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Permit i a CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT A PERMIT #: ELR2006 -00218 _,L DEVELOPMENT SERVICES DATE ISSUED: 9/14/2006 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 9/14/2006 SITE ADDRESS: 09500 SW WASHINGTON SQUARE RD JCPEN ZONING: C -G SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG Project Description: Run conduit for duct dector. Wiring by others. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: 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: X PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: . TOTAL # OF SYSTEMS: 1 Owner: Contractor: WASHINGTON SQUARE LLC JOHNSON CONTROLS BY THE MACERICH COMPANY PO BOX 2012 9585 SW WASHINGTON SQUARE RD MILWAUKIE, WI 53201 TIGARD, OR 97223 Phone: Contact #: FEES Reg #: ELE 26 -216C LIC 65320 Description Date Amount [ELPRMT] ELR Permit 9/14/2006 $75.00 [TAX] 8% State Surcha 9/14/2006 $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. Issued By: Permittee Signature: ma (J 42.41 [. C _. 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. E:>ctri al Permit Application F O R O F I :IC F. u51.ONl.1 City of Ti RECEIVED �e F ® ()& %_a Perrot N,,,„, .• _ S p,..„ —p 4:,2,1 7 v 13125 SW Hall Blvd., Tigard, OR 972z3 Plan Review o :, Phone. 503.639.4171 Fax: 503.598.196 Date/B . Other Perrot I 1 G n p Inspection Line: 503.639 S E P 1 3 2006 Date Ready/By Si See Page 2 for Internet: www.tigard - or.gov Notified/Method Supplemental Information CITY OF TI(aARfl TYPE OF waltKLDING DIVISION PLAN REVIEW ❑ New construction [3 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 stones ❑ Demolition ❑ Other: where the available fault current ❑ Mannas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commeraal -use agncultural ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Ftre pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E ", "I - 2 ",' 1 -3 ", /�� l 4t I' or more. occupancy Job no.: Job site address y am! ` J 6� V(�t�t�J� l •i ore resi dential wets 0 Recreational vehicle parks. Cl /$tact /ZIP: �' ❑ Health facilities ❑ Supply voltage for more than � ,q ` ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: � / / G !� (/ ❑ Service or feeder 600 amps or more job site: Description FEE SCHEDULE Cross street/directions to J I Qty. 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.) � ��` C n c) u r A ), (� (� Limited energy, multi - family 75.00 2 1 residential (with above sq. ft.) i Services or feeders installation, alteration, and/or relocation)Q-( -1 1 L- ili l 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ NANT 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/ State/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 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder'fee, 46.85 2 Contact name: first branch circuit Address: Each add'I 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: ( ) iFax: : ( ) Reconnect only 66.85 2 E -mail: 72.001 9 0 1 Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 7 Business name: T \Nc Q ` Signal panel, or limited - energy panel, all teration, or 0 • Address: � ) - � I �— W it � { I E (,,�.,w/ ekten�ion Page 2 2 (( `"' �- ll City /State/ZIP: \ - ` ` �, / .: ^ 1, � f Each additional inspection over allowable In any of the above I .1 i poi inspection 62.50 Phone: l Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic•�j3 Electrical Lica j... uprv. Lic.:\C69R s Industrial plant per hour 73.75 ELECTRICAL PERMIT "FEES . 'Suprv. Electrician ignature, require.: % '\ \ \` Subtotal: `7 5 1 , Plan review (25% of permit fee): Print name: 3 - 7 Date: 7 State surcharge (8% of permit fee): b — Authorized signature: TOTAL PERMIT FEE: I Print name: 1 f /Q Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. • Number of inspections allowed per permit. IABuilding \Peim \itsELC- PerinitAppclot 0523/06 e d _ D .,.4 a y a S 440-4615T(I I /05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for an residential systems combined $75.00 Check Type of Work`Involved: E l Audio and Stereo Systems* El Burglar Alarm El Garage Door Opener* El Heating, Ventilation and Air Conditioning System* • ❑ Vacuum Systems* El Other. COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 260 -260) Check Type of Work Involved: El Audio and Stereo Systems El Boiler Controls El Clock Systems El Data Telecommunication Installation El Fire Alarm Installation El HVAC El Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical El Nurse Calls El Outdoor Landscape Lighting* • El Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1 \Buildmg\Pennits\ELC- PeanitApp doc 03/23/06 Building Division TIGARD Request for Permit Action T RECEIVED O. CITY OF TIGARD Permit System Administrator MAR 2 9 2007 13125 SW Hall Blvd., Tigard, OR 97223 CITY (*TIGARD Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gosunite mom FROM: ❑ Owner 7 Applicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: ^ Aft tz J INVOICE TO: (Business or Individual) y - ��� � / 1 1 ,,, i - 1 41-0 � ,1 ♦ ♦♦ �� 111 V 0 1 ® Mailing Address: { O Box 7 City /State /Zip: I v}I & 1 L -t'1< 5L (,J I 0./0 Phone No.: 5 3 i PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): 5D3• • 1 7 6 R. CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: ( anc)(0 Site Address or Parcel #: S O V Project Name: C, 'ftdf nNi tOitur 1 s9 • Subdivision Name: Lot #: EXPLANATION: 6 c b( - I) C)C) pip I P • _' yi OL to. • • 1 0‘ • r • Signature: Date: k I'° at ©� Print Name: ``), k -- L 3c Refund Policy `J 1 The Director or Building Official may authorize the refund of a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended c) not more than 80% of the land use application fee for issued permits c) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. d) not more than 80% of the building permit fee for issued permits prior to any inspection requests 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds • FOR OFFICE USE ONLY • Rte to S s Admin: Dat4 a - p7 B j Rte to Bld: Admin: Date y0�, : 11 Refund Processed: Date 7r -f .7 By :ter Invoice Processed: Date By Permit Canceled: Date 9 VG 7 B - %/4_ Parcel Tag Added: Date By Receipt #0‘. ' Date y/ /vJot Method ea_ Amount $ I•\ Building \Forms \RegPermitAction oe ev 05/24/0 7� oD Cam' at ex, - � � j cU