Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
r l DEVELOPMENT SERVICES PERMIT #: ELR2005 -00245
cal I l DATE ISSUED: 8/24/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09329 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Limited energy, HVAC wiring.
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 ARROW MECHANICAL
BY THE MACERICH COMPANY 10330 SW TUALATIN RD
9585 SW WASHINGTON SQUARE RD TUALATIN, OR 97062
TIGARD, OR 97223
Phone: 503- 639 -8865 Phone: 503- 692 -1565
Reg #: LIC 5193
ELE 34 -47CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 8/24/2005 $75.00
[TAX] 8% State Surchart 8/24/2005 $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 R 9 -0;0 F0 0. You may obtain copies of these rules or direct question/ UNC at 503 - 246 -6699.
Issued y: Permittee Signature , // .
OWNER INSTALLATION ONLY /6P
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 caret 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 Peentit'Application , Folz OFFICE USE ONLY .
ecei �
City of Tigard DateB ved ��rA'1 Permit No. _,....t._ ' „ .000,024/5". .000,024/5". 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /ia na C r w {.I R `'- Date/B Other Penna.
Inspection Line: 503.639.4175 ='I I - Date ReadyBy 'tads: See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
TYPE OF WORK • PLAN REVIEW
] New construction ❑ Addition/alteration/replacement Please check all that apply
m
/❑ Demolition ❑Other: ❑Service over 225 amps, com'I ❑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 ❑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 0 Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: 93 2,9 W ,li 5 Rp ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State/ZIP: 7 / (,.AAO 0 q? Z 2-3 The above are not applicable to temporary construction service
/
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: 5 Er°H6 ',Z. Description Qtr. Fee* Tam ••
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 I
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Lv ) Yo-. '1 SEAT , C rl.cg/�,E _ dwelling service and/or feeder 90.90 2
����C.-7'U4.- 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 I ❑ CONTACT PERSON . A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: A,4,40,.., N &U•r branch circuit
B. Fee for branch circuits
Contact name: T €itiz,rj F/ without service or feeder fee, 46.85 2
lJ4-LA r/ / 4.0 Each a branch a branch it
Address: (0
�O Sw T Each add'I branch circuit 6.65 2
City/State/ZIP: rv/ac.,p =-B j , OA q-7-06, . Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( mss a ) 6,17_, /5-& Fax:: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circult(s) or limited -
CONTRACTOR energy panel, alteration, or
• extension. Describe: Page 2 2
Business name:
..rte.
Address: A izAU z r Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Investigation per hour (I hr mm) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: S / 9 3 Electrical Lic.: 34 /... 547Ci Suprv. Lic.: Subtotal 75.0 0
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) • 41PC7
Print name: Date: -
TOTAL PERMIT FEE g1, v
Authorized signature: � This permit application expires if a permit is not obtained within 180
2� di days after it has been accepted as complete
Print name: Ai 40 Date: • Fee methodology set by Tri- County Building Industry Service Board
L Number of inspections per permit allowed.
I \Buildmg\Permits\ELC- Pnmi1App dos 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL' WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: T
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total-number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\ Budding\Permits\ELC- PermitApp doc 04/03
•
CITY OF TIGARD :
BUILDING DIVISION PERMIT #: ELR2005- 00245.
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/24/2005
Phone: (503) 639- 4171 �n
Inspection Requests (24 Hrs.): (503) 639 -4175 IL
INSPECTION WORKSHEET FOR DATE: 11/W2005 TIME: 7:00AM PAGE: 108
SITE ADDRESS: 09329 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: SEPHORA
DESCRIPTION: Limited energy, HVAC wiring.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503- 639 -8865
CONTRACTOR: ARROW MECHANICAL PHONE #: 503- 692 -1565
Inspection Request Scheduled For: Date: 11/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
13 Low voltage 020549-01 503 -692- 1565 N
Corrections /Comments /Instructions:
•
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: <s - Date: P hone #: (503) 718-