Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00717
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/28/2010
Parcel: 151260000300
Jurisdiction: TIG
Site address: 9755 SW WASHINGTON SQUARE RD D03
Project: T- MOBILE Subdivision: Lot:
Project Description: (2) branch circuits for back room of retail store.
Contractor: LEGACY WIRELESS SERVICES INC Owner: WASHINGTON SQUARE LLC
15580 SE FOR MOR CT BY THE MACERICH COMPANY
CLACKAMAS, OR 97015 9585 SW WASHINGTON SQUARE RD
TIGARD, OR 97223
PHONE: 503 - 656 -5300 PHONE:
FAX: 503 - 656 -5305
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 12/28/2010 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/28/2010 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 R 952 - 001 -0090. You c pyb ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
A
Issued By Permittee 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.
12/27/2010 14:26 4806545141 MIKE AND KATHY LYNE PAGE 01
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Electrical Permit . I 1 licatioREV,-, . — 1 01..1 ('El ['sr. oNI.I.
:t of zolo Received
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SMWMIEI • a
,... t :13125 SW Hall B d., Tigard, OR 97223 D 2 1
II II I
r‘ Plan Review
Phone: 503.7)8.2 ' 39 Fax: 503.598.1969 ...-.1 rlc 104 . DatlBy; 1 Other Pesmit: i I •
I i , ; A I. I 4 Inspection Line: 03.639.4175 CI 1 U' ..,,, iiSION Data Ready/By: ' lt: 1
ho - See Pegs Z for
Internet: www.ti:. d-or.gov :OWING UN 1 Nottfted/Mahod: • 1—T uppiementai Information
OilliVimi .,.::r..3 ;:A.,,,,,:::,:irm•,,,,,,„„,„ ,..:.„1 ,,,,,,,,,,,,„ S
,.„.,, 1 F. W■qt/ g 1141,7114,yrnenli: ,:.,:;, 110,1 I W arn
, .10 ill :,• ' '; ' -.NT 4 Kin' ' ,"' .:1:.:imr‘,:::'1! : "''' ! ' L "' ' 1 " ................... ;I:i.!ii. , i1.-.;: ,, i', : * , : , : ,, :: r.F.r. wit4a ,, .), , , , * ;; - .1 g...L, ._
0 New construction (E) Addition/alteration/replacement Mau elleta all that - 'Y (submit 2 sets of plane w/items checked below):
17 Demolition 0 Other: D Service or feeder , ' amps or more a Building over three storiea .
where the available ult entrain 0 Marinas and boatyards
7iitivisavT ,,,,.„,,,;,,,,: 7. :2:c. N : : '7; . -.' ,i' ,.. ■.;■ exceeds 10,000 a . at 150 volts or 0 Floating buildings.
■21' 41. .. . -',. '= ' TE ego 4iieliii !''' ;`:' `'?•- I' '',
leas to ground, or - , ds
0 1-and 2-family dwelling 187 Commercial/ioduStrial 0 Accessory building amPa for ell other i [illations. 14,000 0 Commercial,use agricultural buildings.
0 Multi-family 0 Master builder 0 Other: El Fire pump. , 0 installation of 75 KvA or
• l ...,4 A: ie IsiOttiotiorox.0. , m. re., ,!),‘,,.,,,,,. ,...• . • - •..,•••••! 0 ?Merge system, larger separareiy derived system.
• "': 'ithilik■iilt •1 ' .... ,...,''. ,..,.. .,.:-....,.., -„„. , .-- ..J. n • , ..,,-. ILt.q. i..7fil r 1 : 1 : : -1 ' ' 1 • : ' ,-, • • 0 Addition anew •,. r load of 0 "A", "E", "1-r. "I -3",
Job no.:
•
Job .ite address: 9755 SW Washington Square Road 100HP or more. , occupancy.
0 Six or more reside .,, I units. 0 Recreational vehicle park
City/State/ZIP: Tigard orego 97223 El Health faciliti 171SuPPly voltage for more than
0 Hazardous locatio i 600 volts nominal
Suite/bldg/apt no.: Project name: Tmobile Retail Store D3 D Sefviet or feeder • f • nips Or MOM.
NIMMMINK EIESEEITAISOMINE!
Cross street/directions to job si c: Washington Square Mall By Newport Bay Description . .9 . Fee, 'NMI -
New residential si .• e- or multi-family dwelling unit.
Resturant Includes attached . c.
Subdivision: I Lot no.: 1,000 sq. ft. or leas ' 168,54
11
Ea. addl 500 sq, ft. ,, , . noon 33.92
Tax map/parcel no.:
Limited energy, resid- nal
above sq
.; (with 00
,c.:,'1,,,i.:41/0' ,711tii , 1577 iii:J..',-..' . ,,,i L':,',.islIvi,.i:::li,i;::::-..:„.1:. th . ft. II 75,
tiLl'•Atiiii13,4,iiitiii:Ki.•t!';iNn tiEHFiii' r
.:4441.117., j, :DliW....: '1: 1 T, •': ' e
Limited energy, mu mily
Add two circuits for Radio E uipment to back room of retail Store residential with : . e ... ft. 75,00
Services or feeders stallation, alteration and/or relocation
200 amps or less 100 70
illi;. •51'• , .14 l'!::,''.i'', *: 11 , '--,. t• q:' . 4 ily• , i ");.- . .:1 . l::::;:.:,.7- 201 amps to 400 am ,,, 13156
Name Tmobit 401 amps to 600 amps '1 200.34
: e
601 amps to 1,000 a : 301.04 2
Address: 1500 NE Irving ST Over 1,000 amps or . 552.26 2
Temporary service ' r feeders installation, alteration, and/or
City/State/ZIP: Portland Oreg .ri relocation
Phone: ( ) Fax: ( ) 200 amps or less , 59.36 1 1
201 amps to 400 amps 125.08 2
Owner installation: This insta !talon is being made on property that I own which is not
401 amps to 599 amps : 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701,
Branch circuits - it . , alteration, or extension, per panel
Owner signature: Date: A. Fee for branch sir ,.., with
q TA. ,m. r( ,J leammi:::,... above service or f . • fee,
7.42 2
isii)r,1:,111 . 4i, '; Wr';;d • Ag ...il ,.:■' ■ ! '!' rt. .,.arylwit . r each branch circuit :I
Business name: Legacy Wirel s Services a. Fee for branch ci .. ,. without
.... — service or feeder f.. first 1 56.18 56.18
2
Contact name; Pat Lyn, branch circuit
Each add'I branch ci • t 1 7.42 7,42 2
—
Address: 15580 SE For Mor swift Miscellaneous (se ' or feeder not Included)
Each manufactured or odular 67
City/State/ZIP: Clackamas, 0 egon 97015 dwelling, service and/ feeder .84 2
Phone: (503) 869-0365 [ Fax: : (503) 656-5305 Reconnect only d 67.84 2
Pump or irrigation ci • ' 67,84 2
E-mail: plyn . .(11egacy-wireles .COM , Sign or outline lightia .1 67,84 2
iagillifirifillE'NEN:Mr...M. J.Karti: -, ...4, , ,g,:,y,-, : :.:,:,-,,, si circuit(S) orb --ener
•anet alteration or e 1 K ion. F-: 2 2
Business name: Legacy Wire . :s Services
Each additional Ins coon over allowable in any of the above
Address; 15580 SE For Mor C I urt Additional inspection i hr MM) 66.25/ hr
Investigation (1 hr mm 1 66.25/ hr
City/State/ZIP: Clackamas, 0 egon 97015
• Industrial plant (1 hr ) • 78.18/ hr
Phone: (503) 656-5300 Fax: (503) 656-5305 Inspections for which 1 ', fee is 90.00/ hr
s , - ificall listed '/S in
CCB Lic.: 150432 Iectrical Lic,: 37-9:9 Suprv. Lic.: 4154S SSIMIllglar 1711 a.VITY7,171, :30MPIA
I 0/1 //5 il Subtotal: 63.60
Suprv. Electrician signature, - , uired: • 4 - x 4 , 46
Plan -•iew (25% of permit fee):
Print mune: Patrick F Lyne Date: 12/27/10 State sir ,1 ;. ge (IN, of permit fee): 7,63
TOTAL PERMIT 1 7 1.23
Authorized signature: .--.)„,, ' , , J2, Thls permit appal expires Ka permit is not obtained within 180
,-.....4-.,... days a , it has been accepted as complete.
Print name: Patrick LYne Date: 12/27/10 • INumber of inspecti al owed Ptr verInit.
440-4815T(11/05/COWWE0
IABollaineermital•C•PertnnAppctor 07/01/ 0