Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
" COMMUNITY DEVELOPMENT Permit #: ELR2010 -00107
Date Issued: 06/11/2010
I GARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S 126CB00500
Jurisdiction: TIGARD
Site address: 9300 SW WASHINGTON SQUARE RD 001
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Macys
Project Description: Low voltage for Protective signaling.
FEES
Owner:
MACY'S DEPARTMENT STORES INC Description Date Amount
ATTN: TAX DEPT, 7 WEST SEVENTH ST Restricted Energy Permit 06/11/2010 $67.84
CINCINNATI, OH 45202 12% State Surcharge - Electrical 06/11/2010 $8.14
PHONE:
Contractor:
ADT SECURITY SERVICES INC
2815 SW 153RD DR
BEAVERTON, OR 97006
PHONE: 503 - 469 -7212
FAX: 503- 469 -7114
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: N Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: Y
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 at 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 • 2 -001 -0100. You - • • r • • •_s or direct questions to OUNC by callin 03.246.6699 or 1.800.34.
Issued By: `i /��� - - � Permittee Signature: r '
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.
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Electrical Perm y {��i)a yn ��G N�y�f
- "'YYP .r •.Y w "j^y -61" °.:R "'�.1F1 ' '.''"7 �'1'J.u. -�l. - + Cff - • -, �: T . � '
f licat on 4, ., ,. 9,141 2tt 1 t e ! A
�. � " Received r City of Tigard i I I l0 77 -- Permit Nu. ja Q 96(0-- • )w7
Y g Dale /13y r / L iil�
13125 S W Hall Blvd., Tigard, OR 97223 Plan Rc"e,
Other Permit:
- .. y z ; ` Phone: 503.639.4171 Fax: 503.595.1(X 0 Date/
•- F+•zwx Inspection Line: 503.639.4175
„TIGARD' Date Ready/I5 El See Page 2 for
!?wfYS.'�' Internet: tv(t•tv.tigatd- or.gov Notitietl /Method: rj"XC9 Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of p l a ns , 'ems checked below): ❑ New construction ® Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: there the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION ex;eeds 10.000 amp, at 150 volts or ❑ Phtating buildings
less to ground. 0! exceeds 14.0(1(1 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ®Commercial /Industrial ❑ Accessory building, amps for all other installations. buildings.
❑ Multi - f ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installat tt( 75 KVA or
❑ Lmergencv system. larger separately derived system.
JOB SITF. INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A" "F" •' "1 -' "1 -3"
rj - m U I001iP or more. occupancy.
Jo no.: 7 �� / /� Job site address. �j/�/� $4) ,' )�I� ` ` /
9\Jt /fJ [N/TJ /' (/ w ❑Sin or more residential units. ❑ Recreational vehicle parks.
City /State /LIP: . /,'' nn 7 a-a ❑ Hcatth -care facilities. ❑ Supply voltage for more than
�- � /Z ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.', 1 Project name: 4 a ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: Description �rv. Fee. 1 Iola) •
N'ew' residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. It- or less (65.54 J .1
La. add'( 500 sq. fi, or punion 33.97 I
Tax map /parcel no.: Limited energy, residential
> (with above s 11.1 67.34
DESCRIPTION OF .� ORk —
Limited energy, multi - family I 1
'IL T _ -� ` I / ' residential (with above sq. it.)
tw �t- n.e -C/7 , Scrx ices or feeders inslallation. :Iltcratiun, :Ind /ur relocation
�d� i� �� � rf 200 amps of Icss 100.70 /Iiirtlk&
❑ PROPERTY OWNER ❑ TENANT 201 amps to .100 amps 1 133Sh 1_ J
-till amps t., 000 amps 300.31
Name:
601 amps to 1,000 amps 1 301.04
Address: Over 1 . 1 ( 0 0 0 1 1 1 )2 5 1 1 volt 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /LIP: relocation
Phone: ( ) 1 Fax: ( l 300) amps or less I 1� 55.36 1 I
201 amps to 400 any,-; 1 125.08. 3 .
Owner installation: I his installation iS tine made on property w that I own which is not
b 101 amp; l0 599 amps 165.54 '-
intcndcd for sale, lease, rent, or exchange, according to ORS 447, 4 :19. 670, and 7(11
13raitch circuits - new, alteration, or e\ tension, per panel -
Date: A. Fee Ibr branch Cirruils , 11)11 — 1
Owner signature: '
❑ APPLICANT CON' I'AC "1' PERSON abo. r srn ice or !Ceder c -
each branch ctrcuu
Business name: H. Fee for branch circuits nirhlnr) -
',/'p/ service or feeder fee. first 56.10
Contact name: ____.72 "� — _ branch circuit
Bach add branch circuit 7sl _j
Address: Miscellaneous (service or feeder nut included)
Bach manufactured or modular 67 tid
City /State /LIP': ,
dwelling, service and or li edei
Phone:
6-0 )
3 9 /a Fax: - : ( ) Reconnect only 67.54
Pump or rT Manion circle 67.54
L -mail: (,7.5-1 ,
Sign or outline lighting.
CONTRACTOR Signal circuit(s) or limited - energy
I3usinesS lrunc \Uf SI.CURLI_�, panel. alteration, or ex I I'age 2 67.5'1 I
Each additional inspection over .allowable in any of the abu'c
Address: 2815 SW I531tn DR Additional inspection (1 hr min) 66 -25/ hi
Investigation (I hr min) 1 66 -25/ Iv
City /State /LIP 13EAVERI'ON OR 97006 }
Industrial plant (1 IIr min) 78.15/ hr
Phone: (503) 969 - 7699 Fax: (503) 469 - 7114 Inspections for which no Ice is 90.06/ hr
specifically listed ('/1 hr min)
CCf3 Lic.: 59944 ] Electrical Lic.: 26209CLE Suprv. Lic.: LEA389 ELECTRICAL PERMIT FEES
�r7 b l 1 1 r I T -- �U p � 11 Subtotal: 67.84
Suprv. I lectr si nature, required:
Plan review (25 °4, of penult fee):
Print name: KEN KRAUS Date: / l /+//0 St: to surcharge (12% of permit fee): 5.14
// "TOTAL PERMIT FEE: 75.00
■
Authorized ilgna[ul'C'. i "1'his permit application expires if a permit is not obtained within 180
e.
daps after it has been accepted as complete.
Print 011)170 Dale: • Number of inspections allowed per permit.
I.•melding .l'cnnit,'fl- C:- )'ermitApp -dce 10.01■09 - 1 - )0-- 161 Il05ii :OAt'V6(I1
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $67.84
Check Type of Work Involved:
1 1 Audio and Sti rco Systems*
1 1 Burglar Alarm
I I Garage boor Opener*
Heating, Ventilation and :Air Conditioning System*
1 1 Vacuum Systems*
Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(S I E: ()AR 918- 309 -00001
Check Type of Work Involved:
I 1 Audio and Stereo Systems
1 1 Boiler Controls
Clock \sterns
Data Telecommunication Installation
I ire Alarm Installation
1 1 1 -I V :v C
Instrumentation
Intercom and Paging Sestcros
1_.andscape Irrigatir,n (_ :ontrol*
1 1 ledical
Nurse Calls
1 1 Outdoor Landscape Lighting*
7 protective Si naliii
Other
Total number of commercial sYstcros: 1
*No licenses are required. Licenses are required
for all other installations
I:13uildinwl'crmi(s`HLC -Po nu:App.du: Iii 01.x)9