Permit ti`
71
'V CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2006 - 00300
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/8/2006
PARCEL: 1 S 126C0 -01403
SITE ADDRESS: 09300 SW WASHINGTON SQUARE RD ZONING: C - G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Low voltage Data
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
MAY DEPT STORES COMPANY, THE PROCOM COMMUNICATIONS INC
ATTN: PROPERTY TAX DEPT 8326 SE 17TH AVE
611 OLIVE STREET PORTLAND, OR 97202
ST LOUIS, MO 63101
Phone: Contact #: PRI 503- 233 -8037
FAX 503- 233 -8052
Reg #: ELE 3- 397CLE
FEES LIC 109929
Description Date Amount
[ELPRMT] ELR Permit 12/8/2006 $75.00
[TAX] 8% State Surcha 12/8/2006 $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
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: &Le, t3,�7,.., Permittee Signature: / _ ��2
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.
J, E
Electrical Permit Applica ONLY
of Tigard DE CEIVE® FOR OFFICE USE O
Receive D Punut �� ,�,� 3 0
`J g D. e/By�a /SS� 'p iezeGfi
13125 SW Hall Blvd., Tigard, OR 9 :►n P O p
O C Plan Review
Phone: 503.639.4171 Fax: 503.59:. 20 06 Date/By Other Pemut
i 1 , A l: I ., Inspection Line: 503.639.4175 CITM Date Ready/By. huts 0 See Page 2 for
Internet: www.tigard - or.gov B UILD I N G IVgRD Notified/Method Supplemental Information
D IViSION
TYPE OF WORK PLAN REVWW
Please check all that apply (submit 2 sets of plans whtems checked below)
❑ New construction R. Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ 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 agncultural
❑ 1- and 2- family dwelling g Commercial/industrial ❑ Accessory building amps for all other installations buildings
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system
JOB SITE INFORMIATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - 2", "t - 3 ",
Q IOOHP or more occupancy
Job no.: Job site address:
q3� �a.a t>tt,�l \!- <D� , N. ❑ Si x or more residential units ❑ Recreational vehicle parks
City/State/ZIP: -�^ ❑ Health -care facilities ❑ Supply voltage for more than
1 I4A(t 9 ' 1 q 223 -4f28 ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: & e. / 1 s ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Ow. 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 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq ft )
Limited energy, multi - family 75.00 2
D /} — ( - residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER Iii TENANT 201 amps to 400 amps 106.85 2
Name � I LL 1�G� ST Z. 401 amps to 600 amps 160.60 2
\�' 601 amps to 1,000 amps 240.60 2
Address: saovic Over 1,000 amps or volts 454.65 2
City / State/ZIP: Temporary services or feeders Installation, alteration, and /or
relocation
Phone: (5o 3) G eo - 3 3 t l x ZQci Q 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
N :APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: pa, C C
•7 (1nW1I%t- I,ICATi0P\, 1 (1.4c B. Fee for branch circuits
without service or feeder fee,
46.85 2
Contact name:
L. -t G1 L.'ES first branch circuit
Address Q ' /►- Each add'! branch circuit 6.65 2
73 3 l 1E $ - Miscellaneous (service or feeder not included)
City / State/ZIP: P &/QrzA`Np ., q7,,, Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (5p )Z ss _ 90 7 Fax: : (Sp,) 2. 33 -g SZ Reconnect only 66.85 2
E -mail: S e.,9w�O polo e.ow fU .M6ttisSai t edam our' • c',., AA Pump or irrigation circle 53.40 2
C'ONTRACT'OR Sign or outline lighting 53.40 2
Business Hanle' Signal circuit(s) or limited- -75e-'!
A� /► energy panel, alteration, or
Address: 83ZG 5E `7 extension. Describe: l Page 2 2
City /State/ZIP: / , egg_ 97 2p Each additional inspection over allowable in any of the above
i Per inspection 62.50
Phone (5 ) . y 7 - 2417 Fax: (563) Z33' gQ Z- Investigation per hour (1 hr nun) 62.50
CCB Lie.: ( ci &2 9 Electrical Lic.: 3 — 39 /ea, Suprv. Lic.:111 ZLEA Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Q/ �� Subtotal: /5. oD
�—a—� '�/
Print name: Date: Plan review {25 ".o of permit fee): .,4.,,,,,..stt � ll�s l2 9 � `O State surcharge (8% of permit fee): 4, •t e7
Authorized sign : ( 5 7 1 ie 4 5✓_ 7" TOTAL PERMIT FEE: e( . Gex) Y Y' This permit application expires ira permit is not obtained within 180
Print name: /-44-6 � Date: l 2 _ e - 1)6 days after it has been accepted as complete.
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CITY OF ��n n n n*�m TIGARD ^
UUUU'DUNG DIVISION- - ' - ' ' ' ' - • � ^ ' ~ ^ - ' - PERMIT'#:--E[R3O
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1202006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639~4175
INSPECTION WORKSHEET FOR DATE: 1/30/2007 TIME: 7:03AM PAGE:
SITE ADDRESS: 09300 SW WASHINGTON SOUARE RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MACY'S
DESCRIPTION: Low voltage Data
OWNER: MAY DEPT STORES COMPANY, PHONE #:
CONTRACTOR: PROCOM COMMUNICATIONS INC PHONE #: 503
Inspection Request Scheduled For: Date: 1/30/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 042707'01 950'519.8447 N
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Corrections/Comments/Instructions:
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J� PASS �� PARTIAL �� CANCEL �� NC�ACCESS
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0 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASS SSEO
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Inspector: �� �\w L�� Date: /0 U° Phone #: � (503) 718- ����� /
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