Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
� DEVELOPMENT SERVICES PERMIT #: EL /19/20 -00355
'� I ° 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/19/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09336 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT:. JURISDICTION: TIG
Project Description: Data /telephone.
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 VERSATILE CABLING, INC.
BY THE MACERICH COMPANY - 12606 NE 95TH ST #C -130
9585 SW WASHINGTON SQUARE RD VANCOUVER, WA 98682
TIGARD, OR 97223
Phone: 503- 639 -8865 Phone: 360 - 816 -1021
Reg #: LIC 161614
ELE 37- 1048CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/19/200.` $75.00
[TAX] 8% State Surchart 10/19/200°. $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 -0 1 -0 0. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -66' 9.
Issued By: Permittee Signature: % , / _ iv_1L
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 Permit App • EIVE r FOR OFFICE USE ONLY
I' Received Q
City of Tigard
Received I r /i � / / o D�J u
PermitNo.:04JD DOs�oO 365
13125 SW Flail Blvd., Tigard, OR 97223 (`' / ^'�
Phone: 503.639.4171 Fax: 503'.598.1960 O Cl 1 g 20 i's'T✓.tr', , ��l i' Date/By: w Other Permit:
' Inspection Line: 503.639.4175 ( / Date Ready/By: HI See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIG ' , .._:.- Notified/Method. L Supplemental Information
+
P: New construction t ❑ Addition/alteration/replacement Please check all that apply:
❑Service over 225 amps, comm'l ['Hazardous location
❑ Demolition El Other:
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
P 7.- ( - O + E a _l C `.' ti '`ca r _(6 `u of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2 - family dwelling .4Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑Other: ❑Occupant load over 99 persons ❑Manufactured structures or
�r ,, r _. r _,
.1 d , fit -k it ! , 1 y t 8 rya. € / -' I \. 4 _ . : ❑Egress/lightingplan RV park
Job no.: Job site address:93 SO f hf2 000 Health care facility ❑
Submit 2 sets of plans with any of the above.
1 /
City/ State/ZIP: � 676‘449 g t2 , 1d. °3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: I Project name: W/ ` to W al; ..
Description Qty. Fee. Total
Cross street/directions to job site: a r ` r New residential single - or multi- family dwelling unit.
/�) Includes attached garage.
W Q xil / fl�j fon � ( 0 1,000 sq. ft. or less 145.15 4
Subdivision: JJ I Lot no.: Ea. add'l 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
d W I ff1 o Q �`• " e t y ' Each manufactured or modular
Q • / r ' Q , - Q dwelling, service and/or feeder 90.90 2
I /v Services or feeders installation, alteration, and/or relocation
cj to // ` 200 amps or less 80.30 2
r- J duo ` ��vl
— L .
�— � — - 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
Phone: ( ) I Fax: ( ) relocation
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
4
M , _ t d i / e _�� ;- 4j i�ri r ' i S K r A. Fe for branch circuits with
_: r as serv or feeder fee, each
Business name: cra/fti.Q j 7 i ' branch circuit 6.65 2
T ..2Y, -eTa /) � -r ' — w
B Fee for branch circuits
Contact name: f/ without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'! branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not Included)
Phoneg,teO e / & /O2/ 4 fti I Fax: : 0) g /( D 36 2 Pump or irrigation circle I I 53.40 I I 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
s s ti-i ¢ t a ft j - energy panel, alteration, or
extension. Describe: I Page 2 / 2
- Business name: �.Q (f £l')./ e oih 1 h y Z
A ddress: / Z(p O (p , j g q G ,r_ cf r. c 13 0 Each additional inspection over allowable in any of the above
/ Per inspection 62.50
City/State/ZIP: V,j rV u V-e r to A- q's L a e Z Investigation per hour (1 hr min) 62.50
Phone: (- ) F: i ) ‘
Industrial plant per hour 73.75
CCB Lic.: '(l, (p) Electrical Lic.• ., • ' Su. 32 1. / u4 Sub total
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: �' /',f 7/"7/ _ State surcharge (8% of permit fee) ( .�
�� (/' Da te: �l p Q TOTAL PERMIT FEE el 0 42
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 Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
/fP
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200S-00355
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/19/2005
Phone: (503) 639-4171 p r14��1+1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 78
SITE ADDRESS: 09336 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: WHITEHOUSE BLACK MARKET
DESCRIPTION: Data/telephone.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503639 -8865
CONTRACTOR: VERSATILE CABLING, NC. PHONE #: 360 - 816 -1021
Inspection Request Scheduled For: - \Date: 10/31/2005 Pour Time:
Code # . - - • Description Coin irm # Contact # Message
135 vir' o a+ .. \ 01975 01 360 816 -1021
Corrections /Co •� - ions:
•
' FA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ' ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
;
,cam i '1
Inspector: NU) Date: t " �1 3I I � Phone #: (503) 718- 1. 0