Permit A • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00360
A I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/20/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09315 SW WASHINGTON SQUARE RD ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: HVAC, Teavana.
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 OREGON HEATING & AIR CONDITIONING
BY THE MACERICH COMPANY PO BOX 397
9585 SW WASHINGTON SQUARE RD DUNDEE, OR 97115
TIGARD, OR 97223
Phone: 503- 639 -8865 Phone: 503 -538 -2953
Reg #: ELE 522LHR
LIC 125815
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/20/200E $75.00
[TAX] 8% State Surcha 10/20/200°. $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 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.
Issued By: D :ZQ 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.
Oct 19 05 03:12p 503 - 537 -2172 p.1 •
• •11.
y Electrical Pe Application (' F ' ' " 1 y" " _
Date received:// d 9 5 Permit no.:� Q f , a 4 II
Aj,',411_. City of Tigard V Project/appl. no.: 1 7 Expire date:
City of Tigard Address: 13125 SW Hall 1 1 r R 9 Date issued: By: Receipt no.:
Phone: (503) 639 -4
Fax: (503) 598 -1960 OCT 19 2005 Case file no.: 'f Payment type:
Land use approval: CITY OF TIGARD
. 11 . PIE Of PER%IIT
•
❑ I & 2 family dwelling or accessory priZornmercial/industrial ❑ Multi - family 0 Tenant improvement
❑ New construction Cl Addition/alteration/replacement 0 Other. ❑ Partial
JOR sun: INFORM:1TION
Job address: dr S Q7 ! f Si Bldg. no.: Suite no.: Tax map /tax lot/account no.:
_ Lot: 'I Block: Subdivision:
Project name: I y- [Description and location of work on premises: Ri
Estimated date of completion/inspection:
CONTRACTOR :APPLIC:ATION FIT•. SCHEDULE
Job no: Fee Max
Business name: ORe n n-1 r a 4 Rlc, (( _ � Description Qty. (n) Total no.insp
Address: ^,`7 New residendal-single ormuh5- family per
yQ X q dwellingunit lecludesattachedgarage.
City: eT)A K {d_e t? I State: O'_ I ZIP: Crf 1 j Service included:
Phone: 5 8T_)953 Fax: .57_..)l1 E -mail: 1000 sq. ft or less 4
CCB no.: 1n-. S I Elec. bus. lie. no: S L%-1tZ Each additional 500 ft. or portion thereof
Limned energy, residential I i 2
ert . IIO. a� Limited energy, non-residential 2
Each manufactured home or modular dwelling
signer ure n ing e lectrician (required) Date • Service and/or feeder 2
Sup. elect name (print): dik1nt t F} License no.4 t �� a lte r s Services location:
llation,
a lteration orre locat
PROPERTY OWNER 200 amps or less 2
Name (print): Ten-YAW (} 201 amps to 400 amps 2
401 am.- to 600 amps 2
Mailing address: ,rj .21,..0 L 11 601 amps to 1000 amps 2
City: /r State° : y1�Z Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, akeration ,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
' 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps I 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of -
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail of service or feeder fee, first branch circuit: f 2
Each additional branch circuit •
PLAN REVIEW (Please check all that appl)) misc. (Service or feeder not included):
O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of 1&2 ❑ Hazardous Location Each sign or outline lighting 2
family dwelling Cl Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* I 2
❑ Building over three stories Cl Feeders, 400 amps or more • Descri.tion:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other: Per inspection I I I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other fT� ���
Not all j urisdictions accept credit cards, please call jurisdiction for more information. Notice: This Permit fee S t J. �Jl/
p i permit application
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number. _ __ _ / / - within 180 days after it has been State surcharge (8%) S
__ t ` y ' rC7 accepted as complete. TOTAL S
— Name of cardho e s shown on credit a
S
Cardholder signature — Amount - 4404615 (6/130:CO1‘1)
... ,,,e_ e y -N.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00360
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2005
Phone: (503) 639 -4171 A I l
Inspection Requests (24 .): (503) 639 -4175 °__..
INSPECTION WORKSHEET FO' DATE: 11 /18/2005 TIME: 7:17AM PAGE: 93
SITE,ADDRESS: 09315 SW WA` INGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON `0UARE LOT #: TYPE OF USE:
PROJECT NAME: TEAVANA
DESCRIPTION: HVAC, Teavana.
• OWNER: WASHINGTON SQUARk LLC, PHONE #: 503 -639 -8865
CONTRACTOR: OREGON HEATING & Al ' CONDITIONING PHONE #: 503- 538 -2953
Inspection Request Scheduled For: Date: 11/18/2005 Pour Time:
Code # Inspection Description • onfirm # Contact # Message
199 electrical fy 02' 793-02 503- 538 -2953 Y
Corre_Qtions /Comments /I s:
• CA> 1 fi
CI
•
F■ PASS ❑ PARTIAL APPROVAL . ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: a 1 V Date: It I Phone #: (503) 718 2 4)
f