Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'has l DEVELOPMENT SERVICES PERMIT #: ELR2005 -00273
cal II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/12/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09330 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Low voltage for HVAC
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 HVAC INC
BY THE MACERICH COMPANY 5188 SE INTERNATIONAL WAY
9585 SW WASHINGTON SQUARE RD MILWAUKIE, OR 97222
TIGARD, OR 97223
Phone: 503- 639 -8865 Phone: 503 - 462 -4822
Reg #: LIC 50897
ELE 26-571CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 9/12/2005 $75.00
[TAX] 8% State Surcharl 9/12/2005 $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
star -: Y i 80 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
yo, to follow rul- adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
th ough OAR 952- 1 O. ou may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Iss► -d By: Permittee Signature: tt�A u �j Vyto7n--i
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.
Electrical• Prmit Application FOR OFFICE USE ONLY
City of Tigard Received G / QS
Date/By 7 Permit No . E S. 3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503 639 4171 Fax: 503 598.1960 A Date/By Other Permit
Inspection Line 503.639 4175 Date Ready/By /W u /► El See Page 2 for
Internet: www.ci tigard.or.us Notified/Method �L - Supplemental Information
_ .. - • �3 :a ;TYPE; O WRI(
F' O. _ - •:'- . , ,, y,: _•' P PLAN...REVIEW
❑ New construction 0 Addition/ teratio Please check all that apply
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
Service over 320 amps - rating ❑ Buildng over 10,000 sq ft ,
. - = CATEGOR '2 OF CONSTRUCTION •'' „ :' - `• I"_ 1;, _ of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwellin �al] Commercia dustrial ❑ Accessory building ['System over 600 volts nominal units in one structure
—
❑ Multi family Master builder ❑ Other: ❑Building over three stones ❑Feeders, 400 amps or more
Y ❑Occupant load over 99 persons ❑Manufactured structures or
° ,.a =; - -- JOB SITE INFORMATZON LOCATION `s, ❑Egress/lighting RV park
Job no. .3%6 Job site address: 9330 Sco teast,s6 Rd ❑Health -care facility ['Other
Submit 2 sets of plans with any of the above.
City/State /ZIP: 7,- A J 0 V .C/Y1 ' The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: Projec ame: ., FEE* •'SCHDiJ
ELE
Description I Qty. I Fee. I 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'l 500 sq. ft or portion 33 40 1
Limited energy, residential 75 00 2
Tax map /parcel no.:
Limited energy, non - residential 75 00 2
tir :;K ; - _ , , •;DESCRIPTION OI? WORK ' .' tT- :. • - - .; Each manufactured or modular
/ j dwelling, service and /or feeder 90 90 2
L ozA_.) 110 I 1/4T-ei . Luuv 1_4.‘ 1_4.‘ 4 "1 k.4i_JL nic ;V?Aj � Services or feeders installation, alteration, and/or relocation
1l� - J Q nQCe_ c o U 200 amps or less 80 30 2
^,-..1-,- . ❑ l 1 -PRQ,P E RTY OWNER ' ?° "::', ' .-i".;`'-'' '4' - :..-.'-,,,•• , 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
1;,. : ,: : ,APPLIC'ANT', ia', ?( :4e; . PERSON ..,k� -' -
.. A Fee for branch circuits with
a ,4. . .: a^ - 'fib service or feeder fee, each 6 65 2
Business name: branch circuit
B 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)
Phone: ( ) Fax. ( ) Pump or imgation circle 53.40 2
Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited-
;, '" :, �,P,s- - . • `' . , r.: ' CONTR _ . , y ' i• energy panel, alteration, or
extension Descnbe / Page 2 2
Business name:
/40.._
Address: f� (SS( S (--_,—
� ` ' v / j
Each additional inspection over allowable in any of the above
^� u Per inspection 62 50
City/ State/ZIP: l �U���` Industrial plant per hour 73 75
(:),,Q, 9 7a, a'_ Investigation per hour (I hr nun) 62 50
Phone: ( ) 4- (6 2.-'" _ a Fax: ( ) Lied_ - G05
- ,t - •.. °.,• ;: -ELECTRICAL "' PERMIT 'FEES *`
CCB Lic.: )q 7 Electrical Lic -..57, eLt Suprv. Lic • .y („43, Subtotal
lo
Supry Electrician signature, required ' , 4 v - C/ r P review I ee) 76
, 1 1 q State surcharge (8% of permit fee) 6 .DO
Print name: M (/� ft 1y� Date: 9 ( /
TOTAL PERMIT FEE g / ,00
Authorized signature: . S g 6 v -1 This permit application expires if a permit is not obtained within 180
I days after it has been accepted as complete
Print name: C � ab(mS6y 5 Date 1 9 /0 S • Fee methodology set by Tn- County Building Industry Service Board
•• Number of inspections per permit allowed.
i iBu tding\Perrnits\ELC- PemiitApp doc 12)03 440.46I5T( I0 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2- = Supplemental Information
LIMITED ENERGY PERMIT FEES:
SIDE ..= al7:01 -W gfatigi 4'° 'g
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
_O Reati1H
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other • -
• Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\Bu4ding\Pvnuts \ELC- PernutApp doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 00273
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 9/12/2005
Phone: (503) 639 -4171 �
Inspection Requests (24 Hrs.): (503) 39 -4175 . .. IL
INSPECTION WORKSHEET FOR \\ATE: 10/6/2005 TIME: 7:02AM PAGE: 35
SITE ADDRESS: 09330 SW WASHIN N SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUA• LOT #: TYPE OF USE:
PROJECT NAME: SOMA
DESCRIPTION: Low voltage for HVAC
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 - 639 -8866
CONTRACTOR: HVAC INC PHONE #: 503- 462 -4822
Inspection Request Scheduled For: D . 10/6/2005 Pour Time:
Code # �.- =�•_- ! scription Confirm Contact # Message
5, Low voltage 017639 -02 503-462 -4822 N
n r*-7 orrectio‘,. /Comrrts4lnstruc io .
r \ a 'P '
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTIO' ❑ ADDITIONAL FEES ASSESSED
Inspector: / -' Date: ' PlO 6 `V Phone #: (503) 718- 2 4 &