Permit ra OF TIGARD
CITY ®1 �IC/�R® ELECTRICAL PERMIT
PERMIT #: ELC2005 -00972
DEVELOPMENT SERVICES DATE ISSUED: 12/22/2005
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VIII: 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09321 SW WASHINGTON SQUARE RD ZONING: C -
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
Project Description: Installation of sign.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASHINGTON SQUARE LLC HIGHLIGHT SIGN CORP
BY THE MACERICH COMPANY PO BOX 23667
9585 SW WASHINGTON SQUARE RD TIGARD, OR 97281 -3667
TIGARD, OR 97223
Phone: 503 - 639 - 8865 Contact #: PRI 503 - 620 -8205
FAX 503 - 624 -3725
FEES
Description Date Amount Reg #: LIC 104599
[ELPRMT] ELC Permit 12/22/200' $53.40 SUP 517SIG
[TAX] 8% State Surcharge 12/22/200' $4.27 ELE 37 660CLS
Total $57.67 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Special • • : • . o er applicable laws.
work will be done in accordance with approved plans. This permit will expire if work is not started , ' •' :0 days of issuance, or if wor 's suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted • e Oregon Utility Notification Center. Those ru are set
forth in OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies o -se rules or direct ques • s to OUNC at 13- 246 -6699 0
1 - 800 - 332 - 2344. C Issued By: • �7 r t P = mittee Signature: ' 1. _ C
OWNER INSTALLATION ONLY r
1.01
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.
66N aoo5 —ooab°
- Electrical Permit Application FOR OFFICE USE ONE)
City of Tigard DateB� / ' __ / 1 Permit No. G /A D ' - I
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax. 503.598.1960 A if�i Date/B Other Permit:
Inspection Line: 503.639.4175 Date Ready/By la See Page 2 for —
Internet: www.ci.tigard.or.us Notified/Method KM Supplemental Information
TYPE OF WORK . PLAN REVIEW '
® New construction ❑ Addition/alteration/replacement Please check all that apply
❑ 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
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family 0 Master builder 0 Other:
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
❑Health -care facility ❑Other:
Job no.: Job site address: WASHINGTON SQUARE MALL
Submit 2 sets of plans with any of the above.
City/State /ZIP: TIGARD, OR The above are not applicable to temporary construction service.
FILE* SCHEDULE
Suite/bldg. /apt. no.:T 6 Project name: geA, n Qt . Fee. Total .. '
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 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
INSTALLATION OF SIGNAGE dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 • 2
❑ PROPERTY OWNER ' ❑ 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: branch circuit
13 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)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting t 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR , ' 3 - energy panel, alteration, or
extension. Descnbe. Page 2 2
Business name: HIGHLIGHT SIGN CORP.
Address: P. O. BOX 23667 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: TIGARD, OR 97281 -3667 Investigation per hour (1 hr mm) 62.50
Phone: (503) 620 -8205 Fax: (503) 624-3725 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: 104599 Electrical Lic.: 57SIG Suprv. Lie.: 37.660CLS Subtotal 5)' 4/ 0
/ Suprv. Electrician signature, required: 6 1SI ALC ee Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5,c,/,.. 7
Print name: �K�i C� Date: ZZ 05 f
r TOTAL PERMIT FEE 5 67 O
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tn -County Building Industry Service Board
•• Number of inspections per permit allowed
i \Bmidmg\Permns\ELC- PernutApp doe 12/03 4404615T(10/02/COM/WEB