Permit L.
CIT OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00459
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/13/2007
PARCEL: 1S12600-00300
SITE ADDRESS: 09607 SW WASHINGTON SQUARE RD L01 B ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: FAST FIX JEWELRY
Project Description: Low voltage for voice and 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:
WASHINGTON SQUARE LLC AMERICA'S PHONE GUYS
BY THE MACERICH COMPANY 1503 SE 103RD. AVE
9585 SW WASHINGTON SQUARE RD VANCOUVER, WA 98664
TIGARD, OR 97223
Phone: Contact #: PR! 360 - 904 -6782
FAX 360 - 254 -1967
FEES Reg #: ELE CLE82
LIC 174014
Description Date Amount SUP 3541LEB
[ELPRMT] ELR Permit 12/13/2007 $75.00
[TAX] 8% State Surcha 12/13/2007 $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 Not - ion ' : ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or : irect question • • U at 503.246.6699 or 1.800.332.2344.
Issue• By: / daiAltilu, 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
Received / y C 7 �s'1 57
City of Tigard Date/By / /e; 07 Permit No L i fXD
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503 639.4171 Fax. 503 598.1960 Date/By Other Permit
T I G A R D Inspection Line. 503.639.4175 Date Ready /B �° ® See Page 2 for
tc
Internet: www.tigard -or gov Notified/Method. Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® 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 stories
❑ 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 agricultural
❑ 1 - and 2- family dwelling ® Commercial /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
❑ Addition of new motor load of ❑ "A", "E", "I - ", "I - ",
Job no.: Job site address: 9607 SW Washington Square Rd. IOOHP or more occupancy
❑ 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: Fast Fix Jewelry & Watch ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: store is in the mall under the food Desenption I Qty. I Fee. I Total I •
court at the bottom of the elevator 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 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq ft )
low voltage voice & wiring Limited energy, multi - family 75 00 2
g g residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
I 200 amps or less 80.30 2
❑ PROPERTY OWNER ® TENANT 201 amps to 400 amps 106 85 2
Name: Fast Fix Jewelry & Watch Repair - Damian Flaherty 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 9607 SW Washington Square Rd. Over 1,000 amps or volts 454.65 2
City/State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (520)405 -6926 Fax: ( ) t 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: America's Phone Guys B. Fee for branch circuits
Contact name: Lois C. Cook without service or feeder fee 46 85 2
first branch circuit
Address: 1503 SE 103"" Ave. Each add'I branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Vancouver, WA 98664 Each manufactured or modular 90.90 2
dwelling, (360) 904 -6782 Fax: : (360) 254 -1967 Reconnect only service and/or feeder
Recn 66.85 2
E -mail: Lois @americasphoneguys.com Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: Americas Phone Guys
energy panel, alteration, or
Address: 1503 SE 103 Ave. extension Describe: I Page 2 75.00 2
City/State /ZIP: Vancouver, WA 98664 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (360) 904 -6782 Fax: (360) 254 -1967
Investigation per hour (I hr min) 62.50
CCB Lie.: 174014 Electrical_ Lie.: E82 Sup. . Lie.: 3541LEB Industrial plant per hour 73 75
d ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: , Subtotal 75.00
Print name: Bert Alvaro D ate: 12/12/07 Plan review (25% of permit fee). 0
State surcharge (8% of permit fee)' 6 00
Authorized signature: 40 0 (/�/) TOTAL PERMIT FEE: 81.00
Print name: Lois C. Cook 'L/ O � / �D�ate: 12/12/07 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
I \Bmlding\Permits\ELC- PermitApp doe 05/23/06 440-4615T(11/05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: El_R2007 00459
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: '121 1312007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/26/2007 TIME: 7 :06AM PAGE: 14
SITE ADDRESS: 09607 SW WASHINGTON SQUARE RD [.01 B CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: FAST FIX JEWELRY
DESCRIPTION: Low voltage for voice and data.
OWNER: WASHINGTON SQUARE. LLC. PHONE #:
CONTRACTOR: AMERICA'S PHONE GUYS PHONE #: 360.9046702
Inspection Request Scheduled For: Date: 12/26J2007 Pour Time:
Code # Inspection Description C f rinoC m -# Contact # Message
13( Low voltage 062108.01 503 -504 -3508 N
e'g9 Rohl
Corrections /Comments / nstructions:
' f \
\ 1
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G"'", Iv Q L Date: a�' `Q� Phone #: (503) 718 - ,.LfL