Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT
PERMIT #: ELR2007 -00024
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/29/2007
PARCEL: 1S12600-00300
SITE ADDRESS: 09730 SW WASHINGTON SQUARE RD F -8 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: LENS CRAFTERS Low voltage: 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 GG TELECOMMUNICATION CO
BY THE MACERICH COMPANY 121SW SALMON ST STE P1
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97204
TIGARD, OR 97223
Phone: Contact #: PRI 503- 295 -2922
FEES Reg #: ELE 3907LEA
LIC 59692
Description Date Amount
IELPRMT] ELR Permit 1/29/2007 $75.00
[TAX] 8% State Surcha 1/29/2007 $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 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: 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.
E� le krical Permit ADDIPIP 04 .--D I OR of FICI l l:
()NI
of Ti and ivy Plano. No. �1 . /
`J g Date . 3q o • r 0 _ o. / �s� z`I
13125 SW Hall Blvd., Tigard, OR 97223 JAN 2 9 2007 Plan Review
Phone- 503.639 4171 Fax: 503.598 1960 _ ep:,,�, i +'`• p ig , Other Penn it
Inspection Line: 503.639.4175 CITY OF ;L: -.A' ; , , ,.I ::' l Date Ready/By ® See Page 2 for
Internet: www.ci.tigard.or.us BUILDING D!VIS,• ^ Notified/Method. Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction E[ Addition/alteration/replacement Please check all that apply:
❑ Demolition ID Other: ['Service over 225 amps, come! ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2 family dwelling Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ID Master builder El Other: ['Building over three stories 0 Feeders, 400 amps or more
['Occupant load over 99 persons II Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: 0 P K A2 ❑Healthcare facility ❑Other:
Submit 2 sets of plans with any of the above.
City/ State/ZIP: I I G Afaz Qe, The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: L s Cli - f 5 FEE* SCHEDULE
.
Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
c dwelling, service and/or feeder 90.90 2
VOICE, 1 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
/ CONTRACTOR energy panel, alteration, or
/l extension. Describe: Page 2 2
a
Business name: G G v twef Umt 64 -r7e50 (� •
Address: / Z( 51-0 SA Lt-to na SKI 7 - f - , 7 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Po e_71.444 p Oa Q 7 Z 1 Investigation per hour (I hr min) 62.50
Phone: (503 ) 2 - 9 5— 2.421. Fax: (503 285_ 0 gal? Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 596 Q L, Electrical U .:34.24 8 C Sup ic.: 1200 LEA Subtotal
Suprv. Electrician si afore, required: I . / Plan review (25% of permit fee)
Da d • : State surcharge (8% of permit fee)
Print name:
11.11.0A022 . CRA4L I - 24 - � TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board
•' Number of inspections per permit allowed.
t \Building\Pennits\ELC- PermitApp doc 12/03 440.4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard • dr
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
1 WORK 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:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of 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: - t.
*No licenses are required. Licenses are required
for all other installations
i \Buildrng\Permits\ELC- PennrtApp doc 09/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00024
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/29/2007
Phone: (503) 639-4171 ,I
Inspection Requests (24 Hrs.): (503) 639 -4175 F' i t ..
INSPECTION WORKSHEET FOR DATE: 3/16/2007 TIME: 7:01AM PAGE: 78
SITE ADDRESS: 09730 SW WASHINGTON SQUARE RD F - 8 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: LENS CRAFTERS
DESCRIPTION: LENS CRAFTERS Low voltage: Voice and Data
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: GG TELECOMMUNICATION CO PHONE #: 503295 - 2922
Inspection Request Scheduled For: Date: 3/ 1612007 Pour Time:
Code # Inspection Description Contact # Message
1 35 Low voltage 044910 -01 503.939 -6823 N
IqG
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Ct Od L Date: 3 `I O Phone #: (503) 718- 14)
•