Permit (28) INCITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2016-00091
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/08/2016
Parcel: 1S126CB00500
Jurisdiction: Tigard
Site address: 9300 SW WASHINGTON SQUARE RD
Project: Macy's Subdivision: None Lot: None
Project Description: (3)branch circuits for suspended gas furnace and(1)low voltage system for HVAC.
Contractor: OWNER Owner: MACY'S DEPARTMENT STORES INC
ATTN:TAX DEPARTMENT
7 WEST SEVENTH ST
CINCINNATI, OH 45202
PHONE PHONE:
FAX:
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 02/08/2016 $71.02
Specifics: Service or Feeder
1 ea Signal circuit or Limited 02/08/2016 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12%State Surcharge- 02/08/2016 $17.52
Electrical
Type of Const:
Occupancy Grp:
Total $163.54
Required Items and Reports(Conditions)
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 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy oft - - •r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: rmittee 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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
lick . Received
City of Tigard Date/By: p2 /(y Q 7 Pennit a: G` ��� ,�n'7/
I 13125 SW Hall Blvd.,Tigard,OR 97223 ) 'ti Plan Review �l /v
Phone: 503.718.2439 Fax: 503.598.1960 �r1 Date/By: Related Permit it: M Q +t J!_`ry��,�
Inspection Line: 503.639.4175 ` V JO Ready Date/By: saris: ® See Page` 2 for (Jr��J
I t' A I`I) ' Notified/Method: i.-1-6, Supplemental Information
TYPE OF WOR1� �('��� I ;
Internet: www.0 and-or. ov � � PLAN REVIEW
g g v Cl(��!
# �i Please check all that apply(submit 2 sets of plans w/items checked):
❑New construction Addition/alterati������ ent
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling '"Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INtiOR)11ATION AND LOCATION ['Emergency system. larger separately derived
Job#: Job site address:ct.?OO S r✓ 1/441.0Sf i2 d .J ❑Addition Hof new motor load of system.
I O0HP or more. ❑"A","E","I-2","I-3",
City/State/ZiP: //661R0 4C,k c 77Z 0 Six or more residential units. occupancy.
t 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ` 1 /1-C t .S 0 Hazardous locations. 0 Supply voltage for more than
'`',�S�/v 6/ 4441714.-c,
N/, 1, ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross1street/directions to job site: W jFe' FEE SCHEDULE
/J FAR
— &"v t Q(11,-p fcz i A par `1/eV Q /0// Description I Qty. I Each 1 Total
a` tC �Vev r`C 1 ,, rG`^"1 7 K (/!��- t ! \ New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ftor portion 33.92 1
DESCRIPTION OF WORK I' ¢ _.t Limited energy,residential 75.00 2
PH/CI' c fxS F 6iirt-1--- 4k-if-1 C6 (with above sq.f1.)
t/ Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
r
Name: n/) /'b\I S 200 amps or less 100.70 2
Address: 9 300 4 .Q ( J- ./1/rrPt.J 914 � M► 201 amps to 400 amps 133.56 2
q 401 amps to 600 amps 200.34 2
City/State/ZiP: 7/ 6' 2D Q� / ? .2� 601 amps to 1,000 amps 301.04 2
Phone:(�( ) 3- l/ 03a Fax:( ) Over 1,000 amps or volts 552.26 2
Email: t)p.J f CQ 0-Le y ,1'J fi G y S- °VW Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 _ 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
(APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: /14above service or feeder fee,
i} Lys 7.42
each branch circuit
Contact name: 17 0,-,) EA c 6 EY
B.Fee for branch circuits without
•
Address: ".?d O SI'V (/Eiji''7,H Sf /°C/VO service or feeder fee,first j
branch circuit J 56.18 ,/X 2
1 51dCity/State/ZIP: 77 TT��� �� �� �� Each add'I branch circuit 7.42 i+Iii.gli 2
Miscellaneous(service or feeder not included)
Phone:�/ )..c63 &O3 Q Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: / v)i C.y S
Iv) Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy .y�h�
Address: panel,alteration,or extension. ee Page 2 iJCII, 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: Inspections for which no fee is
CCB Lie.: Electrical Lic.0 /7 f)..... Suprv. Lic.:3Yq/ specifically listed(/hr min) 90.00/hr
// y,, ELECTRICAL PERMIT:FEES
Suprv. Electrician signature,required: . -----."7---
'�' Subtotal: 7/414Z G
Print name: O v�'i) r y Date: -/C2 /6 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee) -i 7 5,2
Authorizedsignature: '---. TOTAL PERMIT FEE: i 63',5././This permit application expires if a permit is not obtained within 180
Print name:6GiV/9`1� &pc-G 6 y Date:‘).-14C/6 days after it has been accepted as complete.
* Number of inspections allowed per permit.
(:,Building Permits ELC_PermitApp ELR_ERE.doc Res 06 17^_015 440-4615 COM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
7 77 >a fiVYDescription Irt
•
Qty. Each I Total 1
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
' with OAR 918-309-0040)
i=!. eating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr mm)
COMMERCIAL WORK ONLY: witwitCPERiar':FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
XHVAC
❑ 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:Budding Permits 1-LC_PennitApp_ELRERI doc Rex 06 17 2015