Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00382
--- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/1/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09329 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 FIVE STAR ELECTRIC, INC.
BY THE MACERICH COMPANY PO BOX 555
9585 SW WASHINGTON SQUARE RD BANKS, OR 97106
TIGARD, OR 97223
Phone: Phone: 503 324 - 0948
Reg #: ELE 34 -665C
LIC 158231
FEES SUP 4622S
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/1/2005 $75.00
[TAX] 8% State Surchart 11/1/2005 $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 OAR 952- 1- 100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: i! iL� Permittee Signature: 1)7 411004 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.
I'
�ectrical Permit App q ' ( 1EI®�E® FOR OFFICE USE ONLY
,}-+• ��,JJ tltl Received
It, of Tigard o� �8 • Permit No i
i/ , 5 Od� ±�
Date /B / D
13125 SW Hall Blvd , Tigard, OR 97223 OCT 4 200 Plan Review 5 ..
Phone 503 639 4171 Fax 503 598 1960 LJI. •? ) Dat /B
Other Perim ' (� . ' 5
I `� �
Inspection Line' 503 639 4175 _Ai, -`i I Date Ready /By lulls - See Page 2 for
Internet www ci tigard or us CITY OF T -. ' '1. Notified/Method Supplemental Information
N
6a 91742eRMIC PLAN REVIEW
❑ New construction .4ddition/alteration /replacement Please check all that apply
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps - rating ['Bulldog over 10,000 sq ft ,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ I - and 2- family dwelling commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Other: ❑Budding over three stories ❑Feeders. 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
C1 ❑Health -care facility ['Other. lob no.: �S3IZ Job site address: �� w� Submit 2 sets of plans with any of the above
City /Slate /ZIP' l � GSp /Q The above are not applicable to temporary construction service
Suite bldg /apt. no : Project name FEE* SCHEDULE
�(\� � Desenpnon I Qty. I Fee. I Total I -
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
Limited energy, residential 75 00 2
Tax map /parcel no.. Limited energy, non - residential 1 75 00 7500 2
DESCRIPTION OF WORK Each manufactured or modular
LID, _ dwelling, service and/or feeder 90 90 2
w Dt.1K� e1 L ,,.�_
fit' Services or feeders installation, alteration, and /or relocation
�J
P . f a_. f ` 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 ❑ 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,
Address: -
each branch circuit 46 85 2
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 -
CONTRACTOR energy panel, alteration, or
extension Describe. Page 2 2
Business name: Five Star Electric, Inc.
Address: PO Box 555 Each additional inspection over allowable in any of the above
Per inspection 62 50
City /State /ZIP: Banks, OR 97106 . Investigation per hour ( hr min) 62.50 I
Phone: (503) 324 -0948 Fax: (503) 324 -0973 Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES*
CCB Lic. 158231 Electrical Lic s �34 -665C Suprv. Lic.: 4622C Subtotal •7
Supry Electrician signature, required' - ,� Plan review (25 %ofpermit fee)
�� (} �� I �i s4. -i ea t i J Date: 1 OI State surcharge (8% of permit fee)
Print name: I
" GN l l �1 ✓ TOTAL PERMIT FEE
Authorized signature' This permit application expires if a permit is not obtained within 180
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 \Budding\Penruts\ELC- PermitApp doc 12/03 440- 4615T(I0 /02/COM/WEn
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00382
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/1/2005
Phone: 639 -4171 , (+�
Inspection Requests (24 Hrs.): (503) 639 -4175 �'!! "'I L .
INSPECTION WORKSHEET FOR DATE: 11/7/2005 TIME: 7:05AM PAGE: 17
SITE ADDRESS: 09329 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: SEPHORA
DESCRIPTION: Data/telecommunication.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: FIVE STAR EL ■TRIC, INC. PHONE #: 503 - 324 -0948
Inspection Request Scheduled For: Date: 11/7/2005 Pour Time:
Code # n • - on Description Confirm # Contact # Message
ow v to 020485.01 971-246-0351 N
• - - : - : la ments/ I nstru ons:
•
/
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS'
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C"AQ- Not ` • Date: \ � 'Q Phone #: " (503) 718- 244 •