Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00082
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/19/2007
PARCEL: 1512600 -00300
SITE ADDRESS: 09601 SW WASHINGTON SQUARE RD L - 1 ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: FOREVER 21
Project Description: Low voltage for HVAC.
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 JACOBS HEATING AND A/C
BY THE MACERICH COMPANY 4474 SE MILWAUKIE
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97202
TIGARD, OR 97223
Phone: Contact #: PRI 503- 234 -7331
FAX 503- 296 -5351
FEES Reg #: ELE 26- 807CRE
LIC 1441
Description Date Amount SUP 704LHR
[ELPRMT] ELR Permit 3/19/2007 $75.00
[TAX] 8% State Surcha 3/19/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notific ' Center. Those rules are set forth in OAR 952 - 001 -0010 through OAF3M52- 001 -0100. You may obtain copies of these
rules o rect quests OUNC at 503.246.6699 or 1.800.332.2344.
Iss ed By: �y?/� Q, Permittee Si re: Alrr
tom= OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
, A .. . .$ .. , (C`C '`�f e lx
Electrical Permit Application , • n `, i • hf)K f)i'i'i '1': t:si: OENLI
-17 t�
City of Tigard • , • „ Received .��i, Prrm N� � �� s 'j7 i
III
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• C Phone: 503.6394171 Fax, 503.598,1960 Ddte/BV. Other Permit
Tic n 1i r1 inspection Line: 503.639.41 r t + i 1 ` j 200 Date Ready /By lur`� HI Sec Page 2 for
Internet: www.tig,ard- ur.gov fm• Nonfted/Method. t/ /ll
Supplementnt lnrormation
;:ii! i.:M `'; :it;;l, i �1 >�l " t �lif ' ;: "'.. ;i ^ ;,„�, ' .• 1
' 14N R' l W
� New construction Additi nl g t5 W tu:em en t t t` � k all ;;
� 1
( �,l I . - Please check that apply (submit 2 errs of plans whtcros checked below):
Jam' `` ❑ Servica or feeder 400 amps or more ❑ Budding over three stones
❑ Demolition ❑ Other. where the available fault current ❑ Marinas and bodlya
'" "':i" " "' 1 .1 fL 1" '"' " 1a 7 ' " ' " , ' 1'.,'T',! " 000 amps el 130 volts or ❑ Floating buildings.
is � .•.r :;'gin b "•dl 1�i �r�i W 1 ,., n .'' , '� ' • ' •� 1 ,.� ir, • ii'•b n exceeds IU. 1 B
a1,•,.• .. ,i, 1 . _ �1�+5 �tllm:'117t't i "+Y '7 �) r ..lrll:ii.� d „ Ir• di,.�f, ��•. � I d exceeds 14,000 Commercial-use 8 u
' � ' ass to ground, or axx s 0 ❑ a titurJ1 c 1
❑ 1 - and 2- family dwelling 14 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ rife pump. ❑ Inatallmun of 75 KVA or
„ „ n �� �c Y I�` { ��y���m y �,m ❑ Emergency system. larger separately dunved system.
,i ,,. ;!,,., :ri,., `'r. i ,1'i': r
;il!1 r Yti:�r';,rr Rf:!!1- 4^'9! t4l r '>•"'^1,i,H�iM, ,. . . r.rr•if:: .: :: ❑ x f A ", "E'. "1 r. -
,•J Bi i� ,�''�: ' • ;y;,�• Addinonofbewmo� toad ❑ " 3 ",
Job no.: Job site address.C.1 - IOOHPormare occupancy.
`lam 7v.) 1, .;�1'l11► r se a 1R'� ❑ Six or more residential units 0 Recreational vehicle p4rk5•
City/State/ZIP: /State/ "LIP: (�J ❑ Health-care GLLdlut. ❑ Supply voltage for more than
y t (�a l �,� �{� 2 �� 6t10vpltn
❑ Haruduua locations.
Suite /bldg. /apt, no -: Le 4 a Mop Project name: ❑ Service or feeder 600 amps ur more -.
-- � �� y F -;,f � 1 ',,;' 1 , .,F. E •S.CAEDiVL:I''. •', ,. • . ,
Cross street/directions to job site: Dacriptiuu I Qn'• I Fat. I Toni I -
- New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: ` ` " ^ 'Lot no.: 1,00 sq R or less 14 5.15 4
�, ,��, � Ea_ add'I 500 sq, It, or portion 33.40 l
'lax map /parcel no. ; r�gy�ry� ��{) Limited energy, residential ,
. :, 't 1 1i' '.ii''i , � .Y 1,':,1 i ; ii;, �0 •�ir"�57111a!tli�TiTHAi1,IFR��, ';t' '. r �id '.: il�r�i :t ;i' (with above ft ) 75 0�
l • �:,.� , , ■i" . r b non .r. "'�• 1 r aQ.
Limited energy. multi - family 75.00 2
---\-_= jam/' I. ■'71 1rC•1 residential (with above sc1 f.)
Services or feeders installation. alteration, and/or relocation
200 amps or less 80.30 2
n . ,! •iiiiC„ .. ! ,Q.111 10, i Q1 " F( hill „1,(;I ;'' I I ', Ci!''i;ii; �; O''k'E. ?'' „ , .'' ' 201 amps to 400 amps 106.85 2
Name:. 2 1\ 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240 60 2
Address: Gjc� � ��, ° h t l� r' �r 1M L t) L 4 Kr Over 1 amps or volts 454.65 2
City /State /'LIP' '� )� T emporary services or feeders installat alteration. nod /or
Vt ,, i'd' J ��'" C r 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
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: ()ate: A. Fee for branch circuits with
11;,i, i'Il. n i, t ,j i,Iiii1�r t y ri, !i !:ii 1 r "i'! ; (. ■r��/`y.�, ;i004*;'!').; iii •,' t;,
�I(11. �•p ,•rr1:.......li.......l.N..d11 •"_.. ",J'•' � . ' ,'.I1r,.I.1',1 .. •J i r:� 4 ; i IiI1l � ..1.,.: ..i ., l above Service or feeder fa 6.65 2
each branch circuit
Business name: B Fee for branch circuits
�Ar �S \ "' -� �� 7 (Y�.. without service or feeder fee, ab•85 3
Contact name: 7 1 % first branch circuit
Address: -, �i 1 Each add'I branch circuit 6 65 f 2
2e �r -._ l�.i.��c _ll\i �1 Miscellaneous (service or feeder not included) _
- City /State /'LIP: �� f�� G'�j Z �g�"' each manufactured or modular 90 90 2
�� 1 dwelling, service and/or feeder
Phone: (5,S3) Fax: : to7-,) z_9 o ,.2c , 1 Reconnect only 66.85 2
. E - mail: �ie� 1� A Pump or irrigation circle 53.40 2
, ,;i1,11iPII;;! . ,::d''U; _ " " iLr •• r'M1.r� 7hSIn7rt 47 �p L � -- � . (I ;' A I ii(i5i. , ' . 1 q: fr'L:,I Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: ""\--_--x-- ` �/
13 c.-=,\ ` k 6 1" } 11x` energy panel, aheration, or •
Address: extension. Describe: Page 3 2
City /State /ZIP: S'-- � (� �t ' Each additional inspection over allowable in any of the above
P Per inspection 62.50
Phone: ( ) Fax: ( )
investigation per hour (1 hr nun) 62.50
CCB Lie., 1-\4 \ Electrical Lic.:',\ , Suprv. Lie.: Industrial plant per hour
p lyrr p1�ttT T r 1 73.75
:.ELECtoiL> egg E � I,u' '
Suprv. Electrician signature, required: — lr'a Subtotal. ' )
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): ( es ,(
Authorized signaturt(� 1, " TOTAL PERMIT FEE: I F T ` • ("c,
Date; / This permit application expires if a permit is nut obtained within ISU
Print name:
Y b a (Y) � ,:3) 1 Lo Lo / r71 days after It has been accepted in eumpteie.
r • Number of Inspections allowed per permit.
1 tauilrting \PunuiI4ELC- PermiiApp.dec 05/2104 . 440- 46151111,os /COM/NEa
Z0 /Z0 3Edd 9NI1V3H SSODVI LSZEETSEOS OZ :IT L00Z /9I /E0
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007- 000112
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/19/2007
Phone: (503) 639 -4171 4
Inspection Requests (24 Hrs.): (503) 639 -4175 '� Ili
INSPECTION WORKSHEET FOR DATE: 6/21/2007 TIME: 7 :03AM PAGE: 66
SITE ADDRESS: 09601 SW WASHINGTON SQUARE RD L - 1 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: FOREVER 21
DESCRIPTION: Low voltage for HVAC.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: JACOBS HEATING AND NC ItN NA\ PHONE #: 503- 2347331
Inspection Request Scheduled For: Date: 6/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 , Low voltage 050630.01 503 -234 -7331 Y
Corrections /Comments/ Instructions:
•
$PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' /1\1( Date: 6 .14. ' 1 Phone #:' (503) 718- Y
CITY OF TIGARD -.-
BUILDING DIVISION PERMIT #: ELR2007 -00082
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/19/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 -__ "'IL.
INSPECTION WORKSHEET FOR DATE: 6/19/2007 TIME: 7:01AM PAGE: 61
SITE ADDRESS: 09601 SW WASHINGTON SQUARE RD L -1 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: FOREVER 21
DESCRIPTION: Low voltage for HVAC.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: JACOBS HEATING AND NC PHONE #: 503.23' -7331
Inspection Request Scheduled For: Date: 6/19/2007 . Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 050467 -01 503.209.5614 N
Corrections /Comments/ Instructions:
%U' ® f qq 6e l a I t (44_-- O'Lt Ai o s 4 G
❑ PASS KPARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
e
Inspector: 14 52-4 ‘ 1(1 1 Date: 6 — /`1 ` D Y Phone #: (503) 718-
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELR2007-00082
13125 SW Hall Blvd., Tigard, OR 97223 = DATE ISSUED: 3/1912007
Phone: (503) 639 -4171 ill
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/15/2007 TIME: 7:02AM PAGE: 64
SITE ADDRESS: 09601 SW WASHINGTON SQUARE RD L -1 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: FOREVER 21
DESCRIPTION: Low voltage for HVAC.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: JACOBS HEATING AND NC PHONE #: 503 -234 -7331
Inspection Request Scheduled For: Date: 6/15/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 05029401 503- 2345071 Y
Corrections/Comments/Instructions:
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
AIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /(1241d4 Date: 6J 4C° . 9-- Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007- 00082
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/19/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3120/2007 TIME: 7:00AM PAGE: 213
SITE ADDRESS: 09601 SW WASHINGTON SQUARE RD L - '1 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: FOREVER 21
DESCRIPTION: Low voltage for HYAC.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: JACOBS HEATING AND /VC PHONE #: 503 - 234 - 7331
Inspection Request Scheduled For: Date: 3/20/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 045098 -01 503-234-7331 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: W — Date: .4 I fl) Phone #: (503) 718 -i b