Permit r �
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00045
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/4/2009
PARCEL: 1S126CD-00300
SITE ADDRESS: 09500 SW WASHINGTON SQUARE RD ZONING: MUC
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: JC PENNY
Project Description: (3) data telecomm panels.
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: 3
Owner: Contractor:
WASHINGTON SQUARE LLC PRAIRIE ELECTRIC INC
BY THE MACERICH COMPANY 6000 NE 88TH STREET
9585 SW WASHINGTON SQUARE RD VANCOUVER, WA 98665
TIGARD, OR 97223
Phone: Contact #: PM 800 -573 -2750
FAX 360 -573 -9866
FEES Reg #: ELE 37 -491C
LIC 60178
Description Date Amount SUP 3562S
[ELPRMT] ELR Permit 2/4/2009 $225.00
[TAX] 12% State Surch 2/4/2009 $27.00 REQUIRED ITEMS AND REPORTS
Total $252.00
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: Q J[ Permittee Signature: Q \ i Devi
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.
02/04/200y.- 09:4'6 FAX 3605767422 Cj002 /004
Ele Permit Application cE D 1:t,li OF 1: I ,d O\I.\
City of Tigard Re «i,ea /
DateB 4 . Qq Pemtit No. (kte_ CL,0 00145
B 4 2009
• 13125 SW Hall Blvd., Tigard, OR 97223 c plan Reviet
N I Phone: 503 639 -4171 Fax 503.598.1960 Date/By: Other Permit:
I 4 , 1; I . i Inspection Line. 503.639A1 75 p ReadyBy Luria, RI See
Internet. www tigard -or gov CITY OF TIGARD Nonfied/Method S upple Page 2 for
r :rdt 1 1 ' �' X n z v jhs t LS 3 . . mtDtat Information
S
❑ New construction E Addition/alteration /replacement Please check all that apply (submit a 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 ❑ Mannas and boatyards.
bt*'.,, i_ ;W:4,115'. r yti _ -' . o s s volts or Floating exceeds 10,000 amps at 150
^ t uei- , ;r�`;� '%'�!k ii �' tiii. � 4 {:
) � i > P ❑ oaring buildings
El I - and 2- family dwelling ® Commercial/industrial less to ground, or exceeds 14,000 13 Commercial -use agricultural
❑ Accessory building amps for all other installations. buildings
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
L Na,-" F'' . , 41 +: ��„s Y , ,} r T r rr q F r ❑ Emergency system. larger separately derived system
:t cv a _._z, ,_c....:., �:;,.. , ❑ Addition of new motor load of ❑ "A", "E' "1-2", "1-3",
100HPor more. °eminency
Job no.: Job site address
9 500 SW Washington Sq. Rd. ❑ Six or more residential units ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97223 ❑Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.. Project name: J.C. Penney Store 0 Service or feeder 600 amps or more
E
Cross street/directions to job site:
naerip . -5 Qty. Fes iew ■
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 _
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, „ a� =E residential
a § : :r .r "`; r a} r fir. ?„ z. .1 i gy, 75.00 2
�sz ..3v,ridz��„wiffis <� ; , f�'.� �...._,.... . , .. .. .'�. . (with above sq. fl.)
Limited energy, multi - family
Relocating 3 phone back board panels. residential (with above sq. ft.) 75.00 2
Services or feeders installation and/or relocation
200 amps or less
wh"� t v� i 's��ra:'Ls P 80.30 I 2
3}. , . _t r"5 M ` r r i• Z " k $J` 'i+- r
" =` :c?x a 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps J 160.60 2
Address:
601 amps to 1,000 amps 240 60 2
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 amp to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, er panel
�
� A. Fee for branch circuits with
is?: ` o;;"., f ?�. .y5 r. - f6 -=L.i ' a"� f -.a"s 4 r_`75
-- _ `�- *`' .ws ,, above service or feeder fee, 6.65 2
Business name:
each branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
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
Phone: dwelling, service and/or feeder 90.90 2
( ) Fax: ( ) Reconnect only 66.85 2
E -mail:
Pump or irrigation circle 53 40 2
_
4 ,'`±'_J -'�. ; ,i:k ;, N M - . i 51 , 3' ,..3` Sign or outline lighting 53.40 2
Business name: Prairie Electric dba St. Johns Electric Signal circuit(s),or limited-
energy panel, alteration, or
Address: 6000 NE 88th Street extension. Describe Page 2 - _ 2
3 75.00
City/State /ZIP: Vancouver, WA 98665 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone. ( 360 ) 693 - 5100 i Fax: (3 ) 576 - 7422
Investigation per hour (I hr min) 62.50
CCB Lic.: 60178 Electrical Lic.: - 491C Suprv. Lie.: 3562S Industrial Plant per hour 73.75
Suprv. Electrician signature, required: 1 :' i i' r
t Sutal 225
Print name: Bill erg ate: 2 - 4_2009 Plan review (25% of permit bto fee). 00
L State surcharge (12% of permit fee): 27.00
Authorized signature: (J'`T� TOTAL PERMIT FEE. 252.
Print name: Bill Ralberg \ / I Date: 2-4-2009 This permit application expires if a permit is not obtained within 180
tititi/// days after it has been accepted as complete,
• Number of inspections allowed per permit.
1 1Building\Permits\ELC- PermitApp doc 05/23/06 4404615T(11/OS /COM/WEB
02/04/2009:-09:42- FAX 3605767422 f] 003/004
-'Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
_R tri
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
❑ Other:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
E l Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
IN Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
E l Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems: 3
*No licenses are required. Licenses are required
for all other installations
I \Building/Permrts\ELC- PermitApp dot 03/23/06