Permit v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2013-00222
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/05/2013
Parcel: 1 S 126C 600500
Jurisdiction: Tigard
Site address: 9300 SW WASHINGTON SQUARE RD
Project: Macy's Subdivision: FAIRVIEW PLACE CONDO Lot: 20
Project Description: Data telecommunications system.
Contractor: CALLAHAN ELECTRIC Owner: MACY'S DEPARTMENT STORES INC
4830 SE CONG ST ATTN:TAX DEPARTMENT
PORTLAND,OR 97206 7 WEST SEVENTH ST
CINCINNATI,OH 45202
PHONE: 503-421-4553 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/05/2013 $75.00
12%State Surcharge-Electrical 09/05/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.234
.
Issued By: ./L , �� i_- 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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available Inspection date.
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 i t 1 It I 1 i I-I( r. 1 '•;1- i 1\1.)
City of Tigard Rertived is,,,_ (3 _ Permit No.: ,._[e.20,j-,
y •' Plan Review Permit: .
13)25 SW Nall Blvd.,Ti Tr•, - Other
• Phone: 503.718,243' ex: 503.598.1'. e t7atdBy'
�� 3uFs: See Page 2 for
Inspection Line: 503...'.4175 •'."...- A`�) Date Ready/By �
l c ',i'.f'> ►. S%NotifiedIMCthad Suppleroeatal lnfermatioa
Internet: www.tigard-or.gov •
TYPE OF WORK`' ' �%.. � I PLAN REVIEW
�^ __,,tt Please cheek all that apply(submit 1 sets of plans w/items checked below):
❑New construction Addition/alteration/replackik ' `f •:• (�Service or trader 400 amps or more ❑Building over three hones.
❑Demolition ❑Other \`� where the available Fault current ❑Marinas and boatyards.
CATS RY OF CONSTR exceeds 10.000 ernes at 150 volts or ❑Floating buildings.
`� leas to ground,or exceeds 14.000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling Eommercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Other: CI Fire ptm1P. ❑Installation of 150 KVA Of Multi family ❑Master builder 9 Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition anew motor load of ❑-A"°E""1-2^"1.3",
100HP or more. occupancy.
Job no.: Job site address: r u( S(� �uSut •
❑Six or more residential units. ❑Recreational vehicle parks.
` � 'p (� 7 ^� l [�Heallh care facilities. ❑Supply voltage for more than
City/Stine/ZIP:IP: T 'P f 1 1, `1 7 ❑Hazardous locations. 600 vo1La nominal.
&/ Project name: �/I `5 ❑Service or feeder 600 amps or more.
Suite/bldg./apt.apt.no.: I y L FEE gCRgDIDLg
Cross street/directions to job site: tx ertintee 1 Ott. I F... l T°W I •
( 1 I, C et New residential single-or toulti-fatally dwelling unit.
�j �{ 7 (, ?j-f L includes attached garage.
Subdivision: Lot no.:
1,000 sq.It.or less 168.54 4
- - Ea.add'1500 sq.R.Or portion 33,92 I
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRiFTION OF WORK (with above sq.ft.)
Limited energy,multi-family n14,-):-- WI ?j 75.00 2
residential(with above sq.ft.) 1
5n14,-) / 4 Renewable Energy ❑ See Page 2
_ I /, Services or feeders insta latioIhakeratlon.and/or relocation
J
❑ PROPERTY OWNER 1 ❑ TENANT 200 amps or less 100,70 2
201 amps to 400 amps 133.56 2
YName: y r,1 r c 401 amps to 600..._amps 200.34 2 I
Address: 601 amps to 000 amps 301.04 2
-- Over 1.000 amps or voles 552.26 2
City/State/ZIP: Temporary services or feeders igetallation,alteration,and/or -
relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 I
Owner installation:This installation is being made on property that I own which is not '201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extensionper panel
❑ APPLICANT 1 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, ,
2
• y each branch circuit
Business name: B.Fee for branch circuits without
Contact name: service or feeder fee,fast 56.18 2
branch circuit
Address: -Each add'I branch circuit 7.42 I 2
Miscellaneous(service or feeder not Included)
City/State/ZIP: Each manufactured or modular 67.84 2
—1 duelling,service and/or feeder
Phone:( ) Fax::( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2 y
Business name: ,� / � / Signal circuits)or limited-energy 1 yen
. Z Z L/�''�_ _ _panel,alteration,or extension, ` Pale 2 2
Address: v 3 u , .ia ce./ S f s Each additional in pection over allowable in any of the above
�� �� � Additional inspection(1 hr min) 6625/hr
City/State/ZIP: ` Investigation(1 hr min) 66.25/hr
_ _Industrial plant(1 hr min) 78,18/hr
Phone: fit )L � Fax:( ) n s for which no h fee is
571_!/S 90.0(1/hr
CCB Lic.: 1�nr.lectrical Lic.: • 0 Suprv.Lic.: -s 11 E(4IECTRiCAL PERMIT FEES
Suprv.Electrician s1i. at• r•,required: Subtotal: 7 S
-- — 1 ,1 I A �n Date: —_ Plan review(25%of permit fee):
Print name: Lj,il t,�►/'` L� State surcharge(12%of permit fee); /
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after It bas been accepted as complete.
Number of inspections allowed per permit.
1:18uildirePermitslnLC-PermitApp PL1t ERE.40c Rev 05/21/2013 446401 ST(11(05/comnvea
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
REi81ElaENTIA .WORK ONLY: =MULE •
Fee fora residential systems combined.. $75.00 Description Con. l i1 Total 1 •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100,70 2
5.01 to 15 kva 133.56 2
El Audio and Stereo Systems* -15.01 to 25 kva 200,34 2
Wind Aeneratloo systtms In excess;0 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kve 552.26 2
>l00 kva(fee in accordance with 552.26 2
OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning
Solar generation systems in excess of 25 1cvs:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 br min)
Inspections for which no fee is 90.00/br
speciftcally listed('h br min)
COMMERCIAL WORK ONLY: ELBA, twat FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review.if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires N a permit
is not obtained witbta ISO
❑ Audio and Stereo Systems dap after It Ins boos accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
El 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
t:lBultdineennitaLC PamltApp ELR_ERR,doc Rev 0515 112013