Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: _ I / _ within 180 days after it has been State surcharge (8 %) $ (..o
Enp1iec accepted as complete. TOTAL $ e>%. ° - v -
Name of cardholder as shown on credit card
$ _
Cardholder signature Amount , 40 -1615 (6/00/COhtt