Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00171
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/26/2008
PARCEL: 1512600 -00300
SITE ADDRESS: 09567 SW WASHINGTON SQUARE RD B03 B ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: FRED MEYER JEWELERS
Project Description: Installing (1) low voltage audio system.
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:
WASHINGTON SQUARE LLC A & A ELECTRICAL CONTRACTORS INC
BY THE MACERICH COMPANY 1588 SKY TERRACE
9585 SW WASHINGTON SQUARE RD SALEM, OR 97306
TIGARD, OR 97223
Phone: Contact #: PRI 503- 949 -3193
FAX 503- 378 -9085
FEES Reg #: ELE 36 -38C
LIC 153711
Description Date Amount SUP 3769S
[ELPRMT] ELR Permit 6/26/2008 $75.00
[TAX] 12% State Surch 6/26/2008 $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 • OUNC at 503.246.6699 • .800.332.2344.
Issued B . � _ � 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'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.
Electrical Permit Application At. � FOR OFFICE USE ONLY
City of Tigard e v� ennit No /
13125 SW Hall Blvd , Tigard, OR 972 �, Date/B . "`rte
g ��l Pl an R eview
' I I Phone. 503 639 4171 Fax 503 598 1 0 w \ tj `� ,' ;t e/gy, Other Permit
T 1 G n R D Inspection Line 503 639 4175 ,� \v (i , eady /By i See Page 2 for
Internet: www tigard - gov ` I\`+� �j ° ethod -ts 0 Supplemental Information
TYPE OF WORK a N b y` PLAN REVIEW
❑ New construction Addition/alteration/Obi—rent P lease check all that apply (submit 2 sets of plans s checked below)
❑ Service or feeder 400 amps or more ❑ Building ing over three stories
❑ Demolition ❑ ther: 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 ommercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
0 Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: I Job site address: 09, s6 . 7 s'c/ , 5 h / � 't 100HP or more occupancy
❑ Six or more residential units ❑Recreational vehicle parks �. City/State /ZIP: "�� ; , Lca_ ❑ Health -care facilities ❑ Supply voltage for more than
( 1 4 l at ❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: 1303 , Project name: f " J l a ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: ,/ Sp U.1
Description I Qty. I Fee. I row I •
"ti 7 c New residential single- or multi- family dwelling unit.
e )L'( Y.s1.e a . Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 145 15 4
Ea add'l 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 )
7 Limited energy, multi - family 75 00 2
df f b 51/574Y7 residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER I V TENANT 201 amps to 400 amps 106 85 2
Name: 401 amps to 600 amps 160 60 2
r 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: ( ) ] 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, er panel
A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
/bit- each branch circuit 6.65 2
Business name: ,Gem (. B. Fee for branch circuits
Contact name: without service or feeder fee 46 85 2
first branch circuit
Address: Each add] 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: ( ) 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: 1-1-1- el. / 04: r ( 0. energy panel, alteeratiodo n, or
Address: / J
63c 7 , - Je ^ _ `� („e. C, extension Describe: Page 2 - 2
City/State /ZIP: 5 4 (- � � u2 � a o al-, 9 73 Q 4 Each additional inspection over allowable in any of the above
�` � Per inspection 62 50
Phone: ( ) 3 ) 9 ({9 _ z / 9 3 Fax: ( - 3 ) D 7 F ?o ' S _ Investigation per hour (1 lir min) 62.50
CCB Lie.: / S37f ( Electrical Lie.: 36,- Suprv. Lie.: 376 215 Industnal plant per hour 73 75
ELECTRICAL PERMIT FEES
rv. E lectrician signature, required °v
Su
p g 9 Subtotal. !I
Print name: Date: Plan review (25% of permit fee).
J � State surcharge (12% of permit fee). 9
Authorized signature: TOTAL PERMIT FEE SL
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit
1 \Budding\Permits\ELC- PermiApp doe 05/23/06 440 -4615T(11 /05 /COM)WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information -
LIMITED ENERGY PERMIT FEES:
FRESIDENTIALWORK'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:: : -. 71
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type Work Involved:
Audio 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
1 \Building\Permus\ELC- PermttApp doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: El-R2001100171
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2612008
Phone: (503) 639 - 4171+4
Inspection Requests (24 Hrs.): (503) 639-4175 ...'.
INSPECTION WORKSHEET FOR DATE: 6/27 /2008 TIME: 7:01AM PAGE: 26
SITE ADDRESS: 09567 SW WASHINGTON SQUARE RD 603 8 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: FRED MEYER JEVNELERS
DESCRIPTION: Installing (1) low voltage audio system.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: A & A ELECTRICAL CONTRACTORS INC PHONE #: 503 -949 -3193
Inspection Request Scheduled For: Date: 6/27/2008 Pour Time:
Code # Inspection Description Co firm -# Contact # Message
v
135 Low voltage 07192(1.01 503-949-3193 N
Corrections /Comments /Instructions: /
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • i v Ve U Date: 4 2 t )ft1 O Phone #: (503) 718-
•