Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00040
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/27/2009
PARCEL: 1512600 -00300
SITE ADDRESS: 09502 SW WASHINGTON SQUARE RD J03 ZONING: MUC
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: AT &T MOBILITY
Project Description: Restricted energy sound system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON SQUARE LLC MUZAK LLC
BY THE MACERICH COMPANY 12449 NE MARX ST BLDG 10
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97230
TIGARD, OR 97223
Phone: Contact #: PRI 503 -554 -2594
FAX 503- 889 -3883
FEES Reg #: ELE 26- 1055CLE
LIC 142760
Description Date Amount
[ELPRMT] ELR Permit 1/27/2009 $75.00
[TAX] 12% State Surch 1/27/2009 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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
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: X11 ' &ti 01 Permitte e Signature: I0 Q 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'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.
i
Eitrllal Permit Application RECEIVE 1 FOR OFFICE USE ONLY
City of Tigard Received
Z - r, _ Pemut No. p .'1/
,„ �
,
2 7 200 Date/B :
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C : J A N Phone: 503.639.4171 Fax: 503.598.1960 Date /By. Other Permit:
T I G A R D Inspection Line: 503.639 4175 OF ,� , , s ate Ready /By lwrs El See Page 2 for
Internet: www.tigard- or.gov CI 1 ified/Method. r I Supplemental Information
TYPE OF WORMR I�GDNIS(• PLAN REVIEW
❑ New construction • Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /Items 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling — W-Commercial /industrial ❑ Accessory building amps for all other installations. buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
ON ❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION ( ❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "I - ",
Job no.: Job site address: G't sb SW ioO pig i ' ►/ I) or more. occupancy
�.CX ❑ S ix o or r more residential units ❑ R ecreational vehicle parks
City /State /Zip: --1-1 / A ^ ❑ Health -care facilities. ❑ Supply voltage for more than
lT FYI a�. a� Z� 12 Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: "3j3 Project name: A-T 1-r AA .L L,.1.1 ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq ft.)
Limited energy, multi - family 75.00 2
_a _ y I. I� / i 4 • I a residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I 0 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/Statc/ZiP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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 I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: first branch circuit
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: ( ) I Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: I V I u , LAX. Signal panel, or limited -
energy panel, alteration, or
Address: I 1, q k.(42 pi_ V A n l.n extension. Describe: 1 Page 2 2
City/State /ZIP: 0 LAI- ..00 0a. 1 � ..3 Each additional inspection over allowable in any of the above
I Per inspection 62.50
Phone: ($ l) 55 t f _ 155`{ I Fax: ( 563 )8' _303 3 Investigation per hour (1 hr min) 62.50
CCB Lic.: 1 l# Z.1 ( I Electrical Lic.: 1,_ j o ,guprv. Lic.: 'fit 1 L e4 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
--a
Print name: 4 T 14 V' Da 9 ! i I A P lan review (25% of permit fee):
f 1` 7 C 1 State surcharge (12% of permit fee):
Authorized signature: l Jt,-u-i.l� C�/�� TOTAL PERMIT FEE �� . t� d
V This permit application expires if a permit is not obtained within 180
Print name: •tt1 A ..-----?) � Date. 1 I Z (1 Q t days after it has been accepted as complete.
J i " Number of inspections allowed per permit
I \ Building \Permits \ELC- PermitApp doe 05/23/06 440- 461Sr(t 1 /05 /COM/WEB
•
CITY OF TIGARD ,
j
BUILDING DIVISION PERMIT #: EI- 82009 -00(v 0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/27/ 2009
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 AJ 4
INSPECTION WORKSHEET FOR c3/2009 TIME: 7 :00AM PAGE: 19
SITE ADDRESS: 0%02 SW WASHINGTON SQUARE RD J03 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: i,T R,T MOBILITY
DESCRIPTION: Re;. 'cted energy sound sy'.tem.
OWNER: WASHINGTO UARE LLC, PHONE #:
CONTRACTOR: MUZAK LLC PHONE #: 503. 554
Inspection Request Scheduled For: Date: 27 2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final. 080398 -01 803 5E4 2583 N
13Lr KO c)hh:1 N .
Corrections/Comments/Instructions: •
Etz ‘131105
13 ELL- Agi
• 12.6 1 of
T- s7Ar
m)57 8
Pr l
. cANN61 us it. /Ayt.. [_48a__
IU N PASS n PARTIAL APPROVAL XCANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G- Oba _. Date: 21 ' 1 Phone #: (503) 718 - Lillt
lecgica1 Permit Application - City of Tigard
P.age'2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ 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:
A udio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ 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 \Buddmg \Permus \ELC- PermiApp doc 03/23/06