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Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT I� DEVELOPMENT SERVICES PERMIT #: ELR2005 -00366 . ,— 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/21/2005 PARCEL: 1S12600-00300 SITE ADDRESS: 09302 SW WASHINGTON SQUARE RD ZONING: C -G SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG Project Description: HVAC low voltage. 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 HVAC INC BY THE MACERICH COMPANY 5188 SE INTERNATIONAL WAY 9585 SW WASHINGTON SQUARE RD MILWAUKIE, OR 97222 TIGARD, OR 97223 Phone: 503 639 - 8865 Phone: 503 462 - 4822 Reg #: LIC 50897 ELE 26 -571 CLE FEES Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 10/21/200f. $75.00 [TAX] 8% State Surchart 10/21/200f. $6.00 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 fo • ru - adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throug OAR 952 -06 :1;e. You may obtain copies of these rules or direct question to OUNC at 503-246-6699. Issued :y: / • ' 4 Permittee Signature :)( j L 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. RECEIVED Electrical Permit Application mull OI:FR I: t tii: 0.1.1 City of Tigard ocT 2 1 2005 A Received `� at v5 i Permit No.. y _o __co 13125 S Hall Blvd., Tigard, 9722 • 1 Y Ur - I ILiWHU P lan eW / /h - Phone: 500 3.639.4171 Fax: 50303 .598. Date/B . O t h er P etmir: i r a^• _Po 7 Inspection Line: 503.639.4175 3 ILDING DIVISI4L, jl • Date Ready/By.. Jw ® See • age 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information - ' - •... • TYPE' OF WORK - , - ,: ' �: _ " : ' : _ •, • -PLAN, REVIEW ". Y � .r „ ❑ New construction ❑ Addition/alrtiot>lteplacement Please check all that apply: El Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., - • ' - - . CATEGORY. OF CONSTRUCTION - - - of 1 -and 2 -family dwellings 4 or more new residential ❑ I and 2 family dwelling .1aCommercial/industrial ❑ Accessory building El System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or • : •- ' -: JOB SITE'INFORMATION AND LOCATION -- . - - - - g h g plan t1 Ian RV park no.: Job site address: 930 -- Sw c ,,,,,LS £ ❑Health -care facility ❑der. Submit 2 sets of plans with any of the above. City/State/ZIP: ✓ yG/r ct Dv - !m The above are not applicable to temporary construction service. �� : , FEEt SCIEDULE 1 - •_ q < : „' : -: , , • i . Suite/bldg. /apt. no.: v _ 5 / Proje name:. 0. ?�� Description Q,y, Fee. w To •• Cross street/directions to job site: dd 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 I 1 dwelling, service and/or feeder 90.90 2 In'`Q_ \A) �` S1- Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ••,, . = - .:. ❑ PROPERTY :OWNER''-' -' • ' - - El . .. '. ,. , • 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 I 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 . • • - ' I - ❑ 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, each branch circuit 46.85 2 Address: Each add'I branch circuit 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax : ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- - energy panel, alteration, or extension. Describe: / Page 2 2 Business name: 14t) 4c_. -r/,c. Address: S1 $g ,, a '4 (,v Each additional inspection over allowable in any of the above nui Per inspection 62.50 City/ State/ZIP: t cuter, (IL, ©rte Investigation per hour (I hr min) 62.50 Phone: ( ) 4 ( . J . . ( $ ).2 Fax: ( 4(0=1 -1055 Z Industrial plant per hour - 73.75 :ELECTRICAL PERMIT FEW., - :k': CCB Lic.: 5 ci 7 I Electrical Lic. 7/ eli Suprv. Lic.: orz ,l9 Subtotal , — - Suprv. Electrician signature, required: �� 7j7 0 Plan review (25% of permit fee) — Print name: 4.4_, C O S C be /24 Date: CO State surcharge (8 %ofpermit fee) 6 _ TOTAL PERMIT FEE Authorized signature: � � OL �,'■ This permit application expires If a permit is not obtained within 180 days after it has been accepted es complete Print name: '1, v __,,,, ,r, � t l_NlS Date: 1o/ / � /o3 • Fee methodology set by Tri County Building Industry Service Board ( • • Number of inspections per permit allowed i\ Building Wmnita\ELC- PamitAppdoe 12/03 4404615T(i602/COM/WFB CITY OF TIGARD BUILDING DIVISION PERMIT #: ELR200S -00366 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/21/2005 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 ' ^'.. INSPECTION WORKSHEET FOR DATE: 11/16/2005 TIME: 7:03AM PAGE: 78 SITE ADDRESS: 09302 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINTO\ SQUARE LOT #: TYPE OF USE: PROJECT NAME: RAG DESCRIPTION: VAC low voltag- OWNER: WASHINGTON SOU RE LLC, PHONE #: 503-639 -8865 CONTRACTOR: HVAC INC PHONE #: 503- 462 -4822 Inspection Request Scheduled For: Date: 11/16/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Low voltage 021397 -01 503462 -4822 Corrections/Comments/Instructions: • • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: -A Q N-(56/4: L4 Date: u(113(66 .Phone #: (503) 718- La o