Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
err^ DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00417
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/17/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09312 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Data/Telecommunication.
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 OES LLC
BY THE MACERICH COMPANY 5285 NE ELAM YOUNG PKWY # A600
9585 SW WASHINGTON SQUARE RD HILLSBORO, OR 97124
TIGARD, OR 97223
Phone: 503- 639 -8865 Phone: 503- 693 -6000
Reg #: LIC 159395
ELE 34 -572C
FEES SUP 4587S
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/16/200E $75.00
[TAX] 8% State Surcha 11/16/200E. $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: � � � 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.
I'
Nov 16 05 01:07p Jim ± Judy Bunce (503) 693 -8660 p.
'.le Permit A R ( � �rIVED / ■ FOR OM(: E 1_ SE 0:1 L 1' J) n
City of Tigard
tl u� °° ved _/ I D� ' Permit No.: l 'D V I
13125 SW Hall Blvd., Turd. OR 97223 , 1 P "
Phae►e: 503.639.4171 Fax: 503.5911.1944p U L oO� " r
ltupeci on Line: 503.639.4175 .12_ Dam neatly/By: � St ts See page i for
e 2 for
Internet www.d.tigtud.orats Notibed/hietbod Innituuttion
"1T1� �G -ji(,ARD - PLAN REVIEW ION
Please check all that apply: [] New oottstrueYion dition/alteratiodrt lemma ['Service over 225 amps, commis ['Hazardous location
❑ Demolition ❑ Other: 0Strvice over 320 amps - rating ❑Bunking over 10,000 sq. R,
of L and 2- family dwellings 4 or most new residential
CATEGORY OF CONSTRUCTION ❑�� over 600 volts nominal units in auc ��
❑ 1- and 2-family dwelling (� Commercial/industrial ❑ Accessory building ❑Feeders, 400 amps or more
['Budding ova three stories
❑ Multi - tinnily ❑ Master builder 0 Other. E30ocapeot load over 99 persons ❑ Manlieeoad 4nechhrts eu RV JOB SITE INFORMATION AND LOCATION ❑Egcsslli@htifl 8 ❑��
_ D /V ❑Hcalth.careI facility Job 110.: fj D2 S ` id) Site address: 7 7 W/ !�N 5 H N G t Submit 2 acts aliens with any of the above.
City/StateJZ1P: .50c A e E The above are not applicable to tamponuy construe service.
z j FEE* SCHEDULE
Suit I. dg/apt no.: W 3 ] Project name: P/ A y J EI J L.fRS ue, Qw. I fee. To1e 1 ••
Cross Mt:et/directions to job site: ; S / A) G j 0 AI ti A i 4 F New r et ideetial single - or multi-508y dwelling unit
jii Includes attached garage.
S/ t o tl p e i N G E Ai E 1,000 sq. 8. or less 145.45 4
Subdivision: I
Ea. add/ 500 sq. IL or inaction 33.40 t
Lidded energy, residential 75.00 2 :
Tax map/parcel no.: Limited energy, ma- residential _ 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder
Services or feeders installation, alteration, and/or relocation
200 amps or less 5030 2
❑ PROPERTY OWNER I ❑ TENANT 201 apps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Over 1000 amps or volts 454.6
2
Address: Reconnect only 66.85 2
City lP . - Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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, adding to ORS 447, 449, 670, and 701. 401 600 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, Per panel
T PERSON A. Foe for branch circuits with
ID APPLICANT ❑ CONTACT service or feeder fen, each 6.65 2
bran& circuit
Business name: B. Fee for branch euarits
Contact name: without service or feeder Fee, 46.85 2
each branch a ircuh
Address: Each add? branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation code 53.40 2
Phone: ( ) l Face : ( ) Signor outline lighiMg 53.40 2
E-mail: Signal circuit(s) or limited-
CONTRACTOR ACFOR energy panel, alteration, or 2
extension. D=Ibe: Q ES L A - a I '75.06)
Business name: !� t/ /�
Address: 52 es )0E F_ i A m ` 0 (,e r0 6 / J� / e p !` wi f t / E Fch inspection over allowable of the above
Caj/StaiclZW: H I [...Ls 61,120 (")(Z. 9 7(2 q 5 ctii re A G.0 raga per boor brono) 6230
p `� ' Fax: (503) [ 9 3 — 8 6.I a Industrial plant Per hour 73.75
Phone: (503) ! — l0 1� 0 0 1 ELECTRICAL PERMIT - FEES*
CCB Lie.: ( r9 3 9 Electrical Lic.: 31 72. Supev. 'c.: 7/2 Subtotal 7 S , CO
Super_ Electrician signature, requited: — i Plan review (25% of pe,mit fee) 'l
/ state surcharge (8 %of Permit fee) l0 . C
Print n8[nee ��Y u e: /0 TOTAL PERMIT FEE... 8 o v
Authorized signature: Thus permit application empires if a permit B not eh a ed w i th in 180
days after it bas been accepted ere complete
Date: • Fee methodology art uakim=
by Trly Hbadostty Setviae Bawd
Print name: U Number ofio onsoer=unit allowed.
1